scholarly journals Using a Real-Time Locating System to Evaluate the Impact of Telemedicine in an Emergency Department During COVID-19: Observational Study (Preprint)

2021 ◽  
Author(s):  
Birju Patel ◽  
Stacie Vilendrer ◽  
Samantha M.R. Kling ◽  
Ian Brown ◽  
Ryan Ribeira ◽  
...  
Keyword(s):  
Emergency Department ◽  
Real Time ◽  
Healthcare Workers ◽  
Statistical Significance ◽  
Total Duration ◽  
Personal Contact ◽  
Daily Average ◽  
Movement Data ◽  
Remote Care ◽  
The Impact

BACKGROUND Telemedicine has been deployed by healthcare systems in response to the COVID-19 pandemic to enable healthcare workers to provide remote care for both outpatients and inpatients. Although it is reasonable to suspect telemedicine visits limit unnecessary personal contact and thus decrease the risk of infection transmission, the impact of the use of such technology on clinician workflows in the emergency department is unknown. OBJECTIVE To use real-time locating systems (RTLS) to evaluate the impact of telemedicine on in-person interaction between healthcare workers and patients. METHODS The RTLS platform was used to collect movement data for nursing and physician staff in each patient room of the emergency department. Movement data was captured between March 2nd, 2020, the date of the first patient screened for COVID-19 in the emergency department, and April 20th, 2020. A new telemedicine platform was released to clinicians on March 29th, 2020. Number of entrances and duration of in-person interactions per patient encounter, adjusted for patient length of stay, were obtained for pre- and post-implementation phases and compared with t-tests to determine statistical significance. RESULTS There were 15,741 RTLS events linked to 2,662 encounters for patients screened for COVID-19. There was no significant change in number of in-person interactions between the pre- and post-implementation phases for both nurses (5.7 vs 7.0 entrances per patient, p=0.07) and physicians (1.3 vs 1.5 entrances per patient, p=0.12). Total duration of in-person interaction did not change (56.4 vs 55.2 minutes per patient, p=0.74) despite an increase in telemedicine videoconference frequency (0.6 vs 1.3 videoconferences per patient, p<0.01 for change in daily average) and duration (4.3 vs 12.3 minutes per patient, p<0.01 for change in daily average). CONCLUSIONS Telemedicine was rapidly adopted with the intent of minimizing pathogen exposure to healthcare workers during the COVID-19 pandemic, yet RTLS movement data did not reveal significant changes for in-person interactions between staff and patients under investigation for COVID-19 infection. Additional research is needed to better understand how telemedicine technology may be better incorporated into emergency departments to improve workflows for frontline healthcare clinicians.

scholarly journals The Impact of Proper PPE Protocol in A Highly Community Spread of Infectious COVID-19 in Semporna

2021 ◽  
Vol 5 ◽  
pp. 21
Author(s):  
Muhammad Farid Bin Zainal Abidin ◽  
Nur Farhana Binti Zainan ◽  
Mafeitzeral Bin Mamat ◽  
Sivasankar Pubalan ◽  
Mohd Syahfadzreen Bin Yunus
Keyword(s):  
Emergency Department ◽  
Healthcare Workers ◽  
Task Force ◽  
Control Unit ◽  
Third Wave ◽  
District Hospitals ◽  
Crisis Services ◽  
Multiple Issues ◽  
The Impact ◽  
Multiple Units

Introduction: The district of Semporna, Sabah was majorly hit by the third wave surge of COVID-19 in September 2020. At the peak of the crisis, services in Semporna Hospital were paralyzed with 40 healthcare workers (HCW) found to be COVID-19 positive; contributing to 14% of the total manpower.Objectives: Due to the immediate crisis, the main priority was to control the spread of COVID- 19 amongst the Semporna Hospital HCWs. This was important to curb direct infection from handling suspected patients seeking treatment in Semporna Hospital. Based on the hospital capabilities and resources, a comprehensive modified protocol was needed to control the situation.Methods: Semporna Hospital pandemic emergency task force was established with the presence of multi department and specialties. Multiple issues were raised and attended to, especially; issue of preparedness, low PPE stock and Emergency Department infrastructure.Results: The number of Semporna Hospital HCWs infected with COVID-19 was minimal after the initial disaster. Emergency Department infrastructure was improvised, workflow processes modified, HCW protection education prioritized and complete PPE sets were stocked up. All these efforts were under the strict supervision of the infectious control unit. The presence of multiple units of Powered Air-Purifying Respirator (PAPR) completed our adherence to the Ministry of Health (MOH) guidelines in managing the highly infectious level 4 patients for aerosolized generating procedures (AGP).Conclusion: This achievement can be used as a preparedness reference for other non-specialist district hospitals in Malaysia.International Journal of Human and Health Sciences Supplementary Issue: 2021 Page: S21

No Implementation Without Representation: Real-Time Pharmacist Intervention Optimizes Rapid Diagnostic Tests for Bacteremia at a Small Community Hospital

2021 ◽  
pp. 001857872110375
Author(s):  
Brandon J. Tritle ◽  
Robert Watteyne ◽  
Abby Hickman ◽  
Todd J. Vento ◽  
Bert K. Lopansri ◽  
...  
Keyword(s):  
Real Time ◽  
Diagnostic Tests ◽  
Community Hospital ◽  
Statistical Significance ◽  
Pharmacist Intervention ◽  
Rapid Diagnostic Tests ◽  
Control Group ◽  
Small Community ◽  
The Impact ◽  
Small Community Hospital

Background: Rapid diagnostic tests (RDTs) for bacteremia allow for early antimicrobial therapy modification based on organism and resistance gene identification. Studies suggest patient outcomes are optimized when infectious disease (ID)-trained antimicrobial stewardship personnel intervene on RDT results. However, data are limited regarding RDT implementation at small community hospitals, which often lack access to on-site ID clinicians. Methods: This study evaluated the impact of RDTs with and without real-time pharmacist intervention (RTPI) at a small community hospital with local pharmacist training and asynchronous support from a remote ID Telehealth pharmacist. Time to targeted therapy (TTT) in patients with bacteremia was compared retrospectively across 3 different time periods: a control without RDT, RDT-only, and RDT with RTPI. Results: Median TTT was significantly faster in both the RDT with RTPI and RDT-only groups compared with the control group (2 vs 25 vs 51 hours respectively; P < .001). TTT was numerically faster for RDT with RTPI compared with RDT-only but did not reach statistical significance ( P = .078). Median time to any de-escalation was significantly shorter for RDT with RTPI compared with both RDT-only (14 vs 33 hours; P = .012) and the control group (14 vs 45 hours; P < .001). Median length of stay was also significantly shorter in both RDT groups compared with the control group (4.0 vs 4.1 vs 5.5 hours; P = .013). Conclusion: This study supports RDT use for bacteremia in a small community hospital with ID Telehealth support, suggesting additional benefit with RTPI.

scholarly journals P003: Door-to-antibiotics and mortality for emergency department patients presenting with septic shock

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S64
Author(s):  
A. Aguanno ◽  
K. Van Aarsen ◽  
S. Pearce ◽  
T. Nguyen
Keyword(s):  
Emergency Department ◽  
Septic Shock ◽  
Linear Regression ◽  
Hospital Discharge ◽  
Statistical Significance ◽  
Serum Lactate ◽  
Secondary Outcome ◽  
Clinical Equipoise ◽  
Time To Antibiotics ◽  
The Impact

Introduction: We examined our local sepsis patient population, and specifically our most vulnerable patients - those presenting to the emergency department (ED) in septic shock - for variables predictive of survival to hospital discharge. We applied the familiar ED paradigm of, “Door to,” to calculate the impact of time to antibiotics against patient survival to hospital discharge. Methods: Retrospective chart review of patients aged &gt; = 18 years, presenting to tertiary care ED between 01 Nov 2014 and 31 Oct 2015. Patients determined to have sepsis if A) &gt; = 2 SIRS criteria and ED suspicion of infection (ED acquisition of blood/urine cultures or antibiotic administration) and/or B) received ED or Hospital discharge diagnosis of sepsis (ICD-10 diagnostic codes A4xx and R65). Patients sub-classified with septic shock if A) triage SBP &lt; = 90mmHg, B) triage MAP &lt; = 65mmHg or C) serum lactate &gt; = 4mmol/L. “Door Time” was defined as the earliest time recorded for the patient encounter, either the time the patient registered in the Emergency Department, or the triage time. A generalized linear model was performed with a binomial distribution using survival to discharge as the response variable. Age, sex, ED arrival method, time to antibiotics, ED serum lactate and ED serum glucose level were the predictor variables. Results: 13506 patient encounters met inclusion criteria (10980 unique patients). Linear regression of time to antibiotics against survival to hospital discharge failed to achieve statistical significance. Linear regression of the secondary outcome variables achieved statistical significance for age and serum lactate level. Per the model, as age increased by 1 year, the odds of dying prior to hospital discharge increased by 3.8% and as serum lactate increased by 1 mmol/L, odds of dying prior to hospital discharge increased by 11.1%. Conclusion: We found no association between time to antibiotic treatment and mortality. Causal relationships require randomized controlled trials, and this analysis contributes to clinical equipoise.

scholarly journals The Impact of an Automated Patient Digital Engagement Platform on Revisit Reduction

Iproceedings ◽  
10.2196/15091 ◽  
2019 ◽  
Vol 5 (1) ◽  
pp. e15091
Author(s):  
Adam Beck ◽  
Caroline Robinson
Keyword(s):  
Emergency Department ◽  
Patient Engagement ◽  
Information Exchange ◽  
Negative Impact ◽  
Statistical Significance ◽  
General Medicine ◽  
Inpatient Setting ◽  
Hospital Inpatient ◽  
Digital Platform ◽  
The Impact

Background Revisits within 30 days to an emergency department (ED), observation care unit, or inpatient setting following patient discharge continues to be a challenge, especially in urban settings. In addition to the consequences for the patient, these revisits have a negative impact on a health system’s finances in a value based care or global budget environment. Objective The objective was to evaluate the effectiveness of a customized automated digital patient engagement application (GetWell Loop) to prevent 30-day revisits after home discharge from an ED or hospital inpatient setting. Methods The LifeBridge Health Innovation Team collaborated with the GetWell Network to customize their patient engagement platform (GetWell Loop) with automated check-in questions and resources. An application link was emailed to adult patients discharged home from the ED. A retrospective study of ED visits for patients treated for general medicine and cardiology conditions (accounting for 24% of our adult ED discharges) between August 1, 2018, and December 31, 2018, was conducted using CRISP, Maryland’s state-designated health information exchange. We used this database to identify the index visits that experienced an emergency department visit, inpatient admission, or observation stay at any Maryland facility within 30 days of discharge. We also used data within GetWell Loop to track patient activation and engagement. The primary endpoint was a comparison of ED patients that experienced a 30-day revisit and who did or did not activate their GetWell Loop account. Secondary end points included overall activation rate and the rate of engagement as measured by the number of logins, alerts, and comments generated by patients through the platform. Statistical significance was calculated using the Fisher’s exact test with a P<.05. Results ED discharges who were treated for general medicine conditions (n=787) and activated their GetWell Loop account experienced a 30-day revisit rate of 18.9% compared to 25.2% who did not activate their account (P=.06). For patients treated for cardiology conditions (n=722), 10.5% of patients who activated their GetWell account experienced a 30-day revisit compared to 17.4% not activating their account (P=.02). During the course of this study, 26% of patients receiving an invite to use the digital platform activated their account (n=1652) logged in a total of 4006 times, generated 734 alerts, and submitted 297 open ended comments/questions. Conclusions These results indicate the potential value of digital health platforms to improve 30-day revisit rates. The strongest impact was observed amongst cardiology patients where the revisit rate is 39.8% lower for patients using GetWell Loop compared to general medicine patients where the relative difference is 25.2%. The results also indicate patients are willing to utilize a digital platform postdischarge to proactively engage in their own care. We attempted to control for potential selection bias that may impact this analysis given patient adoption and use of a digital platform by looking for differences in the subpopulations who did and did not activate the platform. LifeBridge Health is proving healthcare systems can leverage automated mobile platforms to successfully impact clinical outcomes at scale without compromising customer service and patient experience.

scholarly journals Impact of Delayed Admission to the Intensive Care Unit from the Emergency Department upon Sepsis Outcomes and Sepsis Protocol Compliance

2017 ◽  
Vol 2017 ◽  
pp. 1-7 ◽  
Author(s):  
Michael Agustin ◽  
Lori Lyn Price ◽  
Augustine Andoh-Duku ◽  
Peter LaCamera
Keyword(s):  
Emergency Department ◽  
Hospital Mortality ◽  
Statistical Significance ◽  
Tertiary Care ◽  
Included Study ◽  
Chi Square ◽  
Significant Difference ◽  
Protocol Compliance ◽  
Sepsis And Septic Shock ◽  
The Impact

Rationale. The impact of emergency department length of stay (EDLOS) upon sepsis outcomes needs clarification. We sought to better understand the relationship between EDLOS and both outcomes and protocol compliance in sepsis. Methods. We performed a retrospective observational study of septic patients admitted to the ICU from the ED between January 2012 and December 2015 in a single tertiary care teaching hospital. 287 patients with severe sepsis and septic shock were included. Study population was divided into patients with EDLOS < 6 hrs (early admission) versus ≥6 hours (delayed admission). We assessed the impact of EDLOS on hospital mortality, compliance with sepsis protocol, and resuscitation. Statistical significance was determined by chi-square test. Results. Of the 287 septic ED patients, 137 (47%) were admitted to the ICU in <6 hours. There was no significant in-hospital mortality difference between early and delayed admissions (p=0.68). Both groups have similar compliance with the 3-hour protocol (p=0.77). There was no significant difference in achieving optimal resuscitation within 12 hours (p=0.35). Conclusion. We found that clinical outcomes were not significantly different between early and delayed ICU admissions. Additionally, EDLOS did not impact compliance with the sepsis protocol with the exception of repeat lactate draw.

scholarly journals The Impact of the Coronavirus Pandemic on US healthcare workers: A Discursive Analysis of Frontline Secondary Traumatic Stress Using Twitter Data

2021 ◽  
Author(s):  
Lisa Wolf ◽  
Cydne Perhats ◽  
Altair Delao ◽  
Hannah S Noblewolf
Keyword(s):  
Discourse Analysis ◽  
Real Time ◽  
Traumatic Stress ◽  
Secondary Traumatic Stress ◽  
Healthcare Workers ◽  
Methodological Approach ◽  
High Stress ◽  
Community Setting ◽  
Post Traumatic Stress ◽  
The Impact

The demands of the COVID-19 pandemic have resulted in an increased physical, clinical, and emotional workload for healthcare workers. Both the Veterans Affairs system and the Emergency Nurses Association have recognized the specific hazards and health risks of providing frontline care in this unprecedented global emergency including an increase in multiple factors associated with post-traumatic stress disorder (PTSD). The purpose of this study was to explore real time PTSD in US healthcare workers using Twitter posts and to describe the impact on healthcare workers as the pandemic unfolds across the US. 1000 tweets were randomly selected from a larger dataset of 443,918 tweets by 281,021 unique authors posted using the hashtags #getmePPE and #getusPPE. Directed content analysis and discourse analysis were used to analyze the tweets and place them into a larger conversation about the pandemic. Healthcare workers and others, using a digital community setting delineated by the hashtags #GetUSPPE and #GetmePPE created a conversation centering around fear of illness, alarm at pandemic spread, and frustration at the label of “hero”, which is unsupported by resources at the local or Federal level. healthcare workers as a group have grave concerns, and high stress levels about inadequate material support (specifically personal protective equipment, or “PPE”) during the first 3 months of the Covid-19 pandemic. Real time analysis using social media posts as a dataset is a useful and feasible methodological approach for explicating the healthcare discourse within the social and political context of this pandemic. Keywords: emergency care; secondary traumatic stress; Covid-19; discourse analysis; emotional workload

scholarly journals Identification of processes that mediate the impact of workplace violence on emergency department healthcare workers in the USA: results from a qualitative study

BMJ Open ◽  
2019 ◽  
Vol 9 (8) ◽  
pp. e031781 ◽  
Author(s):  
Marie C Vrablik ◽  
Anne K Chipman ◽  
Elizabeth D Rosenman ◽  
Nancy J Simcox ◽  
Ly Huynh ◽  
...  
Keyword(s):  
Emergency Department ◽  
Qualitative Study ◽  
Workplace Violence ◽  
Healthcare Workers ◽  
Negative Impact ◽  
Cognitive Appraisals ◽  
Well Being ◽  
Phenomenological Approach ◽  
Qualitative Interview Study ◽  
The Impact

ObjectivesViolence towards emergency department healthcare workers is pervasive and directly linked to provider wellness, productivity and job satisfaction. This qualitative study aimed to identify the cognitive and behavioural processes impacted by workplace violence to further understand why workplace violence has a variable impact on individual healthcare workers.DesignQualitative interview study using a phenomenological approach to initial content analysis and secondary thematic analysis.SettingThree different emergency departments.ParticipantsWe recruited 23 emergency department healthcare workers who experienced a workplace violence event to participate in an interview conducted within 24 hours of the event. Participants included nurses (n=9; 39%), medical assistants (n=5; 22%), security guards (n=5; 22%), attending physicians (n=2; 9%), advanced practitioners (n=1; 4%) and social workers (n=1; 4%).ResultsFive themes emerged from the data. The first two supported existing reports that workplace violence in healthcare is pervasive and contributes to burn-out in healthcare. Three novel themes emerged from the data related to the objectives of this study: (1) variability in primary cognitive appraisals of workplace violence, (2) variability in secondary cognitive appraisals of workplace violence and (3) reported use of both avoidant and approach coping mechanisms.ConclusionHealthcare workers identified workplace violence as pervasive. Variability in reported cognitive appraisal and coping strategies may partially explain why workplace violence negatively impacts some healthcare workers more than others. These cognitive and behavioural processes could serve as targets for decreasing the negative effect of workplace violence, thereby improving healthcare worker well-being. Further research is needed to develop interventions that mitigate the negative impact of workplace violence.

scholarly journals The Impact of Tai Chi Exercise on Health Care Utilization and Imputed Cost in Residents of Low-Income Senior Housing

2021 ◽  
Vol 10 ◽  
pp. 216495612098547
Author(s):  
Jennifer Perloff ◽  
Cindy Parks Thomas ◽  
Eric Macklin ◽  
Peggy Gagnon ◽  
Timothy Tsai ◽  
...  
Keyword(s):  
Older Adults ◽  
Emergency Department ◽  
Low Income ◽  
Tai Chi ◽  
Statistical Significance ◽  
Emergency Department Visits ◽  
Care Utilization ◽  
P Value ◽  
Senior Housing ◽  
The Impact

Background/Objectives This study was designed to test the impact of Tai Chi (TC) on healthcare utilization and cost in older adults living in low-income senior housing. We hypothesized that TC would improve overall health enough to reduce the use of emergency department (ED) and inpatient services. Design Cluster randomized controlled trial with randomization at the housing site level. Setting Greater Boston, Massachusetts. Participants The study includes 6 sites with 75 individuals in the TC treatment condition and 6 sites with 67 individuals in the health education control condition. Intervention Members of the treatment group received up to a year-long intervention with twice weekly, in-person TC exercise sessions along with video-directed exercises that could be done independently at home. The comparison group received monthly, in-person healthy aging education classes (HE). Study recruitment took place between August, 2015 and October, 2017. Key outcomes included acute care utilization (inpatient stays, observation stays and emergency department visits). In addition, the cost of utilization was estimated using the age, sex and race adjusted allowed amount from Medicare claims for a geographically similar population aged ≥ 65. Results The results suggested a possible reduction in the rate of ED visits in the TC group vs. controls (rate ratio = 0.476, p-value = 0.06), but no findings achieved statistical significance. Adjusted estimates of imputed costs of ED and hospital care were similar between TC and HE, averaging approximately $3,000 in each group. Conclusion ED utilization tended to be lower over 6 to 12 months of TC exercises compared to HE in older adults living in low-income housing, although estimated costs of care were similar.

scholarly journals The Impact of Healthcare Worker Influenza Vaccination on Nosocomial Influenza in a Tertiary Hospital: An Ecological Study

2019 ◽  
Author(s):  
Wycliffe Enli Wei ◽  
Stephanie Fook-Chong ◽  
Wen Kai Chen ◽  
Maciej Piotr Chlebicki ◽  
Wee Hoe Gan
Keyword(s):  
Influenza Vaccination ◽  
Healthcare Worker ◽  
Healthcare Workers ◽  
Ecological Study ◽  
Statistical Significance ◽  
Tertiary Hospital ◽  
Vaccination Rate ◽  
Incidence Rates ◽  
Vaccination Rates ◽  
The Impact

Abstract Background To protect hospitalized patients who are more susceptible to complications of influenza, seasonal influenza vaccination of healthcare workers (HCW) has been recommended internationally. However, its effectiveness is still being debated. To assess the effectiveness of HCW influenza vaccination, we performed an ecological study to evaluate the association between healthcare worker influenza vaccination and the incidence of nosocomial influenza in a tertiary hospital within Singapore between 2013-2018.Methods Nosocomial influenza was defined by influenza among inpatients diagnosed 7 days or more post-admission by laboratory testing, while healthcare worker influenza vaccination rate was defined as the proportion of healthcare workers that was vaccinated at the end of each annual seasonal vaccination exercise. A modified Poisson regression was performed to assess the association between the HCW vaccination rates and monthly nosocomial influenza incidence rates.Results Nosocomial influenza incidence rates followed the trend of non-nosocomial influenza, showing a predominant mid-year peak. Across 2,480,010 patient-days, there were 256 nosocomial influenza cases (1.03 per 10,000 patient-days). Controlling for background influenza activity and the number of influenza tests performed, 10% increase in vaccination coverage corresponded to 11% decrease in nosocomial influenza incidence rate (IRR 0.89, 95%CI:0.69-1.15, p =0.37).Conclusion We observed a negative association between influenza vaccination rates and nosocomial influenza incidence rates, although statistical significance was not reached. Aligning local HCW vaccine timing and formulation to that of the Southern Hemisphere may improve effectiveness. HCW vaccination remains important but demonstrating its effectiveness in preventing nosocomial influenza is challenging.

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