scholarly journals The Impact of the COVID-19 Outbreak on Intensive Care in Northern Saitama Japan

2021 ◽  
Author(s):  
Ken Nakamura ◽  
Kouan Orii ◽  
Taichi Kondo ◽  
Mitsutaka Nakao ◽  
Makoto Wakatabe
Keyword(s):  
Intensive Care ◽  
Medical Care ◽  
Emergency Patient ◽  
Overtime Work ◽  
Surgical Units ◽  
Number Of Patients ◽  
Team Medical Care ◽  
The Impact ◽  
Integrated Team ◽  
Local Medical Care

Abstract Background We examined and compared the actual impact of COVID-19 on local medical care in northern Saitama Japan, especially in intensive care units (ICUs), before (2019) and during (2020) the pandemic. Methods The impact of COVID-19 on emergency care responses was compared with acceptances and refusals in 2019 and 2020. We also examined the number of surgeries performed by ICU surgical departments. The impact on intensive care was examined regarding the numbers of incident reports and the severity percentage calculated from the integrated team medical care and safety system. We also compared the overtime work of physicians working. Results In 2019, there were 2,136 emergency patient requests, and 1,811 patients were received. In contrast, in 2020, there were 2,371 emergency patient requests, and 1,822 patients were accepted, representing a decrease of 76% (p = 0‧931). There were significantly more refusals in 2020, 303 (14‧1%) in 2019 and 506 (21‧3%) in 2020 (p = 0‧0004). In 2020, the number of surgeries increased in neurosurgery, cardiac surgeries, and vascular surgeries and over time increased in all surgical units. There were 396 incidents reported in ICUs in 2019; this increased significantly to 510 in 2020 (p = 0‧001). Conclusion Even though intensive care management was restricted, the number of patients and doctors’ overtime work increased compared to before the spread of COVID-19, and the surrounding environment led to an increase in the number of incidents. The environments in ICUs must be actively improved to prepare for an even more severe situation in the future.

The Impact of Implementing a “Pain, Agitation, and Delirium Bundle” in a Pediatric Intensive Care Unit: Improved Delirium Diagnosis

2021 ◽  
Author(s):  
Lise D. Cloedt ◽  
Kenza Benbouzid ◽  
Annie Lavoie ◽  
Marie-Élaine Metras ◽  
Marie-Christine Lavoie ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Pediatric Intensive Care ◽  
Post Intervention ◽  
Number Of Patients ◽  
Implementation Period ◽  
Short And Long Term ◽  
The Impact

AbstractDelirium is associated with significant negative outcomes, yet it remains underdiagnosed in children. We describe the impact of implementing a pain, agitation, and delirium (PAD) bundle on the rate of delirium detection in a pediatric intensive care unit (PICU). This represents a single-center, pre-/post-intervention retrospective and prospective cohort study. The study was conducted at a PICU in a quaternary university-affiliated pediatric hospital. All patients consecutively admitted to the PICU in October and November 2017 and 2018. Purpose of the study was describe the impact of the implementation of a PAD bundle. The rate of delirium detection and the utilization of sedative and analgesics in the pre- and post-implementation phases were measured. A total of 176 and 138 patients were admitted during the pre- and post-implementation phases, respectively. Of them, 7 (4%) and 44 (31.9%) were diagnosed with delirium (p < 0.001). Delirium was diagnosed in the first 48 hours of PICU admission and lasted for a median of 2 days (interquartile range [IQR]: 2–4). Delirium diagnosis was higher in patients receiving invasive ventilation (p < 0.001). Compliance with the PAD bundle scoring was 79% for the delirium scale. Score results were discussed during medical rounds for 68% of the patients in the post-implementation period. The number of patients who received opioids and benzodiazepines and the cumulative doses were not statistically different between the two cohorts. More patients received dexmedetomidine and the cumulative daily dose was higher in the post-implementation period (p < 0.001). The implementation of a PAD bundle in a PICU was associated with an increased recognition of delirium diagnosis. Further studies are needed to evaluate the impact of this increased diagnostic rate on short- and long-term outcomes.

scholarly journals The Impact of Changes to an Electronic Admission Order Set on Prescribing and Clinical Outcomes in the Intensive Care Unit

2020 ◽  
Vol 11 (01) ◽  
pp. 182-189
Author(s):  
Ellen T. Muniga ◽  
Todd A. Walroth ◽  
Natalie C. Washburn
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Clinical Outcomes ◽  
Prescribing Patterns ◽  
Number Of Patients ◽  
Order Sets ◽  
Critical Care Admission ◽  
The Impact ◽  
Order Set

Abstract Background Implementation of disease-specific order sets has improved compliance with standards of care for a variety of diseases. Evidence of the impact admission order sets can have on care is limited. Objective The main purpose of this article is to evaluate the impact of changes made to an electronic critical care admission order set on provider prescribing patterns and clinical outcomes. Methods A retrospective, observational before-and-after exploratory study was performed on adult patients admitted to the medical intensive care unit using the Inpatient Critical Care Admission Order Set. The primary outcome measure was the percentage change in the number of orders for scheduled acetaminophen, a histamine-2 receptor antagonist (H2RA), and lactated ringers at admission before implementation of the revised order set compared with after implementation. Secondary outcomes assessed clinical impact of changes made to the order set. Results The addition of a different dosing strategy for a medication already available on the order set (scheduled acetaminophen vs. as needed acetaminophen) had no impact on physician prescribing (0 vs. 0%, p = 1.000). The addition of a new medication class (an H2RA) to the order set significantly increased the number of patients prescribed an H2RA for stress ulcer prophylaxis (0 vs. 20%, p < 0.001). Rearranging the list of maintenance intravenous fluids to make lactated ringers the first fluid option in place of normal saline significantly decreased the number of orders for lactated ringers (17 vs. 4%, p = 0.005). The order set changes had no significant impact on clinical outcomes such as incidence of transaminitis, gastrointestinal bleed, and acute kidney injury. Conclusion Making changes to an admission order set can impact provider prescribing patterns. The type of change made to the order set, in addition to the specific medication changed, may have an effect on how influential the changes are on prescribing patterns.

scholarly journals Using ICU data to improve the real-time estimation of the effective reproductive number of the COVID-19 epidemic in 9 European countries

2020 ◽  
Author(s):  
Samuel Hurtado ◽  
David Tinajero
Keyword(s):  
Intensive Care ◽  
Healthcare System ◽  
Time Estimation ◽  
European Countries ◽  
Reproductive Number ◽  
Mass Gatherings ◽  
Number Of Patients ◽  
Response Team ◽  
Using Data ◽  
The Impact

1.SummaryWe replicate a recent study by the Imperial College COVID-19 Response Team (Flaxman et al, 2020) that estimates both the effective reproductive number, Rt, of the current COVID-19 epidemic in 11 European countries, and the impact of different nonpharmaceutical interventions that have been implemented to try to contain the epidemic, including case isolation, the closure of schools and universities, banning of mass gatherings and/or public events, and most recently, widescale social distancing including local and national lockdowns. The main indicator they use for measuring the evolution of the epidemic is the daily number of deaths by COVID-19 in each country, which is a better statistic than the number of identified cases because it doesn’t depend so much on the testing strategy that is in place in each country at each moment in time.We improve on their estimation by using data from the number of patients in intensive care, which provides two advantages over the number of deaths: first, it can be used to construct a signal with less bias: as the healthcare system of a country reaches saturation, the mortality rate would be expected to increase, which would bias the estimates of Rt and of the impact of measures implemented to contain the epidemic; and second, it is a signal with less lag, as the time from onset of symptoms to ICU admission is shorter than the time from onset to death (on average, 7.5 days shorter). The intensive care signal we use is not just the number of people in ICU, as this would also be biased if the healthcare system has reached saturation (in this case, biased downwards, as admissions are no longer possible when all units are in use). Instead, we estimate the daily demand of intensive care, as the sum of two components: the part that is satisfied (new ICU admissions) and the part that is not (which results in excess mortality).Thanks to the advantages of this ICU signal in terms of timeliness and bias, we find that most of the countries in the study have already reached Rt<1 with 95% confidence (Italy, Spain, Austria, Denmark, France, Norway and Switzerland, but not Belgium or Sweden), whereas the original methodology of Flaxman et al (2020), even with updated data, would only find Rt<1 with 95% confidence for Italy and Switzerland.

scholarly journals Dermatovenereology of Russian Federation in 2020: Working Under a Pandemic

2021 ◽  
Vol 97 (4) ◽  
pp. 8-32
Author(s):  
Alexey A. Kubanov ◽  
Elena V. Bogdanova
Keyword(s):  
Medical Care ◽  
Russian Federation ◽  
Skin Diseases ◽  
Subcutaneous Tissue ◽  
Incidence Rates ◽  
Sexually Transmitted ◽  
Number Of Patients ◽  
Day Hospitals ◽  
Infectious Skin Diseases ◽  
The Impact

The article presents an analysis of the resources and activities of medical organizations providing medical care in the field of dermatovenereology for the period 20152020. Up-to-date data on the number of medical organizations and units providing specialized medical care in the field of dermatovenereology are provided. A description of the main changes in the provision of the population of the Russian Federation with dermatovenereologists, staffing with dermatovenereologists of medical organizations is given. Changes in the number of outpatient visits in 2020 are given. The dynamics of the bed fund of 24-hour and day hospitals of a dermatovenereological profile, the bed occupancy, the number of patients treated is described. The data on the incidence of sexually transmitted infections, infectious skin diseases are presented. Prevalence and incidence rates of diseases of the skin and subcutaneous tissue, including atopic dermatitis and psoriasis, are given. The impact of measures aimed at preventing the spread of a new coronavirus infection and organizing the provision of medical care to patients with COVID-19 on the performance rates of dermatovenereologic medical organizations has been demonstrated.

scholarly journals Care time and quality indicators in Intensive Care Units

2019 ◽  
Vol 72 (suppl 1) ◽  
pp. 166-172
Author(s):  
Paulo Carlos Garcia ◽  
Daisy Maria Rizatto Tronchin ◽  
Fernanda Maria Togeiro Fugulin
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Quality Indicators ◽  
Venous Catheter ◽  
Care Quality ◽  
Unplanned Extubation ◽  
Number Of Patients ◽  
Quality And Patient Safety ◽  
Nursing Professionals ◽  
The Impact

ABSTRACT Objective: To verify the correlation between nursing care time and care quality indicators. Method: Observational, correlational study, developed in 11 Intensive Care Units. The population comprised records of the number of nursing professionals, the number of patients with at least one of the Oro/Nasogastroenteral Probe (GEPRO), Endotracheal Tube (COT) and Central Venous Catheter (CVC) therapeutic devices and the occurrences related to the losses of these artifacts. Results: The time corresponded to 18.86 hours (Hospital A), 21 hours (Hospital B) and 19.50 hours (Hospital C); the Unplanned Outflow Incidence of GEPRO indicator presented a mean of 2.19/100 patients/day; Unplanned Extubation of COT Incidence, 0.42/100 patients/day; and CVC Loss Incidence, 0.22/100 patients/day. There was no statistically significant correlation between time and indicators analyzed. Conclusion: This research may support methodological decisions for future investigations that seek the impact of human resources on the care quality and patient safety.

scholarly journals Analysis of in-hospital stage of emergency medical care and 24-hour mortality in emergency patients

2013 ◽  
Vol 94 (1) ◽  
pp. 111-114
Author(s):  
Z G Valeev ◽  
V G Belyakov ◽  
L Y Salyahova
Keyword(s):  
Medical Care ◽  
Care Provision ◽  
Emergency Medical Care ◽  
Emergency Patient ◽  
Emergency Hospital ◽  
Department Staff ◽  
Emergency Medical ◽  
Number Of Patients ◽  
Life Threatening ◽  
Staff Qualification

Aim. To reveal the management defects of timely and sufficient emergency care provision at emergency patient admission. Methods. The mortality among the adult Kazan city inhabitants who were urgently admitted to Municipal Emergency Hospital was examined in a retrospective cohort study. The retrospective analysis of in-patients medical charts, ambulance accompanying talons and autopsy protocols of 543 patients who has succumbed during the first 24 hours after being admitted to Municipal Emergency Hospital №1 Kazan, Russia since January 1st, 2009 to December 31, 2011, was performed, emergency medical care on the pre-hospital stage was analysed. Results. The number of patients who got the out-patient care in the admission department of the emergency hospital has increased during the last several years, distracting admission department staff form their primary job and causing errors in medical care. The number of errors due to the medical care mismanagement can be estimated as 23.3%. Low staff qualification, lack of subspecialty consultations or councils and lack of case monitoring are among the reasons. Conclusion. Providing high quality medical aid in out-patients clinics would allow Emergency hospitals to focus on admitting and treating patients with life-threatening emergencies.

scholarly journals Impact of long-stay beds on the performance of a tertiary hospital in emergencies

2015 ◽  
Vol 49 (0) ◽  
Author(s):  
Antonio Pazin-Filho ◽  
Edna de Almeida ◽  
Leni Peres Cirilo ◽  
Frederica Montanari Lourençato ◽  
Lisandra Maria Baptista ◽  
...  
Keyword(s):  
Intensive Care ◽  
Tertiary Care ◽  
Semiparametric Regression ◽  
Tertiary Hospital ◽  
Confounding Factors ◽  
Average Hospital ◽  
Specific Protocol ◽  
High Dependency ◽  
Number Of Patients ◽  
The Impact

ABSTRACT OBJECTIVE To assess the impact of implementing long-stay beds for patients of low complexity and high dependency in small hospitals on the performance of an emergency referral tertiary hospital. METHODS For this longitudinal study, we identified hospitals in three municipalities of a regional department of health covered by tertiary care that supplied 10 long-stay beds each. Patients were transferred to hospitals in those municipalities based on a specific protocol. The outcome of transferred patients was obtained by daily monitoring. Confounding factors were adjusted by Cox logistic and semiparametric regression. RESULTS Between September 1, 2013 and September 30, 2014, 97 patients were transferred, 72.1% male, with a mean age of 60.5 years (SD = 1.9), for which 108 transfers were performed. Of these patients, 41.7% died, 33.3% were discharged, 15.7% returned to tertiary care, and only 9.3% tertiary remained hospitalized until the end of the analysis period. We estimated the Charlson comorbidity index – 0 (n = 28 [25.9%]), 1 (n = 31 [56.5%]) and ≥ 2 (n = 19 [17.5%]) – the only variable that increased the chance of death or return to the tertiary hospital (Odds Ratio = 2.4; 95%CI 1.3;4.4). The length of stay in long-stay beds was 4,253 patient days, which would represent 607 patients at the tertiary hospital, considering the average hospital stay of seven days. The tertiary hospital increased the number of patients treated in 50.0% for Intensive Care, 66.0% for Neurology and 9.3% in total. Patients stayed in long-stay beds mainly in the first 30 (50.0%) and 60 (75.0%) days. CONCLUSIONS Implementing long-stay beds increased the number of patients treated in tertiary care, both in general and in system bottleneck areas such as Neurology and Intensive Care. The Charlson index of comorbidity is associated with the chance of patient death or return to tertiary care, even when adjusted for possible confounding factors.

Invasive Pulmonary Aspergillosis in AML and ALL Patients Hospitalized into an Intensive Care Unit Divided into 2 Areas with a Different Specific Air Environment: Evaluation of Posaconazole Prophylaxis and Comparison Between the Two Specific Air Environment Areas

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 5260-5260
Author(s):  
Marie Y. Detrait ◽  
Stephane Morisset ◽  
Jean-Pierre Delville ◽  
Arnaud Lixon ◽  
Sabine Meurisse ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Invasive Aspergillosis ◽  
Disease Diagnosis ◽  
Term Survival ◽  
Allogeneic Hsct ◽  
Air Treatment ◽  
Probability Of Survival ◽  
Number Of Patients ◽  
The Impact

Abstract Background Invasive aspergillosis (IA) during induction chemotherapy of acute leukemia or allogeneic HSCT has a negative impact on the outcome of patients and is a major concern in haematology department. The impact of air treatment on invasive aspergillosis since the introduction of posaconazole prophylaxis is not very well studied at this time. In our center, the haematological intensive care unit contain ten single rooms each, of which 4 rooms are equipped with laminar airflow named “Controlled Air Zone” (CAZ) and 6 rooms have no specific air treatment (NSAT). Objective Our objective in this study was to compare the development of IA during hospitalization in the two areas of the unit and to analyze the impact of posaconazole prophylaxis on the short- and long-term survival. We compared the outcome of 56 consecutive patients hospitalized for induction treatment of ALL, AML or underwent allogeneic HSCT for AML/ALL in CR1 or had been hospitalized for GvHD treatment between the years 2009 and 2013. Posaconazole prophylaxis was introduced in 2013. Results In this study, there were 29 (52%) male and 27 (48%) female with a median age of 53 years (range, 20-64), diagnosis were AML for 35 (62.5%) patients, ALL for 11 (19.65%) patients, allogeneic HSCT for 4 (7.14%) patients (AML in CR1 for 3 and ALL in CR1 for 1), episode of aGvHD for 4 (7.14) patients and biphenotypic AL for 2 (3.57%) patients. All patients with GvHD had a grade III-IV of acute GvHD with digestive involvement. Fourty (71%) patients were hospitalized in the CAZ and 16 (29%) patients in the NSAT zone. Eleven (19%) patients received posaconazole and 45 (81%) patients received fluconazole (p=0.007). IA was observed in 19 (34%) patients: 12 (21%) patients in the CAZ and 7 (12%) patients in the NSAT zone with a median time of 2.7 months (range, 0.3-20.50) since disease diagnosis. Twenty-five (44.6%) patients died in this study: 21(37.5%) from relapse and 4 (7%) from aspergillosis. After a median follow-up of 12.23 months (range, 0.4-54), the probability of survival at 6 months and 12 months was for patients in CAZ: 72.5% and 64.44% respectively and for patients not in CAZ: 67.71% and 54.17% respectively. The probability of survival at 6 months and 12 months for posaconazole patients was 90% for both, and for fluconazole patients: 66.67% and 54.17% respectively. The survival according to treatment and zone is presented in Figure 1. The cumulative incidence of aspergillosis at 6, 12 and 24 months for fluconazole patients: 28.89%, 28.89% and 35.88% respectively and for patients with posaconazole prophylaxis: 9.09%, 9.09% and 50%. All patients who had AI in the posaconazole group had aGvHD with digestive involvement and were hospitalized during this event in the NSAT zone. The incidence of aspergillosis according to zone was 25% and 46.88% at 6 and 12 months respectively for patients not in CAZ and for patients in CAZ: 25%, 25% and 34% at 6, 12 and 24 months respectively. For posaconazole patients in CAZ, there were no event of AI. The incidence of aspergillosis is presented according zone and treatment in Figure 2. In univariate analysis, we found an impact of gender (p=0.045), ALL (p<0.001), GvHD (p=0.099), age (p=0.029) and a trend for CAZ (p=0.36) and posaconazole (p=0.79). The multivariate analysis shows a significant impact of age (HR= 1.06 [1.01-1.1], p = 0.019), gender (HR = 0.39 [0.14-1.09], p =0.07), ALL (HR=8.4 [2.27-31.09], p = 0.0014) and confirm a trend for CAZ (HR 0.6 [0.16-2.24], p = 0.45) and posaconazole (HR 0.66 [0.09-4.85], p = 0.6) despite non-significant p-values because the incidence curves cross in both case. Altough this study concerning a small number of patients, IA was associated with age, male gender and ALL diagnosis. Protective factor is female gender and there is a trend for CAZ and posaconazole. Conclusion In conclusion, we found a trend for a protective impact of Controlled Air Zone and we confirm the impact of posaconazole prophylaxis on survival. The global environmental strategy in haematologic department associated with antifungical prophylaxis have an important impact in the management of AI and large prospective studies are needed to improve this strategy. Figure 1 Figure 1. Figure 2. Figure 2. Disclosures No relevant conflicts of interest to declare.

scholarly journals AB0687 EFFECT OF COVID-19 ON PATIENTS ATTENDING AMBULATORY DEEP VENOUS THROMBOSIS OUT-PATIENT CLINIC: A RETROSPECTIVE, COHORT ANALYSIS[KI1] [KI1]101 CHARACTERS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1376.2-1377
Author(s):  
T. Hill ◽  
K. P. Iyengar ◽  
A. Nune
Keyword(s):  
Cohort Study ◽  
Intensive Care ◽  
Venous Thromboembolism ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Point Of Care ◽  
Meta Analysis ◽  
Number Of Patients ◽  
Ambulatory Patients ◽  
The Impact

Background:COVID-19 has been acknowledged as an procoagulant disorder with increased risk of venous thromboembolism (VTE) [1]. High rates of VTE in patients admitted to intensive care unit have been reported [2]. However effect of COVID-19 on ambulatory patients attending out-patient clinics has not been described.Objectives:This retrospective, observational cohort study analyses the impact of COVID-19 on incidence of Deep Venous Thrombosis (DVT) in patients referred to Ambulatory Deep Venous Thrombosis Out-patient Clinic (ADOC). A comparative analysis of patients attending ADOC during a similar period in 2019 is undertaken.Methods:Patients who attended the ADOC with suspected DVT during the ‘first wave’ of the COVID-19 pandemic between 01 February and 30 June 2020 at Southport and Ormskirk NHS Trust were studied and compared to a similar period in 2019. Patients characteristics, comorbidities, risk factors, incidence of DVT and relationship with COVID-19 with the evaluation of haematological parameters including D-dimer and two- tier Wells score. Additionally we examined patients outcomes including morbidity, mortality and hospital admissions.Results:Overall, there was a decrease in the number of patients attending the ADOC from 290 in 2019 to 233 in 2020. However, a total of 38 patients tested positive for DVT, a rate of 16.3%, which is compared to an incidence of 7.9% in 2019. Due to evolving protocols, the COVID-19 status of all patients attending the ADOC could not be ascertained. However, 5/233 of the 2020 cohort patients either had a positive test result (n=4) or were symptomatic of COVID-19 (n=1).Conclusion:There has been a 129% increase in the incidence of DVT in patients presenting to ADOC at our trust during the ‘first wave’ of the COVID-19 pandemic. Furthermore, despite fewer patients presenting with DVT symptoms to the ADOC, there appears to be a higher incidence of confirmed DVTs in ambulatory patients during COVID-19.Although there is a strong association inferred between COVID-19 and VTE [3], lack of access to SARS-CoV-2 nasal swab testing of patients attending ADOC for VTE assessment was a limiting factor to establish an association in this study. Because of this, we cannot extrapolate a definite association in patients with mild to moderate COVID-19 illness in the community and DVT.What we postulate is perhaps the higher incidence in the 2020 cohort could be a marker for a mild case of asymptomatic COVID-19 in these patients. Currently there is no guidance as to whether point of care testing should be available in ADOC. We wonder whether a point of care COVID-19 testing of these patients would have positive impact on the rate at which COVID-19 is identified in the community. Furthermore patients have been avoiding hospitals during the pandemic, greater testing should help to reassure and encourage them to seek help earlier during their illness, minimising potential complications such as PE, hospital admission and death.References:[1]Malas MB, Naazie IN, Elsayed N et al. Thromboembolism risk of COVID-19 is high and associated with a higher risk of mortality: A systematic review and meta-analysis. EClinicalMedicine. 2020 Dec;29:100639. doi: 10.1016/j.eclinm.2020.100639.]#[2]Helms J, Tacquard C, Severac F et al. CRICS TRIGGERSEP Group (Clinical Research in Intensive Care and Sepsis Trial Group for Global Evaluation and Research in Sepsis). High risk of thrombosis in patients with severe SARS-CoV-2 infection: a multicenter prospective cohort study. Intensive Care Med. 2020 Jun;46(6):1089-1098. doi: 10.1007/s00134-020-06062-x.[3]Di Minno A, Ambrosino P, Calcaterra I, Di Minno MND. COVID-19 and Venous Thromboembolism: A Meta-analysis of Literature Studies. Semin Thromb Hemost. 2020 Sep 3. doi: 10.1055/s-0040-1715456.Disclosure of Interests:None declared

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