Effect of Caring of Critically Sick Patients with COVID-19 Pneumonia at Undesignated ICU Wards on Secondary Infections

<b><i>Introduction:</i></b> COVID-19 has caused high rates of mortality. During pandemic peak, a significant number of patients were admitted to undesignated ICU areas before transferring to designated ICU, owing to unavailability of ICU beds. We aimed to record the effect of care of critically sick patients with COVID-19 on prevalence of secondary bacterial infection. <b><i>Methods:</i></b> We retrospectively studied all critically ill patients with COVID-19 pneumonia meeting ICU admission criteria who were admitted to Dubai hospital between January 1, 2020, and June 30, 2020. All the patients who transferred to wards other than designated ICU constitute category as cases. All patients who directly admitted to the designated ICU ward from emergency department constitute controls. The demographics, clinical parameters, and treatment profile of these patients were recorded and compared. Prevalence of secondary bacterial infection was calculated. <b><i>Results:</i></b> Patients with COVID-19 had high prevalence of secondary bacterial infection. Patients who stayed at undesignated ICU wards had higher occurrence of inpatient fever, hypoxemia, and they were more likely to be sedated and paralyzed than patients who stayed in designated ICU wards. Multiple logistic regression analysis showed care outside designated ICU ward does not predict increase in secondary nonviral microbial infections. <b><i>Conclusion:</i></b> Care of patients at undesignated ICU wards prior to admission to designated ICU does not impact prevalence of secondary bacterial infection.

Admission criteria in critically ill COVID-19 patients: A physiology-based approach

Introduction The COVID-19 pandemic required careful management of intensive care unit (ICU) admissions, to reduce ICU overload while facing limitations in resources. We implemented a standardized, physiology-based, ICU admission criteria and analyzed the mortality rate of patients refused from the ICU. Materials and methods In this retrospective observational study, COVID-19 patients proposed for ICU admission were consecutively analyzed; Do-Not-Resuscitate patients were excluded. Patients presenting an oxygen peripheral saturation (SpO2) lower than 85% and/or dyspnea and/or mental confusion resulted eligible for ICU admission; patients not presenting these criteria remained in the ward with an intensive monitoring protocol. Primary outcome was both groups’ survival rate. Secondary outcome was a sub analysis correlating SpO2 cutoff with ICU admission. Results From March 2020 to January 2021, 1623 patients were admitted to our Center; 208 DNR patients were excluded; 97 patients were evaluated. The ICU-admitted group (n = 63) mortality rate resulted 15.9% at 28 days and 27% at 40 days; the ICU-refused group (n = 34) mortality rate resulted 0% at both intervals (p < 0.001). With a SpO2 cut-off of 85%, a significant correlation was found (p = 0.009), but with a 92% a cut-off there was no correlation with ICU admission (p = 0.26). A similar correlation was also found with dyspnea (p = 0.0002). Conclusion In COVID-19 patients, standardized ICU admission criteria appeared to safely reduce ICU overload. In the absence of dyspnea and/or confusion, a SpO2 cutoff up to 85% for ICU admission was not burdened by negative outcomes. In a pandemic context, the SpO2 cutoff of 92%, as a threshold for ICU admission, needs critical re-evaluation.

An Intelligent Patient Admission Model of Day Surgery Using Heterogeneous Data with Semi-Supervised Learning: A Case Study of Laparoscopic Cholecystectomy (Preprint)

BACKGROUND Day surgery has many advantages including shortening hospital stay, decreasing the risk of hospital-associated infections, and increasing cost efficiency over traditional surgery, it has gained a great reputation and popularity in recent years. However, the patients’ admission criteria of day surgery at present were mainly based on expert experience, which was a lack of scientific evidence. OBJECTIVE Our study is to investigate the day surgery patient’s admission criteria and build an intelligent machine learning model of day surgery patients who underwent laparoscopic cholecystectomy, to ensure patients’ safety and medical quality, providing reference and inspiration for other day surgery admission decisions. METHODS We analyzed the clinical data of day surgery patients who underwent laparoscopic cholecystectomy at West China Hospital from Jan 1st 2009 to Dec 31st 2021 and developed a semi-supervised artificial intelligence algorithm, SDSPA algorithm, which is built by self-training and uses both structured data like patient characteristics and unstructured clinical diagnosis to assist surgeons to make quick admission decisions. RESULTS After comparing several classifiers with self-training in our experiment, the performance of LightGBM with unstructured text processed by BERT were the best, obtaining an accuracy of 0.85 and an f1-score of 0.83, as well as reaching 0.97 on the precision score, which is an important indicator related to patients’ safety. CONCLUSIONS The application of our SDSPA algorithm can make the patient admission of day surgery more intelligent, and maximize the utilization of medical resources while ensuring patients’ safety.

TP9.2.17Developing Novel Referral Pathways in Emergency Surgery

Introduction In line with the principles of GIRFT and recognising the demand on the Emergency Department (ED) the Acute Surgical Unit (ASU) developed a direct admission pathway entitled ‘ASU Direct’ (ASUD). Nurse led ED triage with adherence to a referral proforma allows direct admission of suitable surgical patients eliminating medical ED review or discussion with the on-call Registrar. Aim Investigate the usefulness of the ASUD pathway and adherence to admission criteria. Method Two retrospective audits of ASUD referrals were completed and compared with concurrent traditional registrar referrals. Inter-departmental discussions occurred between audit cycles. Results Audit 1: 13 days, 150 cases (8 excluded). 75 (53%) referred via ASUD, 67 (47%) via surgical registrar. Sixteen ASUD cases (22%) breached pathway protocols including 3 young women referred without pregnancy tests. Seventeen (25%) cases referred via the Registrar fulfilled ASUD criteria. Documentation complete in 56% of ASUD cases. Audit 2: (3 weeks after feedback) - 10 days, 120 patients (25 excluded). Fifty one ASUD cases (54%) and 44 (46%) registrar referrals. 24% cases breached ASUD criteria, 7 registrar referrals (15%) appropriate for ASUD. ASUD documentation completed in 60% with 100% pregnancy status recorded. Conclusions Proportion of ASUD / registrar referrals remained constant but there were fewer missed opportunities for ASUD. Inappropriate ASUD admissions remained similar. While ASUD worked well for visible pathology, less-so for protocol-driven abdominal pain. Senior ‘front-door’ triage in ED might improve protocol compliance, helping to develop such pathways, observing GIRFT and avoid unnecessary transfer of patients (especially during the COVID pandemic).

EP.FRI.57 Audit of Medical Records on Structure and Content of T&O Documentation

The aim of the audit was to assess if Trauma & Orthopaedic admission documentation and record-keeping met the national standards. Standards used included the ‘Royal College of Physicians-Generic Record Keeping Standards 2, 4, 6, 10’ and ‘Professional Records Standards Body, Section 2 Admission Record’. Seventeen admission criteria and eight documentation criteria where audited from the respective standards. Retrospective data were collected using A&E clerking documents, GP referral letters, admission clerking proformas and continuation notes from hospital admission. Initial data showed that only 41% of pages of documentation had appropriate patient identification details listed. Of the 17 admission criteria audited, only 7 criteria scored above 90%. The major downfalls were in vital signs (38%) and assessment scales i.e. Abbreviated Mental Test Score (18%) and venous thromboembolism assessment (32%). With regards to subsequent separate entries, the main failure was entries not listed in chronological order (48%), with only two criteria scoring above 90% (entries dated and legibility). Following the implementation of an updated admission proforma and education on documentation; only 5 of the 17 admission criteria scored 90% or above. However, 46% of pages had the correct patient identification details on admission. On subsequent ward entries, 7 out of the 8 sections had improved, with 62% of notes in chronological order. Furthermore, 4 out of the 8 documentation criteria scored above 90%. Informing staff on correct documentation helped improve doctors’ entries in patients’ notes. Improvements in the admission proforma need to be made to help meet record-keeping standards.

The Role of Families, Schools, and Colleges

This chapter explores the challenges for families and schools in channeling ambitions in more productive directions. Today’s adolescents confront a world of growing pressures, which are also increasing mental health challenges. Parents’ vicarious ambitions can compound the problems if they push children to focus too much on extrinsic markers of success at the expense of intrinsic motivations to learn and ethical values. Both schools and families should help students to develop persistence, resilience, a strong moral compass, and commitment to the common good. Opportunities for service learning, internships and mentorships can encourage constructive ambitions. So too, parents and colleges must better control the preoccupation with prestige that has hijacked admission processes and encouraged gaming the system. Educators should also modify admission criteria such as legacy, donor, and athletic preferences that advantage already advantaged applicants.

Treating an Epidemic During a Pandemic: Experience Treating Opioid Use Disorder at the Baltimore Convention Center Field Hospital

During the COVID-19 pandemic, access to addiction treatment has plummeted. At the same time, patients with opioid use disorder are at higher risk for COVID-19 infection and experience worse outcomes. The Baltimore Convention Center Field Hospital (BCCFH), a state-run COVID-19 disaster hospital operated by Johns Hopkins Medicine and the University of Maryland Medical System, continues to operate 14 months into the pandemic to serve as an overflow unit for the state’s hospitals. BCCFH staff observed the demand for opioid use disorder care and developed admission criteria, a pharmacy formulary, and case management procedures to meet this need. This article describes generalized lessons from the BCCFH experience treating substance use disorder during a pandemic.

Transdisciplinarity of India's Master's Level Public Health Programmes: Evidence from Admission Criteria of the Programmes Offered Since 1995

BackgroundIn Indian subcontinent, Master's level public health (MPH) programmes attract graduates of diverse academic disciplines from health and non-health sciences alike. Considering the current and futuristic importance of the public health cadre, we described them and reviewed their transdisciplinarity status based on MPH admissibility criteria 1995 to 2021. MethodsUsing a search strategy, we abstracted information available in the public domain on MPH and their admissibility criteria. We classified disciplines specified for admission into Science, Social sciences and Arts, Health and Non-health categories. We described the MPH programmes by location, type of institutions, course duration, pedagogical methods, specialisations offered, and nature of admission criteria statements. We calculated descriptive statistics for eligible educational qualifications for admission to MPH programmes. ResultsOverall, 74 Indian institutions offered 88 MPH programmes. We included 85 for review. These programmes represent 50% increase (n=44) from that of 2016-17. They are mostly concentrated in 21 provinces and union territories of India. These programmes stated that they admit candidates of but not limited to "graduation in any life sciences", "three-year bachelors degree in any discipline", “graduation from any Indian universities”, and "graduation in any discipline". Of the 72 institutions, 14 admit multidisciplinary academic graduates in their 16 programmes. Except three institutions from public sector, 69 provide MPH admission opportunities to multidisciplinary health and non-health academic graduates. ConclusionOur review suggests that India's MPH programmes are less transdisciplinary. India's Master's level public health programmes should transcend to be more inclusive and admit graduates of various academic educational backgrounds.

Admission assessment criteria in predicting students’ academic performance in newly established medical school

Introduction: Various medical education institutions around the world have different methods and criteria in selecting the ideal candidate. This study aims to determine the most appropriate admission criteria for predicting student academic performance in a newly established medical faculty in Indonesia.