scholarly journals Sort and Sieve: Pre-Triage Screening of Patients with Suspected COVID-19 in the Emergency Department

2021 ◽  
Vol 18 (17) ◽  
pp. 9271
Author(s):  
Kirsten R.C. Hensgens ◽  
Inge H.T. van Rensen ◽  
Anita W. Lekx ◽  
Frits H.M. van Osch ◽  
Lieve H.H. Knarren ◽  
...  
Keyword(s):  
Emergency Department ◽  
Older Patients ◽  
Primary Outcome ◽  
Screening Method ◽  
Single Centre ◽  
Medical Unit ◽  
Acute Medical Unit ◽  
Single Centre Study ◽  
Screening Accuracy ◽  
Specific Symptoms

Introduction. To reduce the risk of nosocomial transmission, suspected COVID-19 patients entering the Emergency Department (ED) were assigned to a high-risk (ED) or low-risk (acute medical unit, AMU) area based on symptoms, travel and contact history. The objective of this study was to evaluate the performance of our pre-triage screening method and to analyse the characteristics of initially undetected COVID-19 patients. Methods. This was a retrospective, observational, single centre study. Patients ≥ 18 years visiting the AMU-ED between 17 March and 17 April 2020 were included. Primary outcome was the (correct) number of COVID-19 patients assigned to the AMU or ED. Results. In total, 1287 patients visited the AMU-ED: 525 (40.8%) AMU, 762 (59.2%) ED. Within the ED group, 304 (64.3%) of 473 tested patients were COVID-19 positive, compared to 13 (46.4%) of 28 tested patients in the AMU group. Our pre-triage screening accuracy was 63.7%. Of the 13 COVID-19 patients who were initially assigned to the AMU, all patients were ≥65 years of age and the majority presented with gastro-intestinal or non-specific symptoms. Conclusion. Older COVID-19 patients presenting with non-specific symptoms were more likely to remain undetected. ED screening protocols should therefore also include non-specific symptoms, particularly in older patients.

Early re-presentation to hospital after discharge from an acute medical unit: perspectives of older patients, their family caregivers and health professionals

2013 ◽  
Vol 22 (3-4) ◽  
pp. 445-455 ◽  
Author(s):  
Susan Slatyer ◽  
Christine Toye ◽  
Aurora Popescu ◽  
Jeanne Young ◽  
Anne Matthews ◽  
...  
Keyword(s):  
Family Caregivers ◽  
Health Professionals ◽  
Older Patients ◽  
Medical Unit ◽  
Acute Medical Unit

The effect of context on performance of an acute medical unit: experience from an Australian tertiary hospital

2012 ◽  
Vol 36 (3) ◽  
pp. 320 ◽  
Author(s):  
Belinda Suthers ◽  
Robert Pickles ◽  
Michael Boyle ◽  
Kichu Nair ◽  
Justyn Cook ◽  
...  
Keyword(s):  
Emergency Department ◽  
Nursing Home ◽  
Length Of Stay ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Local Context ◽  
Health Staff ◽  
Medical Unit ◽  
Acute Medical Unit ◽  
Transfers Of Care

Objective. To ascertain the improvements in length of stay and discharge rates following the opening of an acute medical unit (AMU). Methods. Retrospective cohort study of all patients admitted under general medicine from June–November 2008. Main outcome measures were length of stay in hospital and in the emergency department (ED). Results. The length of time spent in the emergency department for those admitted to the AMU was significantly shorter than those admitted directly to a medical ward (6.83 h v. 9.40 h, P < 0.0001). A trend towards shorter hospital length of stay continued after the AMU opened compared with the same period in the previous year (5.15 days (2.49, 11.57 CI) v. 5.66 days (2.76, 11.52 CI)). However, the number of ward transfers for a patient and the need to wait for a nursing home bed or public rehabilitation affected length of stay much more than the AMU. Conclusion. An AMU was successful in decreasing ED length of stay and contributed to decreasing hospital length of stay. However, we suggest that local context is crucially important in tailoring an AMU to obtain maximal benefit, and that AMUs are not a ‘one size fits all’ solution. What is known about the topic? Acute Medical Units were pioneered in the UK and have been shown to decrease length of stay with no increase in adverse events. As a result, they have been enthusiastically adopted in Australia. However, most studies have been single point ‘before/after’ designs looking at all medical patients, and there has been little consideration of the context in which AMUs operate and how this might affect their performance. What does this paper add? We consider length of stay trends over many years and separate single organ disease from multi-system disease patients, in order to ensure that gains are not simply a result of selective entry of healthier patients into AMUs. We also show that the effect of an AMU is small compared with other systemic issues, such as waiting for nursing home placement and the number of transfers of care. What are the implications for practitioners? Although there may be gains in terms of length of stay in the emergency department, those considering the establishment of an AMU need to consider other factors that may mitigate the improvements in hospital length of stay, such as the roadblocks to discharge, the organisation of allied health staff, and the number of transfers of care.

scholarly journals A swift and dynamic strategy to expand emergency department capacity for COVID-19

2020 ◽  
pp. 1-13
Author(s):  
Dennis Gerard Barten ◽  
Renske Wilhelmina Johanna Kusters ◽  
Nathalie Antoinne La Reine Peters
Keyword(s):  
Emergency Department ◽  
Emergency Care ◽  
Potential Model ◽  
Risk Area ◽  
Hospital Size ◽  
Medical Unit ◽  
Expansion Strategy ◽  
Local Factors ◽  
Acute Medical Unit ◽  
Dynamic Strategy

ABSTRACT Emergency departments (EDs) worldwide struggled to prepare for COVID-19 patient surge and to simultaneously preserve sufficient capacity for ‘regular’ emergency care. While many hospitals used costly shelter facilities, it was decided to merge the acute medical unit (AMU) and the ED. The conjoined AMU-ED was segregated into a high-risk and a low-risk area to maintain continuity of emergency care. This strategy allowed for a feasible, swift and dynamic expansion of ED capacity without the need for external tent facilities. This report details on the technical execution and discusses the pearls and potential pitfalls of this expansion strategy. Although ED preparedness for pandemics may be determined by local factors such as hospital size, ED census and primary healthcare efficacy, the conjoined AMU-ED strategy may be a potential model for other EDs.

Should older hypertensive patients be kidney donors?

2019 ◽  
Vol 4 (6) ◽  
pp. 314-321
Author(s):  
Rhodri Pyart ◽  
Vinod S Dibbur ◽  
Maike Eylert ◽  
Ann Marsden ◽  
Rhian Cooke ◽  
...  
Keyword(s):  
Older Patients ◽  
Kidney Donor ◽  
Single Centre ◽  
Living Kidney Donor ◽  
Donor Pool ◽  
Hypertensive Patients ◽  
Additional Group ◽  
Single Centre Study ◽  
Donor Criteria ◽  
Marginal Donors

Relaxing living kidney donor criteria allows donor pool expansion, but the risks to marginal donors who are both older and hypertensive are not well defined. This single-centre study of donors compared post-nephrectomy changes in blood pressure and estimated kidney function stratified by age, gender and the presence of hypertension. Data from an additional group of hypertensive older patients undergoing unilateral nephrectomy for malignancy were also analysed.

scholarly journals Comprehensive geriatric assessment on an acute medical unit: a qualitative study of older people’s and informal carer’s perspectives of the care and treatment received

2016 ◽  
Vol 31 (1) ◽  
pp. 126-134 ◽  
Author(s):  
Janet Darby ◽  
Tracey Williamson ◽  
Pip Logan ◽  
John Gladman
Keyword(s):  
Randomized Controlled Trial ◽  
Qualitative Study ◽  
Activities Of Daily Living ◽  
Daily Living ◽  
Older Patients ◽  
Controlled Trial ◽  
Medical Unit ◽  
Randomized Controlled ◽  
Acute Medical Unit ◽  
Informal Carers

Objective: This qualitative study was imbedded in a randomized controlled trial evaluating the addition of geriatricians to usual care to enable the comprehensive geriatric assessment process with older patients on acute medical units. The qualitative study explored the perspectives of intervention participants on their care and treatment. Design: A constructivist study incorporating semi-structured interviews that were conducted in patients’ homes within six weeks of discharge from the acute medical unit. These interviews were recorded, transcribed, and analysed using thematic analysis. Setting: An acute medical unit in the United Kingdom. Participants: Older patients ( n = 18) and their informal carers ( n = 6) discharged directly home from an acute medical unit, who had been in the intervention group of the randomized controlled trial. Results: Three core themes were constructed: (1) perceived lack of treatment on the acute medical unit; (2) nebulous grasp of the role of the geriatrician; and (3) on-going health and activities of daily living needs postdischarge. These needs impacted upon the informal carers, who either took over, or helped the patients to complete their activities of daily living. Despite the help received with activities of daily living, a lot of the patients voiced a desire to complete these activities themselves. Conclusions: The participants perceived they were just monitored and observed on the acute medical unit, rather than receiving active treatment, and spoke of on-going unresolved health and activity of daily living needs following discharge, despite receiving the additional intervention of a geriatrician.

scholarly journals P0412VALUE OF INTERNATIONAL RISK-PREDICTION TOOL IN IGA NEPHROAPTHY : A SINGLE CENTRE STUDY

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Dhawal Arora ◽  
Durga Kanigicherla ◽  
Patrick Hamilton
Keyword(s):  
Iga Nephropathy ◽  
Risk Prediction ◽  
Primary Outcome ◽  
Risk Scores ◽  
Prediction Tool ◽  
Single Centre ◽  
Exclusion Criteria ◽  
Centre Study ◽  
Single Centre Study

Abstract Background and Aims A new International Risk-Prediction Tool in IgA Nephropathy developed was recently developed to help predict disease progression over a 5-7 year period1. We tested use of this Risk-Prediction Calculator in patients diagnosed with IgA Nephropathy to stratify the risk and predict outcomes during follow up. Method All adult patients (aged ≥18years) with biopsy proven IgA Nephropathy diagnosed between 2011 and 2016 at Manchester University NHS Foundation Trust were included in the study. Exclusion criteria included patients with secondary causes, prior exposure to immunosuppression, or presentation eGFR of less that 15ml/min. Demographic, clinical phenotypic & renal histological characteristics (MEST score) at baseline were used to calculate the individual risk scores. These risk scores were compared with outcomes seen during subsequent follow up. Primary outcome was a composite of first ESRD or reduction in eGFR to below 50% of value at biopsy. Patients were censored at last follow visit for primary outcome or death. Renal outcomes were analysed using Kaplan Meier survival plots of subgroups based on predicted risk (&lt;16th percentile, 16-50th percentile, 50-84th percentile or &gt;84th percentile). Results 121 patients were included in the analyses. 45 other patients were excluded based on exclusion criteria. 84 patients (69%) were males, mean age was 42±16 years, eGFR was 63±34ml/min and uPCR was 151±42mg/mmol. Mean follow up was 51.4±28 months. 87% were on RAS inhibition at or within 6 weeks of kidney biopsy diagnosis. During the follow up period 23 patients (19%) developed the primary outcome. Outcomes were significantly worse in patients with higher risk-prediction scores (Fig 1 log rank p&lt;0.01). Conclusion This single centre study confirms that the International IgA Nephropathy Risk-Prediction Model for kidney outcomes can be a valuable tool for prognostication in Primary IgA Nephropathy in routine clinical practice.

scholarly journals Microtransplantation Improves the Outcome of Older Patients With Newly Diagnosed Acute Myeloid Leukaemia: a Single-centre Study With Long-term Follow-up

2022 ◽  
Author(s):  
Juan Liu ◽  
Xiao-mei Huang ◽  
Si-yuan Zhao ◽  
Ya-kun Yang ◽  
Yuan-yuan Qu ◽  
...  
Keyword(s):  
Overall Survival ◽  
Stem Cell ◽  
Complete Remission ◽  
Older Patients ◽  
Newly Diagnosed ◽  
Single Centre ◽  
Free Survival ◽  
Single Centre Study ◽  
Acute Myeloid

Abstract Purpose: This retrospective single-centre study was to validate the efficacy and safety of microtransplantation (or micro-stem cell transplantation, MST) in the treatment of older patients with acute myeloid leukemia (AML).Methods: MST combines chemotherapy and human leukocyte antigen (HLA)-mismatched peripheral blood stem cell infusion without graft-versus-host disease (GVHD) prophylaxis. In total, 26 newly diagnosed AML patients were enrolled in our study from April 2008 to April 2018. The deadline date of follow-up was December 31, 2019. All of them received MST. Patients were divided into 2 age groups: 60~70 years (n=17) and >70 years (n=9). The outcomes of complete remission (CR) rate, overall survival (OS), leukemia free survival (LFS), hematopoietic recovery time, and treatment related toxicities were analyzed and summarized in this study.Results: 10 patients were still alive with complete remission (CR) at the deadline date, and the median overall survival (OS) was 64 months (range, 21-135 months). The CR, relapse and nonrelapse mortality rates were 84.6%, 38.5% and 30%, respectively. Both OS (p < 0.0001) and leukaemia free survival (LFS) (p < 0.0001) were significantly higher in the younger group than in the older group. The median times of neutrophil and platelet recovery were 12 days and 14 days, respectively. Conclusions: These data showed that MST could be an alternative treatment for older AML patients.

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