Best Practices in Managing Cardiac Arrest in the Emergency Department During the COVID-19 Pandemic.
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ABSTRACT:
SUBMITTER: Heaton HA
PROVIDER: S-EPMC7566671 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:We aimed to evaluate the effectiveness of a single institution's hand surgery clinical care guidelines at preventing the transmission of COVID-19. This is an anonymous survey study distributed to all employees within the division of hand surgery at a single quaternary-care academic medical facility. The primary outcome measure was the result of their employee surveillance and/or symptom initiated COVID-19 antibody (prior transmission) or polymerase chain reaction test (active infection) after institution of a COVID-19 exposure and transmission mitigating clinical care protocol. Employees were also asked multiple questions regarding their perceived and actual risk of exposure to COVID-19 while performing their clinical duties. Fifty-five of 69 (79.7%) hand clinic personnel employed during the COVID-19 surge from March 23, 2020 to May 18, 2020 (therapist: 15/19; consulting physicians: 11/16, nurses: 10/11; hand surgery residents: 6/6; hand surgery fellows: 4/5; physician assistant/nurse practitioners: 4/7; clinical desk operations specialists 3/4) responded to the survey. Forty-two employees were tested and all were negative for COVID-19 antibodies (42/42). Seventeen (17/55, 30.9%) employees had a known exposure to COVID-19 of which 13 of the 17 (76.5%) were from patients. Ten of these 17 (58.8%) employees were tested for COVID-19 antibodies and were negative. Twenty four of the 55 (43.6%) respondents felt they were at high risk for transmission of COVID-19. These data support ongoing care of emergent and urgent hand surgery patients during the COVID-19 surge and safe operation of an elective hand surgery practice amidst the ongoing pandemic through a multimodal approach.
| S-EPMC8166454 | biostudies-literature
Project description:IntroductionThe novel coronavirus 2019 (COVID-19) pandemic in the United States (US) prompted widespread containment measures such as shelter-in-place (SIP) orders. The goal of our study was to determine whether there was a significant change in overall volume and proportion of emergency department (ED) encounters since SIP measures began.MethodsThis was a retrospective, observational, cross-sectional study using billing data from January 1, 2017-April 20, 2020. We received data from 141 EDs across 16 states, encompassing a convenience sample of 26,223,438 ED encounters. We used a generalized least squares regression approach to ascertain changes for overall ED encounters, hospital admissions, and New York University ED visit algorithm categories.ResultsED encounters decreased significantly in the post-SIP period. Overall, there was a 39.6% decrease in ED encounters compared to expected volume in the pre-SIP period. Emergent encounters decreased by 35.8%, while non-emergent encounters decreased by 52.1%. Psychiatric encounters decreased by 30.2%. Encounters related to drugs and alcohol decreased the least, by 9.3% and 27.5%, respectively.ConclusionThere was a significant overall reduction in ED utilization in the post-SIP period. There was a greater reduction in lower acuity encounters than higher acuity encounters. Of all subtypes of ED encounters, substance abuse- and alcohol-related encounters reduced the least, and injury-related encounters reduced the most.
| S-EPMC7673895 | biostudies-literature
Project description:ObjectiveThe objective of this study was to determine the public's likelihood of being willing to use an emergency department (ED) for urgent/emergent illness during the coronavirus disease 2019 (COVID-19) pandemic.MethodsAn institutional review board-approved, cross-sectional survey of a non-probability sample from Amazon Mechanical Turk was administered May 24-25, 2020. Change in self-reported willingness to use an ED before and during the pandemic (primary outcome) was assessed via McNemar's test; COVID-19 knowledge and perceptions were secondary outcomes.ResultsThere were 855 survey participants (466 [54.5%] male; 699 [81.8%] White; median age 39). Proportion reporting likelihood to use the ED pre-pandemic (71% [604/855]) decreased significantly during the pandemic (49% [417/855]; P < 0.001); those unlikely to visit the ED increased significantly during the pandemic (41% [347/855] vs 22% [417/855], P < 0.001). Participants were unlikely to use the ED during the pandemic if they were unlikely to use it pre-pandemic (adjusted odds ratio, 4.55; 95% confidence interval, 3.09-6.7) or correctly answered more COVID-19 knowledge questions (adjusted odds ratio, 1.37; 95% confidence interval, 1.17-1.60). Furthermore, 23.4% (n = 200) of respondents believed the pandemic was not a serious threat to society. Respondents with higher COVID-19 knowledge scores were more likely to view the pandemic as serious (odds ratio, 1.57; 95% confidence interval, 1.36-1.82).ConclusionsThis survey study investigated the public's willingness to use the ED during the COVID-19 pandemic. Only 49% of survey respondents were willing to visit the ED during a pandemic if they felt ill compared with 71% before the pandemic.
| S-EPMC7771795 | biostudies-literature
Project description:IntroductionOn March 13, 2020, the U.S. declared COVID-19 to be a national emergency. As communities adopted mitigation strategies, there were potential changes in the trends of injuries treated in emergency department. This study provides national estimates of injury-related emergency department visits in the U.S. before and during the pandemic.MethodsA secondary retrospective cohort study was conducted using trained, on-site hospital coders collecting data for injury-related emergency department cases from medical records from a nationally representative sample of 66 U.S. hospital emergency departments. Injury emergency department visit estimates in the year before the pandemic (January 1, 2019-December 31, 2019) were compared with estimates of the year of pandemic declaration (January 1, 2020-December 31, 2020) for overall nonfatal injury-related emergency department visits, motor vehicle, falls-related, self-harm-, assault-related, and poisoning-related emergency department visits.ResultsThere was an estimated 1.7 million (25%) decrease in nonfatal injury-related emergency department visits during April through June 2020 compared with those of the same timeframe in 2019. Similar decreases were observed for emergency department visits because of motor vehicle‒related injuries (199,329; 23.3%) and falls-related injuries (497,971; 25.1%). Monthly 2020 estimates remained relatively in line with 2019 estimates for self-harm‒, assault-, and poisoning-related emergency department visits.ConclusionsThese findings provide updates for clinical and public health practitioners on the changing profile of injury-related emergency department visits during the COVID-19 pandemic. Understanding the short- and long-term impacts of the pandemic is important to preventing future injuries.
| S-EPMC8858709 | biostudies-literature
Project description:BackgroundThere is currently a lack of evidence-based postresuscitation or postmortem guidelines for patients with out-of-hospital cardiac arrest (OHCA) in the setting of an emerging infectious disease. This study aimed to develop and validate a multimodal screening tool that aids in predicting the disease confirmation in emergency situations and patients with OHCA during a coronavirus disease 2019 (COVID-19) outbreak.Materials and methodsWe conducted a retrospective, multicenter observational study of adult patients with OHCA in Daegu, Korea. To identify the potential predictors that could be used in screening tools in the emergency department, we applied logistic regression to data collected from March 1 to March 14. The prediction performance of the screening variables was then assessed and validated on the data of patients with OHCA who were treated between February 19 and March 31, 2020. General patient characteristics and hematological findings of the COVID-19-negative and COVID-19-positive groups were compared. We also evaluated confirmation test criteria as predictors for COVID-19 positivity in patients with OHCA.ResultsAdvanced age, body temperature, and abnormal chest X-ray (CXR) revealed significant predictive ability in the derivation cohort. Of the 184 adult patients with OHCA identified in the validation cohort, 80 patients were included in the analysis. Notably, 9 patients were positive and 71 were negative on the COVID-19 reverse transcription polymerase chain reaction test. Five patients (55.6%) in the COVID-19-positive group had a fever before OHCA, and 12 (16.9%) of the COVID-19-negative group had a fever before OHCA (P = 0.018). Eight patients (88.9%) in the COVID-19-positive group had a CXR indicating pneumonic infiltration. Of the criteria for predicting COVID-19, fever or an abnormal CXR had a sensitivity of 100% (95% confidence interval [CI]: 65.4 - 100) and a specificity of 22.5% (95% CI: 13.5 - 34.0).ConclusionThe screening tools that combined fever or abnormal CXR had a good discriminatory ability for COVID-19 infection in adult patients with OHCA. Therefore, during the COVID-19 outbreak period, it is recommended to suspect COVID-19 infection and perform COVID-19 test if patients present with a history of fever or show abnormal findings in postmortem CXR.
| S-EPMC7779992 | biostudies-literature
Project description:IntroductionThe increase in access to Emergency Departments (ED) worldwide causes inefficiencies, but also signals its importance. The Coronavirus (Covid-19) outbreak allows to study the reactions of patients to the news about the spreading of the infection, which may have generated the fear that ED was no longer safe.MethodsWe study access to ED of a large teaching hospital in Brescia - one of the most hit provinces in Italy by Covid-19 - during the pandemic (from the announcement of the first cases to the explosion of the pandemic, to months after end of the acute phase) to study how patients reacted to the news that ED could no longer be a safe place. We analyse triage code, mode of arrival to ED, and accesses related to chest and abdominal pain, to evaluate who was discouraged most.ResultsAccesses have drastically reduced immediately after the news of the first contagion. During the lockdown accesses and admissions to hospital ward have decreased; this may mean that some patients may have suffered reduced health or increased mortality risks because of this decision. At the end of June accesses to ED and admissions to hospital ward are still lower than usual.DiscussionFear of contagion and appeals not to use ED directly by Covid-19 patients may have discouraged access also for pressing health need.
| S-EPMC7584647 | biostudies-literature
Project description: Not available
| S-EPMC7335492 | biostudies-literature
Project description: Not available
| S-EPMC7436489 | biostudies-literature
Project description:The main objective of this study is to offer and evaluate an interim triage approach for patients waiting for surveillance colonoscopies. This will reduce the waiting period and the psychological stressors for our patients and from a scientific point of view allow us to compare the yield of findings for each approach.
| 2383510 | ecrin-mdr-crc
Project description:ImportanceOut-of-hospital cardiac arrest (OHCA) health care provision may be a good indicator of the recovery of the health care system involved in OHCA care following the COVID-19 pandemic. There is a lack of data regarding outcomes capable of verifying this recovery.ObjectiveTo determine whether return to spontaneous circulation, overall survival, and survival with good neurological outcome increased in patients with OHCA since the COVID-19 pandemic was brought under control in 2022 compared with prepandemic and pandemic levels.Design, setting, and participantsThis observational cohort study was conducted to examine health care response and survival with good neurological outcome at hospital discharge in patients treated following OHCA. A 3-month period, including the first wave of the pandemic (February 1 to April 30, 2020), was compared with 2 periods before (April 1, 2017, to March 31, 2018) and after (January 1 to December 31, 2022) the pandemic. Data analysis was performed in July 2023. Emergency medical services (EMS) serving a population of more than 28 million inhabitants across 10 Spanish regions participated. Patients with OHCA were included if participating EMS initiated resuscitation or continued resuscitation initiated by a first responder.ExposureThe pandemic was considered to be under control following the official declaration that infection with SARS-CoV-2 was to be considered another acute respiratory infection.Main outcome and measuresThe main outcomes were return of spontaneous circulation, overall survival, and survival at hospital discharge with good neurological outcome, expressed as unimpaired or minimally impaired cerebral performance.ResultsA total of 14 732 patients (mean [SD] age, 64.2 [17.2] years; 10 451 [71.2%] male) were included, with 6372 OHCAs occurring during the prepandemic period, 1409 OHCAs during the pandemic period, and 6951 OHCAs during the postpandemic period. There was a higher incidence of OHCAs with a resuscitation attempt in the postpandemic period compared with the pandemic period (rate ratio, 4.93; 95% CI, 4.66-5.22; P < .001), with lower incidence of futile resuscitation for OHCAs (2.1 per 100 000 person-years vs 1.3 per 100 000 person-years; rate ratio, 0.81; 95% CI, 0.71-0.92; P < .001). Recovery of spontaneous circulation at hospital admission increased from 20.5% in the pandemic period to 30.5% in the postpandemic period (relative risk [RR], 1.08; 95% CI, 1.06-1.10; P < .001). In the same way, overall survival at discharge increased from 7.6% to 11.2% (RR, 1.45; 95% CI, 1.21-1.75; P < .001), with 6.6% of patients being discharged with good neurological status (Cerebral Performance Category Scale categories 1-2) in the pandemic period compared with 9.6% of patients in the postpandemic period (RR, 1.07; 95% CI, 1.04-1.10; P < .001).Conclusions and relevanceIn this cohort study, survival with good neurological outcome at hospital discharge following OHCA increased significantly after the COVID-19 pandemic.
| S-EPMC10807256 | biostudies-literature