COVID-19 In Emergency Department Research Articles

Postpandemic Evaluation of the Eco-Efficiency of Personal Protective Equipment Against COVID-19 in Emergency Departments: Proposal for a Mixed Methods Study.

The COVID-19 pandemic has had a profound impact on emergency department (ED) care in Canada and around the world. To prevent transmission of COVID-19, personal protective equipment (PPE) was required for all ED care providers in contact with suspected cases. With mass vaccination and improvements in several infection prevention components, our hypothesis is that the risks of transmission of COVID-19 will be significantly reduced and that current PPE use will have economic and ecological consequences that exceed its anticipated benefits. Evidence is needed to evaluate PPE use so that recommendations can ensure the clinical, economic, and environmental efficiency (ie, eco-efficiency) of its use. To support the development of recommendations for the eco-efficient use of PPE, our research objectives are to (1) estimate the clinical effectiveness (reduced transmission, hospitalizations, mortality, and work absenteeism) of PPE against COVID-19 for health care workers; (2) estimate the financial cost of using PPE in the ED for the management of suspected or confirmed COVID-19 patients; and (3) estimate the ecological footprint of PPE use against COVID-19 in the ED. We will conduct a mixed method study to evaluate the eco-efficiency of PPE use in the 5 EDs of the CHU de Québec-Université Laval (Québec, Canada). To achieve our goals, the project will include four phases: systematic review of the literature to assess the clinical effectiveness of PPE (objective1; phase 1); cost estimation of PPE use in the ED using a time-driven activity-based costing method (objective2; phase 2); ecological footprint estimation of PPE use using a life cycle assessment approach (objective3; phase 3); and cost-consequence analysis and focus groups (integration of objectives1to3; phase 4). The first 3 phases have started. The results of these phases will be available in 2023. Phase 4 will begin in 2023 and results will be available in 2024. While the benefits of PPE use are likely to diminish as health care workers' immunity increases, it is important to assess its economic and ecological impacts to develop recommendations to guide its eco-efficient use. PROSPERO CRD42022302598; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=302598. DERR1-10.2196/50682.

The Effectiveness of the Disaster Plan on the Incidence of COVID-19 in Emergency Department Staff of King Abdulaziz Medical City in Western Region

Background: Considering the rapid and emergent spread of coronavirus disease (COVID-19) or severe acute respiratory syndrome (SARS), hospitals were obligated to follow their emergency disaster plan [1]. This paper evaluates the effectiveness of the disaster plan based on the incidence of COVID-19 in emergency department (ED) staff of King Abdulaziz Medical City – Western Region (KAMC-WR) for one year. Methods: After reviewing the multidisciplinary management guidelines of COVID- 19, a cohort retrospective study was applied from March 2020 to March 2021 to measure the incidence of COVID-19 [2]. All emergency department health care workers (HCWs) were included in the study. Results: During the study period, results showed that 9 (4.24%) HCWs were infected by COVID-19 whereas 203 (95.75%) HCWs were not infected. The prevalence of COVID-19 among ED staff in KAMC-WR was low as compared to previous studies [3,4,5,6,7,8]. This indicates the effectiveness of KAMC-WR disaster plan. KAMC-WR disaster plan strategies that have been taken to lower the risk of infection transmission were discussed in this paper. Conclusion: In conclusion, this study showed beneficial strategies of KAMC-WR disaster plan that lowered COVID-19 incidence among ED staff.

The role of a noninvasive index ‘Spo2/ Fio2’ in predicting mortality among patients with COVID-19 pneumonia

IntroductionNoninvasive risk assessment is crucial in patients with COVID-19 in emergency department. Since limited data is known about the role of noninvasive parameters, we aimed to evaluate the role of a noninvasive parameter ‘SpO2/FiO2’ in independently predicting 30-day mortality in patients with COVID-19 and its prognostic utility in combination with a noninvasive score ‘CRB-65’. MethodsA retrospective study was performed in a tertiary training and research hospital, which included 272 patients with COVID-19 pneumonia diagnosed with polymerase chain reaction in emergency department. Data on characteristics, vital signs, and laboratory parameters were recorded from electronic medical records. The primary outcome of the study was 30-day mortality, and we assessed the discriminative ability of SpO2/FiO2 in predicting mortality in patients with COVID-19 pneumonia and its prognostic utility in combination with conventional pneumonia risk assessment scores. ResultsMultivariate analysis revealed that only SpO2/FiO2 level was found to be an independent parameter associated with 30-day mortality (OR:0.98, 95% CI: 0.98–0.99, p = 0.003). PSI and CURB-65 were found to be better scores than CRB-65 in predicting 30-day mortality (AUC: 0.79 vs 0.72, p = 0.04; AUC: 0.76 vs 0.72, p = 0.01 respectively). Both SpO2/FiO2 combined with CRB-65 and SpO2/FiO2 combined with CURB-65 have good discriminative ability and seemed to be more favorable than PSI in predicting 30-days mortality (AUC: 0.83 vs 0.75; AUC: 0.84 vs 0.75), however no significant difference was found (p = 0.21 and p = 0.06, respectively). ConclusionSpO2/FiO2 is a promising index in predicting mortality. Addition of SpO2/FiO2 to CRB-65 improved the role of CRB-65 alone, however it performed similar to PSI. The combined noninvasive model of SpO2/FiO2 and CRB-65 may help physicians quickly stratify COVID-19 patients on admission, which is expected to be particularly important in hospitals still stressed by pandemic volumes.

Triage in the time of COVID-19

Triage in the time of COVID-19

Triage Management During Covid-19 in Emergency Department: A Phenomenology Approach Among Nurses in Medan

Introduction: Triage is an important link in treating critical patients, but during the COVID-19 pandemic, triage is not only to select and sort patients from emergency status, but to avoid a surge in patients from the limited hospital capacity and medical personnel. The experience of emergency room nurses is needed to formulate a nursing service strategy. The purpose of this study was to explore the experience of nurses in carrying out management of triage (client priority classification system based on the severity of the client's condition or the emergency that requires immediate action) in the Emergency Room (ER) during COVID-19 pandemic in Medan. Methods: The type of research used in this studied was qualitative research with a phenomenological approach. Sampling used purposive sampling technique with the number of participants as many as 10 people. Data collection was done through in- depth interviews. The process of data analysis in this studied used Colaizzi's approach of content analysis. Results: The results of the study found four main themes that describe the experience of nurses in carrying out triage management during the COVID-19 pandemic. The themes that emerged as a result of the research were: 1) Triage management during Covid pandemic, 2) Individual perceptions of infection/contagion Triage, 3) The burden of the triage nurses' during Covid pandemic, and 4) Nurses’ gratitude. Conclusion: The experience of nurses in conducting triage management during the COVID-19 pandemic was focused on initial screening, namely the assessment of acute respiratory infections (ARI), contact history and a history of indications for COVID-19. Then secondary triage was sorting patients based on emergency conditions. The use of personal protective equipment still did not meet the standards, the workload of nurses was high and there was gratitude by them for being at the forefront of handling COVID-19.

Nurse Anxiety of Handling Patient Covid-19 in Emergency Department

Coronavirus or severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a virus that attacks the respiratory system. Coronavirus can cause mild disorders of the respiratory system, severe lung infections, and even death. This study aims to determine the relationship between knowledge, workload, an increasing number of patients, risk of exposure and infrastructure with nurses' anxiety. This study used an analytic observational design with a cross-sectional approach. The sample is 61 nurses, the sampling technique uses Total Sampling, and the analysis uses the Spearman Rank test, Pearson correlation. The results of this study indicate that there is a relationship between knowledge (p = .002, r = - .389), workload (p-value = .047, r = .256), an increase in the number of patients (p-value = .009, r = .333), risk exposure (p-value = .048, r = - .254), and infrastructure (p-value = .040, r = - .264) with anxiety. There is a significant relationship between knowledge, workload, an increasing number of patients, risk of exposure, and facilities and infrastructure with anxiety. The hospital needs to prepare adequate infrastructure and facilities for medical personnel who are on the front line, especially related to personal protective equipment. Abstrak: Virus Corona atau severe acute respiratory syndrome coronavirus 2 (SARS-CoV- 2) merupakan virus yang menyerang sistem pernapasan. Virus Corona bisa menyebabkan gangguan ringan pada sistem pernapasan, infeksi paru-paru yang berat, hingga kematian. penelitian ini bertujuan untuk mengetahui hubungan pengetahuan, beban kerja, peningkatan jumlah pasien, resiko paparan dan sarana prasarana dengan kecemasan perawat. Penelitian ini menggunakan desain observasional analitik dengan pendekatan cross sectional. Sampel sebanyak 61 orang perawat, tehnik sampling menggunakan Total Sampling, dan analisis menggunakan uji Spearman Rank, korelasi pearson. Hasil penelitian ini menunjukkan adanya hubungan antara pengetahuan (p= .002, r= - .389), beban kerja (p value= .047, r= .256), peningkatan jumlah pasien (p value = .009, r = .333), resiko paparan (p value=.048, r = -.254), dan sarana prasarana (p value= .040, r= - .264) dengan kecemasan. Terdapat hubungan signifikan antara Pengetahuan, beban kerja, peningkatan jumlah pasien, resiko paparan, dan sarana dan prasarana dengan Kecemasan. pihak rumah sakit perlu mempersiapkan sarana dana prasarana yang memadai buat tenaga medis yang berada di garda terdepan terutama terkait dengan alat pelindung diri.

Decreased Hospital Visits and Increased Mortality Rate in Emergency Department during the COVID-19 Pandemic: Evidence from Albania.

.Objective:To investigate the hospital visits and mortality rate during the COVID-19 in emergency department of Vlora regional hospital in Albania and to compare with the three previous years (2017–2019).Methods:Secondary data of patients that visited emergency department of Vlora Regional hospital Albania (largest hospital in the south of the country), since January 1, 2017 till December 31, 2020. This is a retrospective study. We used the hard copy of the patients’ health register records. The data extraction was conducted during March 2021 till June 2021. Eligible were all patients admitted and recorded in the registry of the emergency department. The causes of admission were categorized in 14 different disease categories. All registered patients admitted to the Vlora regional hospital were included in the study.Results:Study population included 44,917 patients during 2017–2020. Mean age of patients was 51.5 years, while 53.6% were females. The highest number of patients was in 2017 (n=12,407) and the lowest in 2020 (n=9,266). Increase of patients presented with cardiovascular, psychiatric and renal/urinary tract was observed in 2020 in comparison to 2019. Patients decreased over time with an average annual percent decrease of 7% (p-value=0.22). Joinpoint analysis revealed that mortality rate increased over time with an average annual percent increase of 34.3% (95% confidence interval=42.7% to 214.8%, p-value=0.27).Conclusions:The number of patients visiting emergency department decreased while mortality rate increased. Educating and raising awareness of patient to seek medical assistance should be a key objective of health policy makers and health personnel.

33 Forecasting Daily Patient Arrivals during COVID-19 in Emergency Departments: A Deep Learning Approach

As the fourth wave of coronavirus disease 2019 (COVID-19) surges in Michigan, most health care systems are experiencing an increased hospitalization rate of infected COVID-19 patients. Understanding the arrival rates of patients to the emergency department (ED) is fundamental in managing the limited health care resources. Our objective is to develop an accurate forecasting model based on ED patients’ arrival and COVID-19 status to help manage and facilitate a data-driven resource planning.

Evaluation of The Predictability of Platelet Mass Index for Short-Term Mortality in Patients with COVID 19: A Retrospective Cohort Study

Objective 
 This study aimed to determine the predictability of platelet mass index (PMI) for short-term mortality in patients with COVID 19.
 Material and methods
 This retrospective, observational, cohort study included corrected COVID-19 patients. Demographics, clinical characteristics, biochemical and hematological parameters and the data of all-cause mortality within 30 days after admission were noted. The receiver operating characteristic curve analysis and odds ratio were performed to determine the discriminative ability of the scores.
 Results 
 Of the 1564 patients, with mean of age of 44 ± 16 years included in the study. A total of 57 (3.6%) patients died within 30 days of emergency department presentation. There was a statistically significant difference between the survivor and non-survivor groups in terms of the platelet count, mean platelet volume (MPV) and PMI. According to the best Youden’s index, the cut-off value for the platelet count was determined as 146 (sensitivity: 91.8%, specificity: 87.2%), and the area under curve (AUC) value was 0.593 (95% confidence interval 56.7-61.9). According to the best Youden’s index, the cut-off value for the MPV was determined as 11 (sensitivity: 24.6%, specificity: 91%), and the AUC value was 0.579 (95% confidence interval 55.2-60.5). According to the best Youden’s index, the cut-off value for the PMI was determined as 1513 (sensitivity: 28.1%, specificity: 87.2%), and the AUC value was 0.555 (95% confidence interval 52.8-58.2).
 
 Conclusion 
 Platelet count, MPV and PMI were not predictor of 30-day mortality in patients with confirmed COVID-19 in emergency department.

Clinical Characteristics and Outcome of Patients with Suspected COVID-19 in Emergency Department (RESILIENCY Study II).

Objectives: COVID-19 may show no peculiar signs and symptoms that may differentiate it from other infective or non-infective etiologies; thus, early recognition and prompt management are crucial to improve survival. The aim of this study was to describe clinical, laboratory, and radiological characteristics and outcomes of hospitalized COVID-19 patients compared to those with other infective or non-infective etiologies. Methods: We performed a prospective study from March 2020 to February 2021. All patients hospitalized for suspected or confirmed COVID-19 were prospectively recruited. All patients were evaluated according to a predefined protocol for diagnosis of suspected SARS-CoV-2 infection. The primary endpoint was evaluation of clinical, laboratory, and radiological characteristics associated or not with COVID-19 etiology at time of hospitalization in an emergency department. Results: A total of 1036 patients were included in the study: 717 (69%) patients with confirmed COVID-19 and 319 (31%) without COVID-19, hospitalized for other causes. The main causes of hospitalization among non-COVID-19 patients were acute heart failure (44%) and bacterial pneumonia (45.8%). Overall, 30-day mortality was 9% among the COVID-19 group and 35% in the non-COVID-19 group. Multivariate analysis showed variables (fever > 3 days, dry cough, acute dyspnea, lymphocytes < 1000 × 103/µL, and ferritin > 250 ng/mL) independently associated with COVID-19 etiology. A decision tree was elaborated to early detect COVID-19 patients in the emergency department. Finally, Kaplan–Meier curves on 30-day survival in COVID-19 patients during the first wave (March–May 2020, n = 289 patients) and the second wave (October–February 2021, n = 428 patients) showed differences between the two study periods (p = 0.021). Conclusions: Patients with confirmed diagnosis of COVID-19 may show peculiar characteristics at time of hospitalization that could help physicians to distinguish from other infective or non-infective etiologies. Finally, a different 30-day mortality rate was observed during different periods of the pandemic.

Can hematological and biochemical parameters fasten the diagnosis of COVID-19 in emergency departments?

INTRODUCTION: The primary aim of the study was to compare the laboratory and radiological parameters of COVID-19 positive and negative patients confirmed by Real-Time Reverse Transcription Polymerase Chain Reaction (RT-PCR), and Chest Computed Tomography (CCT) of patients admitting with the suspicion of COVID-19. The secondary purpose of the study was to find objective parameters to speed up the clinician for further examination, treatment or referral decision in COVID-19 suspicion. MATERIAL AND METHODS: A total of 61 COVID-19 suspected patients were evaluated in the study. Swab samples were taken for RT-PCR analysis. CCT was taken for 42 patients who described dyspnea. According to CCT and RT-PCR results, the patient population was divided into 2 groups as COVID-19 positive group (n = 32); and COVID-19 negative group (n = 29). Between two groups; demographic, clinical, laboratory and radiological parameters were compared. RESULTS: Male gender (p = 0.03), PLR value (p = 0.021) and CO-RADS scores were higher in the COVID-19 positive group. Oxygen saturation (SaO2) (p = 0.027) and PCT, WBC, Neutrophil count, Lymphocyte count values were significantly low in COVID-19 positive group (p = 0.03, p = 0.001, p = 0.017, p = 0.021, respectively). PLR showed a positive correlation with fever, CRP, neutrophil count and NLR, which are indicators of inflammation. CONCLUSIONS: SaO2, WBC, lymphocyte count, neutrophil count and low PCT levels, and PLR elevation showed a significant difference in COVID-19 patients in our retrospective cohort study examining the Turkish population. We believe that these results will allow clinicians to make quick decisions in patient management more simply.