Length of stay as quality indicator in emergency departments: analysis of determinants in the German Emergency Department Data Registry (AKTIN registry)

Several indicators reflect the quality of care within emergency departments (ED). The length of stay (LOS) of emergency patients represents one of the most important performance measures. Determinants of LOS have not yet been evaluated in large cohorts in Germany. This study analyzed the fixed and influenceable determinants of LOS by evaluating data from the German Emergency Department Data Registry (AKTIN registry). We performed a retrospective evaluation of all adult (age ≥ 18 years) ED patients enrolled in the AKTIN registry for the year 2019. Primary outcome was LOS for the whole cohort; secondary outcomes included LOS stratified by (1) patient-related, (2) organizational-related and (3) structure-related factors. Overall, 304,606 patients from 12 EDs were included. Average LOS for all patients was 3 h 28 min (95% CI 3 h 27 min–3 h 29 min). Regardless of other variables, patients admitted to hospital stayed 64 min longer than non-admitted patients. LOS increased with patients’ age, was shorter for walk-in patients compared to medical referral, and longer for non-trauma presenting complaints. Relevant differences were also found for acuity level, day of the week, and emergency care levels. We identified different factors influencing the duration of LOS in the ED. Total LOS was dependent on patient-related factors (age), disease-related factors (presentation complaint and triage level), and organizational factors (weekday and admitted/non-admitted status). These findings are important for the development of management strategies to optimize patient flow through the ED and thus to prevent overcrowding.

163. MIC Shifts in Response to Increased Antibiotic Utilization During COVID-19 Pandemic

Background Multiple studies have shown that antibiotic utilization increased during the COVID-19 pandemic. However, the impact of this increased utilization has not been well established. The aim of this study is to describe the trends in minimum inhibitory concentrations for various antibiotics against common gram-negative pathogens observed since the start of the COVID-19 pandemic as compared to previous years. Methods This retrospective study was conducted at the Memphis VA. All respiratory, urine, and blood culture MicroScan results run from October 2017-March 2021 were analyzed. Only inpatient and emergency department data was included. The MIC50 and MIC90 of seven antibiotics for four of the most common pathogens were trended by quarterly intervals. Results MIC50 and MIC90 were compared using standardized breakpoints. As compared to previous years, Pseudomonas aeruginosa was noted to have the most sustained increase in MIC90 across various antibiotics. In the last 3 quarters of the study time frame, piperacillin-tazobactam mean MIC90 increased from 32 to 64, cefepime from 8 to > 16, and meropenem from 4 to > 8. Escherichia coli had a sustained increase in ceftriaxone MIC90 from < 1 to > 8 in the final quarter of 2020 and beginning of 2021. Klebsiella pneumonia was also found to have a sustained increase in cefepime mean MIC90 from < 1 to > 16 during the year of 2020, with return to previous MIC90 the following quarters. Conclusion Previous studies have clearly demonstrated a widespread increase in antibiotic utilization during the COVID era. Our study demonstrates how even short-term increases in antibiotic use can lead to shifts in MIC, if not outright resistance. This was demonstrated across multiple common gram-negative pathogens and to various broad-spectrum antibiotics which were commonly used more frequently during COVID-19. Further analysis will be needed to determine whether these trends continue or whether the decrease in antibiotic utilization in the recent months will lead to similar decrease in MIC. Disclosures All Authors: No reported disclosures

Using routine emergency department data for syndromic surveillance of acute respiratory illness before and during the COVID-19 pandemic in Germany, week 10-2017 and 10-2021

Introduction: To better assess the epidemiological situation of acute respiratory illness in Germany over time, we used emergency department data for syndromic surveillance before and during the COVID-19 pandemic. Methods: We included routine attendance data from emergency departments who continuously transferred data between week 10-2017 and 10-2021, with ICD-10 codes available for >75% of the attendances. Case definitions for acute respiratory illness (ARI), severe ARI (SARI), influenza-like illness (ILI), respiratory syncytial virus disease (RSV) and Coronavirus disease 2019 (COVID-19) were based on a combination of ICD-10 codes, and/or chief complaints, sometimes combined with information on hospitalisation and age. Results: We included 1,372,958 attendances from eight emergency departments. The number of attendances dropped in March 2020, increased during summer, and declined again during the resurge of COVID-19 cases in autumn and winter of 2020/2021. A pattern of seasonality of acute respiratory infections could be observed. By using different case definitions (i.e. for ARI, SARI, ILI, RSV) both the annual influenza seasons in the years 2017-2020 and the dynamics of the COVID-19 pandemic in 2020-2021 were apparent. The absence of a flu season during the fall and winter of 2020/2021 was visible, in parallel to the resurge of COVID-19 cases. The proportion of SARI among ARI cases peaked in April-May 2020 and November 2020-January 2021. Conclusion: Syndromic surveillance using routine emergency department data has the potential to monitor the trends, timing, duration, magnitude and severity of illness caused by respiratory viruses, including both influenza and SARS-CoV-2.

Unacceptably high: an audit of Kimberley self-harm data 2014–2018

Objective: To explore the rates and characteristics of self-harm across the Kimberley region of Western Australia. Method: Retrospective, cross-sectional audit. We obtained and descriptively analysed routinely collected self-harm data from the Kimberley District of the Western Australia Police Force (2014–2018) and the Emergency Department Data Collection (June 2017–December 2018). Variables included age, sex, Indigenous status, time of incident, and alcohol and drug use. Results: The rate of emergency department attendance for self-harm was three times higher in the Kimberley than the rest of Western Australia. Both emergency department and police data showed a disproportionately high percentage of incidents involving Aboriginal people, with highest rates in the 15–19 and 20–24 year age groups. Almost 80% of self-harm events recorded by police involving individuals aged 25–50 years involved alcohol. Many self-harm incidents occurred in the evening and at night. Conclusions: The rates of self-harm across the Kimberley region from 2014–2018 are unacceptably high. Increased funding and alignment of services to meet regional need are required as part of a holistic effort to reduce regional rates of self-harm.

Influences of air substances and meteorological conditions on human health

<p><strong>Influences of air substances and meteorological conditions on human health</strong></p><p>For a long time it has been known that exceptionally strong and long-lasting heat waves have negative health effects on the population, which is expressed in an intensification of existing diseases and over-mortality of certain risk groups (Kampa, Castanas 2008). Often associated with heat are stagnant airflow conditions that cause a large increase in the concentration of certain air substances (Ebi, McGregor 2008). Many of these air substances have a strong adverse effect on the human organism (Kampa, Castanas 2008).</p><p>The aim of the project is to investigate the actual hazard potential air pollution- and climatological variables by quantifying the effects on human health of increased exposure to air constituents and temperature extremes. Different multivariate statistical methods such as correlation analysis, regression models and random forests, extreme value analysis and individual case studies are used.</p><p>As a medical data basis for this purpose, the emergency department data of the University Hospital Augsburg are regarded. In addition to the diagnosis, supplementary information such as age, gender, place of residence and pre-existing conditions of the patients are used. Among the air constituents, the focus is on ozone, nitrogen dioxide and particulate matter. In the meteorological part, the focus is primarily on temperature, which is not only a direct burden but, as in the case of ozone, also has a decisive influence on the formation of ground-level ozone. However, a large number of other meteorological parameters such as precipitation, relative humidity and wind speed as well as the synoptic situation also play a major role in the formation, decomposition process and the distribution of pollutants (Ebi, McGregor 2008).</p><p>The first major question to answer is whether air pollution and meteorological stress situations are visible in the emergency department data. Further in-depth questions are which factors have the greatest negative impact, what is the most common environment-related disease, which weather conditions carry a higher than average risk and what are the health risks of climate change.</p><p>Ideally, the analysis may also provide a short-term forecast from which to derive whether or not there will be an above or below average number of visits to the emergency department.</p><p>The project is funded by the German Federal Foundation for Environment (DBU) and the German Research Foundation (DFG) - project number 408057478.</p><p>Literature:</p><p>Nuvolone D., Petri D., Voller F. (2017): The effects of ozone on human health. doi: 10.1007/s11356-017-9239-3.</p><p>Requia W., Adams M., Arain A., Papatheodorou S., Koutrakis P., Mahmoud M. (2018): Global Association of Air Pollution and Cardiorespiratory Diseases: A Systematic Review, Meta-Analysis, and Investigation of Modifier Variables. doi: 10.2105/AJPH.2017.303839</p><p>Xing Y., Xu Y., Shi M., Lian Y. (2016): The impact of PM2.5 on the human respiratory system. doi: 10.3978/j.issn.2072-1439.2016.01.19</p><p> </p>

Validation of ICD-10-CM codes for injuries complicating pregnancy, childbirth and the puerperium: a medical record review

IntroductionThe purpose of this study was to estimate the positive predictive value (PPV) of International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) codes for injury, poisoning, physical or sexual assault complicating pregnancy, childbirth and the puerperium (PCP) to capture injury encounters within both hospital and emergency department claims data.MethodsA medical record review was conducted on a sample (n=157) of inpatient and emergency department claims from one Kentucky healthcare system from 2015 to 2017, with any diagnosis in the ICD-10-CM range O9A.2-O9A.4. Study clinicians reviewed medical records for the sampled cases and used an abstraction form to collect information on documented presence of injury and PCP complications. The study estimated the PPVs and the 95% CIs of O9A.2-O9A.4 codes for (1) capturing injuries and (2) capturing injuries complicating PCP.ResultsThe estimated PPV for the codes O9A.2-O9A.4 to identify injury in the full sample was 79.6% (95% CI 73.3% to 85.9%) and the PPV for capturing injuries complicating PCP was 72.0% (95% CI 65.0% to 79.0%). The estimated PPV for an inpatient principal diagnosis O9A.2-O9A.4 to capture injuries was 90.7% (95% CI 82.0% to 99.4%) and the PPV for capturing injuries complicating PCP was 88.4% (95% CI 78.4% to 98.4%). The estimated PPV for any mention of O9A.2-O9A.4 in emergency department data to capture injuries was 95.2% (95% CI 90.6% to 99.9%) and the PPV for capturing injuries complicating PCP was 81.0% (95% CI 72.4% to 89.5%).DiscussionThe O9A.2-O9A.4 codes captured high percentage true injury cases among pregnant and puerperal women.