Daily Census Research Articles

Assessment of Bed Utilization Indicators of Medicine Ward of a Tertiary Level Hospital: A Cross-sectional Study in Eastern India

Background: Efficient hospital bed utilization is an important function of hospital administrators. Scarcity of beds, overcrowding, and flooring are often the picture of tertiary hospitals. Objectives: This study aims to find out hospital bed utilization indicators such as average daily census, bed occupancy rate (BOR), average length of stay (ALS), bed turnover rate (BTR), and bed turnover interval (BTI) in Medicine ward of a tertiary hospital in West Bengal, India. Methods: A descriptive cross-sectional study was conducted in acute male and female as well as chronic male and female wards under medicine department of a tertiary hospital in West Bengal from June to August 2018.The record of active beds, patient days, daily admissions and discharge were reviewed for May 2018 by complete enumeration method from admission, discharge and death registers and recorded in a pre-designed pretested checklist. Average daily census, BOR, ALS, BTR, and BTI were computed using standard formula. Pabon Lasso model was used to analyse the performance of the nedicine ward. Results: Average daily census, ALS, BOR, BTR, BTI in medicine ward were 261.81 patients, 8 days, 108.55%, 4.22 patients/ bed and -0.63 days respectively. Pabon Lasso graph reflected high BOR and high discharges per bed (productivity) in acute medicine wards reflecting good quantitative performance in contrast to chronic medicine wards with low discharges per bed (productivity or BTR) and higher ALS. Conclusion: Medicine ward reflected higher BOR and ALS but lower BTR (productivity) as per the Pabon Lasso graph. Efforts must be made to reduce ALS in chronic medicine wards.

A Monte Carlo Simulation Approach to Optimizing Capacity in a High-Volume Congenital Heart Pediatric Surgical Center.

Elective surgeries are primarily scheduled according to surgeon availability with less consideration of patients' postoperative cardiac intensive care unit (CICU) length of stay. Furthermore, the CICU census can exhibit a high rate of variation in which the CICU is operating at over-capacity, resulting in admission delays and cancellations; or under-capacity, resulting in underutilized labor and overhead expenditures. To identify strategies to reduce variation in CICU occupancy levels and avoid late patient surgery cancellation. Monte Carlo simulation study of the daily and weekly CICU census at Boston Children's Hospital Heart Center. Data on all surgical admissions to and discharges from the CICU at Boston Children's Hospital between September 1, 2009 and November 2019 were included to obtain the distribution of length of stay for the simulation study. The available data allows us to model realistic length of stay samples that include short and extended lengths of stay. Annual number of patient surgical cancellations and change in average daily census. We demonstrate that the models of strategic scheduling would result in up to 57% reduction in patient surgical cancellations, increase the historically low Monday census and decrease the historically higher late-mid-week (Wednesday and Thursday) censuses in our center. Use of strategic scheduling may improve surgical capacity and reduce the number of annual cancellations. The reduction of peaks and valleys in the weekly census corresponds to a reduction of underutilization and overutilization of the system.

The promise of excess mobility analysis: measuring episodic-mobility with geotagged social media data

ABSTRACT Human mobility studies have become increasingly important and diverse in the past decade with the support of social media big data that enables human mobility to be measured in a harmonized and rapid manner. However, what is less explored in the current scholarship is episodic mobility as a special type of human mobility defined as the abnormal mobility triggered by episodic events excess to the normal range of mobility at large. Drawing on a large-scale systematic collection of 1.9 billion geotagged Twitter data from 2017 to 2020, this study contributes to the first empirical study of episodic mobility by producing a daily Twitter census of visitors at the U.S. county level and proposing multiple statistical approaches to identify and quantify episodic mobility. It is followed by four case studies of episodic mobility in U.S. national wide to showcase the great potential of Twitter data and our proposed method to detect episodic mobility subject to episodic events that occur both regularly and sporadically. This study provides new insights on episodic mobility in terms of its conceptual and methodological framework and empirical knowledge, which enriches the current mobility research paradigm.

Differentiating properties of occupancy rate and workload to estimate crowding: A Swedish national cross-sectional study.

BackgroundEmergency department (ED) crowding causes increased patient morbidity and mortality. ED occupancy rate (OR; patients by treatment beds) is a common measure of crowding, but the comparability of ORs between EDs is unknown. The objective of this investigation was to investigate differences in ORs between EDs using staff‐perceived workload as reference.MethodsThis was a national cross‐sectional study in Sweden. EDs provided data on census, treatment beds, staffing, and workload (1–6) at 5 time points. A baseline patient turnover was calculated as the average daily census by treatment beds, denoted turnover per treatment bed (TTB), for each ED. A census ratio (CR), current by daily census, was calculated to adjust for differences in the number of treatment beds.ResultsData were returned from 37 (51%) EDs. TTB varied considerably (mean = 4, standard deviation = 1.6; range, 2.1–9.2), and the OR was higher in EDs with TTB >4 compared with ≤4, 0.86 versus 0.43 (0.43; 95% confidence interval [CI], 0.27–0.59), but not workload, 2.75 versus 2.52 (0.23; 95% CI, −0.19 to 0.64). After adjusting for confounders, both TTB (k = −0.3; 95% CI, −0.49 to −0.14) and OR (k = 3.4; 95% CI, 1.76–5.03) affected workload. Correlation with workload was better for CR than for OR (r = 0.75 vs 0.60, respectively).ConclusionOR is affected by patient‐to‐treatment bed ratios that differ significantly between EDs and should be accounted for when measuring crowding. CR is not affected by baseline treatment beds and is a better comparable measure of crowding compared with OR in this national comparator study.

Analysis and Design of Inpatient Daily Cense Information System in Bhayangkara Bengkulu Hospital

Background: Progressing technology in the world need to fast and accurate information in the hospital agencies as the basis for appropriate making decision. The inpatient daily census reporting of system Bhayangkara Hospital Bengkulu don't have utilized the Inpatient Daily census system electronically and still uses a manual system, so that the processing of report data is less than optimal. There are still a lot of inputting errors, inaccurate data, and inefficient time and energy. This study to aim design system information inpatient daily census reporting application at the Bhayangkara hospital to existing problems solving.Methods: The method used in designing and making this application is by utilizing software development methods, namely the waterfall method which includes identification, analysis, design or design, implementation and maintenance of the system.Results: The results this study is creation of an application to facilitys the processing of data into an inpatient daily census report that is needed and to overcome the problems that arise because of the report processing system manually. Design and Creation of Inpatient Daily Census Applications with Visual Basic 6.0 Programming at Bhayangkara Bengkulu Hospital have been made with the results of an analysis of existing systems and according to the method used, and the design of the forms that have been made in accordance with the manual form or home party needs sick and can simplify filling out forms and processing the data.Conclusions: At Bhayangkara Bengkulu Hospital still uses a manual inpatient daily census system, and not on time for reporting daily cencus patient data. The data structure contained in the ledger consists of patient identity, patient diagnosis, and others. There are three processes in the stage of analyzing the needs of the inpatient daily census system, namely the data input process, data processing and data output processes. ledger, patient data consisting of patient identity, doctor's name, patient diagnosis, treatment room, and treatment class. In designing the daily inpatient census system at Bhayangkara Bengkulu Hospit consists of patient data forms, incoming patients, outgoing patients, and patients moving. The implementation of the daily inpatient census system at the Bhayangkara Bengkulu Hospital has carried out socialization and discussions about the user interface design to officers or users of the electronic daily census system. And the maintenance of the daily inpatient census system is carried out in several stages (1) corrective, by correcting design and errors in the program, (2) adaptive, by modifying the system according to user needs, (3) perfective, namely processing census data computerized.

Analisis Grafik Baber Jhonson Berdasarkan Sensus Harian Rawat Inap di Rumah Sakit Khusus Jiwa Soeprapto Bengkulu

The daily inpatient census is a collection of patient data entering and leaving the inpatient room. The daily census data obtained from each treatment room will be processed, so that later it will get the parameters BOR (Bed Occupancy Rate), AvLos (Average Length Of Stay), TOI (Turn Over Interval), BTO (Bed Turn Over). Present in the formulir of Barber Johnson Graph. The purpose of this study was to determine the calculation of the Barber Johnson chart indicator based on the daily census of inpatients at RSKJ Soeprapto Bengkulu in 2017. The type of research used was descriptive observational with a cross-sectional design, the population in this study was inpatient data recorded at the SHRI. in January-March 2017, totaling 560 patients, with a total sample of the existing population, total sampling. Using secondary data, processed univariately. This research was conducted from July to August 2017 at the medical record unit of RSKJ Soeprapto Bengkulu. The results of univariate analysis, from the calculation of hospital service indicators, the BOR value of IPC room was (60.9%) according to standard, Rajawali (27.38%) not according to standard, Orchid (60.33%) according to standard. The AvLos value of IPC space (2.57 days) was according to the standard, Rajawali (5.52 days) was according to the standard, Orchid (14.22 days) was not up to the standard. BTO value of IPC room (18.8 times) was not up to standard, Rajwali (3.15 times) was not up to standard, Orchid (3.32 times) was not up to standard. TOI value of IPC room (1.9 days) was up to standard, Rajwali (24.57 days) is not up to standard, Orchid (11.42 days) is not up to standard. It is expected that health workers, especially medical records, fill out the Inpatient Daily Census (SHRI) form completely so that Barber Johnson charts can be made so that the efficiency of hospital management is known.

Survey of pharmacists on their roles and perceptions of outpatient parenteral antimicrobial therapy in the United States.

To define outpatient parenteral antimicrobial therapy (OPAT) clinical pharmacy practice across the United States, specifically pharmacist functions, design of pharmacist involvement, and to compare pharmacist training of those who practice in OPAT to infectious diseases pharmacists who do not. A survey of a possible 32 questions was emailed to the American College of Clinical Pharmacists (ACCP) Infectious Diseases Practice and Research Network (PRN) e-mail list. Results were focused on US-based respondents. In total, 87 pharmacists responded; 27 of these pharmacists (31%) practiced in OPAT. Training background did not differ between groups. Programs with an OPAT pharmacist were more likely to have a formal OPAT team compared to those without an OPAT pharmacist (P < .001). OPAT pharmacists were early in their careers with 66.7% practicing <5 years in OPAT. Most OPAT pharmacists (66.7%) practiced at an academic medical center with a median full-time equivalent (FTE) of 0.6. Moreover, 63% utilized a collaborative practice agreement and 81.5% shared job functions with other pharmacist roles, most commonly antimicrobial stewardship. Few OPAT programs involved a dispensing component (28%). The median daily census was 43 patients followed by an OPAT pharmacist. Pharmacists performed a variety of tasks in OPAT. Pharmacist nondispensing involvement in OPAT is an emerging trend in the United States with wide variability in program structure and pharmacist tasks. A ratio of 1 OPAT pharmacist for every 45-70 OPAT patients is proposed to facilitate expansion of pharmacist clinical practice in OPAT.

Reproducibility of Hospital Rankings Based on Centers for Medicare & Medicaid Services Hospital Compare Measures as a Function of Measure Reliability

Unreliable performance measures can mask poor-quality care and distort financial incentives in value-based purchasing. To examine the association between test-retest reliability and the reproducibility of hospital rankings. In a cross-sectional design, Centers for Medicare & Medicaid Services Hospital Compare data were analyzed for the 2017 (based on 2014-2017 data) and 2018 (based on 2015-2018 data) reporting periods. The study was conducted from December 13, 2020, to September 30, 2021. This analysis was based on 28 measures, including mortality (acute myocardial infarction, congestive heart failure, pneumonia, and coronary artery bypass grafting), readmissions (acute myocardial infarction, congestive heart failure, pneumonia, and coronary artery bypass grafting), and surgical complications (postoperative acute kidney failure, postoperative respiratory failure, postoperative sepsis, and failure to rescue). Measure reliability based on test-retest reliability testing. The reproducibility of hospital rankings was quantified by calculating the reclassification rate across the 2017 and 2018 reporting periods after categorizing the hospitals into terciles, quartiles, deciles, and statistical outliers. Linear regression analysis was used to examine the association between the reclassification rate and the intraclass correlation coefficient for each of the classification systems. The analytic cohort consisted of 28 measures from 4452 hospitals with a median of 2927 (IQR, 2378-3160) hospitals contributing data for each measure. The hospitals participating in the Inpatient Prospective Payment System (n = 3195) had a median bed size of 141 (IQR, 69-261), average daily census of 70 (IQR, 24-155) patients, and a median disproportionate share hospital percentage of 38.2% (IQR, 18.7%-36.6%). The median intraclass correlation coefficient was 0.78 (IQR, 0.72-0.81), ranging between 0.50 and 0.85. The median reclassification rate was 70% (IQR, 62%-71%) when hospitals were ranked by deciles, 43% (IQR, 39%-45%) when ranked by quartiles, 34% (IQR, 31%-36%) when ranked by terciles, and 3.8% (IQR, 2.0%-6.2%) when ranked by outlier status. Increases in measure reliability were not associated with decreases in the reclassification rate. Each 0.1-point increase in the intraclass correlation coefficient was associated with a 6.80 (95% CI, 2.28-11.30; P = .005) percentage-point increase in the reclassification rate when hospitals were ranked into performance deciles, 4.15 (95% CI, 1.16-7.14; P = .008) when ranked into performance quartiles, 1.47 (95% CI, 1.84, 4.77; P = .37) when ranked into performance terciles, and 3.70 (95% CI, 1.30-6.09; P = .004) when ranked by outlier status. In this study, more reliable measures were not associated with lower rates of reclassifying hospitals using test-retest reliability testing. These findings suggest that measure reliability should not be assessed with test-retest reliability testing.

44. Impact of Nursing Home (NH) Universal Decolonization and COVID Prevention Training on COVID-19 Burden During the 2020-2021 Winter Surge in Orange County (OC), California (CA)

BackgroundOC is the 6th largest U.S. county with 70 NHs. Universal decolonization (chlorhexidine for routine bathing, and twice daily nasal iodophor Mon-Fri every other week) was adopted in 24 NHs prior to the COVID-19 pandemic, and 12 NHs (11 of those adopting decolonization) participated in a COVID prevention training program with a rolling launch from July-Sept 2020. We evaluated the impact of these initiatives on staff and resident COVID cases.MethodsWe conducted a quasi-experimental study of the impact of decolonization and COVID prevention training on staff and resident COVID cases during the CA winter surge (11/16/20-1/31/21), when compared to non-participating NHs. Decolonization NHs received weekly visits for encouraging adherence during the pandemic, and NHs in the COVID training program received 3 in-person training sessions for all work shifts plus weekly feedback about adherence to hand hygiene, masking, and breakroom safety using video monitoring. We calculated incident 1) staff COVID cases, 2) resident COVID cases, and 3) resident COVID deaths adjusting for NH average daily census. We assessed impact of initiatives on these outcomes using linear mixed effects models testing the interaction between any training participation and calendar date when clustering by NH. Because of the overlap of the two initiatives, we evaluated ‘any training’ vs ‘no training.’ Results63 NHs had available data. 24 adopted universal decolonization, 12 received COVID training (11 of which participated in decolonization), and 38 were not enrolled in either. During the winter surge, the 63 NHs experienced 1867 staff COVID cases, 2186 resident COVID cases, and 251 resident deaths due to COVID, corresponding to 29.6, 34.7, and 4.0 events per NH, respectively. In NHs participating in either initiative, staff COVID cases were reduced by 31% (OR=0.69 (0.52, 0.92), P=0.01), resident COVID cases were reduced by 43% (OR=0.57 (0.39, 0.82), P=0.003), and resident deaths were reduced (non-significantly) by 26% (OR=0.74 (0.46, 1.21), P=0.23). The grey box represents the California COVID-19 winter surge (11/16/20-1/31/21). Incident and cumulative COVID-19 cases and deaths for each nursing home were divided by the nursing home’s average daily census and multiplied by 100, representing events per 100 beds, which were aggregated across groups.ConclusionNHs are vulnerable to COVID-19 outbreaks. A universal decolonization and COVID prevention training initiative in OC, CA significantly reduced staff and resident COVID cases in this high-risk care setting.Disclosures Gabrielle Gussin, MS, Medline (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products)Stryker (Sage) (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic products)Xttrium (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic products) Raveena Singh, MA, Medline (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products)Stryker (Sage) (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic products)Xttrium (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic products) Shruti K. Gohil, MD, MPH, Medline (Other Financial or Material Support, Co-Investigator in studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products)Molnycke (Other Financial or Material Support, Co-Investigator in studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products)Stryker (Sage) (Other Financial or Material Support, Co-Investigator in studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products) Raheeb Saavedra, AS, Medline (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products)Stryker (Sage) (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic products)Xttrium (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic products) Robert Pedroza, BS, Medline (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products) Chase Berman, BS, Medline (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products) Susan S. Huang, MD, MPH, Medline (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products)Molnlycke (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products)Stryker (Sage) (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products)Xttrium (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products)

615. A Year with COVID19 – Experience from the Front Line in a Large Infectious Disease (ID) Clinical Practice

BackgroundID Care (IDC) is a large, 43 physician, 74 provider, practice that treats patients in 16 acute care hospitals (ACH) and 120 skilled nursing facilities (SNF) in NJ. March 4, 2021 was the first day a patient with COVID19 seen by IDC. Over the subsequent year IDC evaluated, treated, and tested over 23,000 persons for COVID19. Patients were seen in 2 distinct times - wave 1 (W1) March 5-August 31 and wave 2 (W2) September 1 to March 4. We compare the experience of these 2 waves and report on the year of COVID19 at IDC.MethodsThe administrative data base for IDC was queried for demographic, visit and testing information. A survey of providers was performed to capture incidence of COVID19 and vaccination rates. Daily census logs were used to create epi curves. Comparisons between waves were performed using student T Test or X2. ResultsTable 1 provides the comparisons between waves. More patients were seen in W2, however, the number of visits per patient was less, consistent with a shorter length of stay. Fewer patients were seen in SNF in W2 compared to W1. The age and sex distribution between the waves were the same. A total of 8741 molecular tests were performed. Test positivity peaked the week of December 31 at 6.99% and dropped to 0% by May 1 consistent with vaccination and the NJ epidemic curve. During the year of COVID19, 6/74 (8%) clinicians were infected with SARSCoV2. All recovered. Infections in providers were not clearly work-related exposures. 73/74 clinicians were vaccinated. Table 1. Demographics For the Year in COVID19 at ID Care Figure 1. Test Positivity Rate for ID CareConclusionThe year of COVID19 occurred in 2 distinct waves. W1 was short and intense. The age and gender distributions were the same between the waves. Even though wave 2 was numerically greater, the cases in SNF were statistically less than the first wave likely from improved IP practice initiated in W1. The numbers of visits per patient, a surrogate for LOS, was statistically less in W2. The decline in test positivity paralleled deployment of vaccination. Despite an intensity of exposure of 158 patients/provider or 1198 visits/provider to SARSCoV2 infected persons only 8% of the clinician staff were infected. ID clinical practice can use electronic databases to help describe regional outbreaks of transmissible disease giving additional perspective across the care continuum. A more usable standard tool would enhance this capacity.Disclosures Ronald G. Nahass, MD, Abbvie (Grant/Research Support, Speaker's Bureau)Alkermes (Grant/Research Support)Gilead (Grant/Research Support, Speaker's Bureau)Merck (Grant/Research Support, Speaker's Bureau)

619. Current State of Infectious Diseases Pharmacist OPAT/COpAT Practice in the United States

BackgroundOutpatient parenteral antimicrobial therapy (OPAT) is the process of administering intravenous (IV) antimicrobials outside the acute inpatient setting. Oral antimicrobials for complex infections are referred to as complex outpatient antimicrobial therapy (COpAT). OPAT/COpAT programs are expanding, as are the opportunities for clinical Infectious Diseases (ID) pharmacists (RPHs) involvement. The current state of clinical (non-dispensing) role and the functions being performed by RPHs in OPAT/COpAT is unknown. MethodsTo define the current state of OPAT/COpAT pharmacy practice across the United States (US), specifically the clinical functions performed by RPHs, design of RPH involved OPAT/COpAT clinics, and compare training of RPHs who practice in OPAT/COpAT to ID RPHs who do not, a survey of a possible 31 questions was emailed to the American College of Clinical Pharmacists (ACCP) Infectious Diseases Practice and Research Network (PRN) email list. Results were focused on US-based respondents. ResultsEighty-seven RPHs responded with 27 practicing in OPAT/COpAT. Training background did not differ between groups. Programs with an OPAT/COpAT RPH were more likely to have a formal OPAT team compared to those without an OPAT/COpAT RPH (p < 0.001). OPAT/COpAT RPHs were early in their careers, with roughly half practicing < 5 years in ID, and 66.7% practicing < 5 years in OPAT/COpAT. Most OPAT/COpAT RPHs (66.7%) practiced at an academic medical center with a median full time equivalent (FTE) of 1 RPH. Most (63%) utilized a collaborative practice agreement and 81.5% shared job functions with other ID RPH roles, most commonly antimicrobial stewardship. Few (28%) OPAT/COpAT programs involved a dispensing component. The average daily census was 42 patients followed by an OPAT/COpAT RPH. There was wide variability in the types of tasks ID RPH performed in OPAT/COpAT, the three most important tasks are listed in Figure 1. OPAT Pharmacists Task Ranking by Importance There was wide variability in the types of tasks ID pharmacist performed in OPAT/COpAT. The most OPAT/COpAT pharmacists responded that adjusting medications based on lab values was in their top 3 most important clinical tasks. When ranking the top three most important tasks, selecting the initial OPAT/COpAT regimen was ranked first most often, followed by review of review of OPAT appropriateness for discharge, then adjusting medications based on lab values.ConclusionThis is the largest known survey of OPAT/COpAT RPHs. RPH involvement in OPAT/COpAT in the US is an emerging trend with wide variability in program structure. Tasks performed by OPAT/COpAT RPHs varied significantly; however, OPAT/COpAT RPH respondents’ functions are largely clinical in nature.Disclosures All Authors: No reported disclosures

A retrospective analysis of 902 hospitalized COVID‐19 patients in Lebanon: clinical epidemiology and risk factors

Background: The clinical epidemiology of hospitalized COVID-19 patients has never been described before in Lebanon. Moreover, the hospital admission and PCR positivity rates have not been assessed and compared yet. Objectives: To describe the characteristics and outcomes of hospitalized patients with coronavirus induced disease 2019 (COVID-19) in Lebanon and identify risk factors for severe disease or death. Study design: This is a retrospective mono-center cohort study in which we used patients’ files to extract and analyse data on demographic and clinical characteristics, as well as mortality. Moreover, we tracked the pandemic by recording the daily total and ICU inpatient census and the PCR positivity rate for admitted and outpatients. Results: Although the total admission rate increased from September to April, the ICU census switched this trend in December to stabilize at an average of around 10 patients/day until April. The case fatality rate was 19% for the 902 hospitalized patients, of which the majority (80%) had severe COVID-19. The severity odds ratio is significantly decreased in immunosuppressed cases (OR, 0.18; CI, 0.05-0.67; p=0.011). Additionally, the odds of COVID-19 related death are significantly greater if consolidations are found in the chest computed tomography (CT) scan (OR, 12; CI, 2.63-55.08; p=0.0013). Conclusion: Consolidations in the lungs significantly increase the COVID-19 death risk. Risk factors identification is important to improve patients’ management and vaccination strategies. In addition, hospital statistics are good indicators of a pandemic's track.

162 Regional Emergency Department Census Impacts During a Cyber Attack

Modern emergency department (ED) care is critically dependent on computerized systems such as medical devices, electronic health records, and imaging systems. Many clinical systems have software and hardware vulnerabilities that can be exploited by malicious computer hackers. Cyber-attacks including ransomware on healthcare delivery organizations (HDO) are increasing in severity and frequency, impacting both individual hospitals and the broader regional healthcare delivery ecosystem. The effects of healthcare cyber-attacks on neighboring HDOs has yet to be reported in the literature. The purpose of this study is to report the impact on fully functioning hospital EDs during an active cyber-attack on a neighboring HDO. We performed a retrospective analysis of the daily combined census of two large urban academic EDs in San Diego, CA for the first week of a ransomware cyber-attack on a nearby multi-hospital HDO (May 2nd - 8th 2021). We then compared the mean to the 5-year historical census (2016-2020), matched by week (ex. first full week in May 2020 etc.) A one-way analysis of variance (ANOVA) and Tukey test were used to compare census years. The matched mean combined daily ED census for years 2016 - 2020 (no cyber-attack) were: 2016 – 221 (SD 12), 2017 – 211 (SD 21), 2018 – 174 (SD 30), 2019 – 229 (SD 29), and 2020 – 179 (SD17). For 2021 (week of the cyber-attack) the mean was 281 (SD 37). There was a statistically significant higher census during the cyber attack when compared to the 5 years prior (Table 1). Cyber attacks on hospitals can have significantly detrimental effects on patient care due to the loss of critical digital systems. This study demonstrated an associated “spill over” effect of significantly higher ED census numbers at facilities in proximity to HDOs under active cyber-attack.

108 Emergency Department Crowding Resulting from a Local Health System Cyberattack

Emergency department crowding continues to be a concern in many major urban emergency departments. The causes of ED crowding are complex and multi-factorial, and now cyber attach threats are contributing to this ongoing issue. We analyze the impact of a cyberattack on a large, multi-hospital health system on the already burdensome crowding in our emergency department. This is a retrospective study evaluating the boarding of admitting patients on two EDs from a single healthcare system during an ongoing ransomware cyberattack on a neighboring health system in San Diego. San Diego regional hospitals serve an estimated population of roughly 3.3 million residents across a 4,206-square-mile land mass; approximately 1.4 million reside within the City of San Diego. One ED is in an urban level one trauma center and the other is a suburban academic hospital. They have a combined annual census of ∼80, 000). Census and admitted patients from the two-week period before (April 17 through April 30, 2021) and two weeks after (May 2 through May 15, 2021) the incident started (May 1, 2021). In the study period, the number of admissions, discharges and LWBS statuses increased therefore increasing daily ED census. Between the pre- and post-cyberattack periods, the average number of admissions, discharges, LWBS and overall census increased by 46 (95% CI = 24.32, 67.68), 7 (95% CI = -1.93, 17.93), 25 (95% CI = 13.55, 36.45) and 8 (95% CI = 3.02, 12.98), respectively. The number of EDIPs increased in the post-period. The percent of admissions being held in the ED to ED census were roughly 13% in the pre-period and 14% in the post-period, demonstrating an increased in the percent % of EDIPs within daily ED volume. These results reveal the significant rise in ED visits and boarding as a result of the ransomware cyberattack on a neighboring health system. As these attacks likely become more common in the future, local and regional response strategies to consider the safe management of patients by other unaffected health systems may help reduce the impact on ED crowding and maintain flow in the department so a sustained surge doesn’t impact patient safety.

7 Impact of a Hospital Cyberattack on EMS Arrivals at Neighboring Emergency Departments

Cyber attacks, including ransomware on health care delivery organizations (HDO), are increasing in severity and frequency. Emergency medical services (EMS) plays a significant role in emergency care and disaster response, including the rapid transport of acute patients to receiving emergency departments (EDs). EMS ambulance diversion from one facility to another is a common occurrence with ED crowding, but it can be a result of internal or external disasters as well. The effects of health care cyber attacks on EMS transports and census has yet to be reported in the literature. The purpose of this study is to report regional EMS census impacts during an active cyber-attack on a neighboring HDO. We performed a retrospective analysis of the daily combined EMS transport census of two large urban academic EDs in San Diego, CA during the first week of a ransomware cyber-attack on a nearby multi-hospital HDO (May 2nd - 8th 2021). We then compared the mean to the previous 4 weeks. A one-way analysis of variance (ANOVA) and Tukey test were used to compare EMS transport numbers by week. The mean combined daily EMS census for weeks 1 - 4 (no cyber-attack) were: week 1 (April 4th – 10th) – 69 (SD 10), week 2 (April 11th – 17th) – 68 (SD 5), week 3 (April 18th – 24th) – 71 (SD 7), and week 4 (April 25th – May 1st) – 75 (SD 9). For week 5 (week of the cyber-attack) the mean was 116 (SD 24). There was a statistically significant higher EMS census during the cyber-attack when compared to the 4 weeks prior (Table 1), with most days experiencing double the normal volume (Range 78 -144). This study reports a significant increase in EMS ambulance arrivals at two EDs in proximity to a multi-hospital HDO under active cyber-attack. This result suggests cyber-attacks can have significant regional impacts on EMS volumes, and therefore, cyber disaster planning should take into consideration potentially large diversions of patients to other facilities via EMS.

Early Impacts of the COVID-19 Pandemic on Telehealth Patterns in Primary Care, Mental Health, and Specialty Care Facilities in Texas.

Since the onset of the coronavirus disease 2019 (COVID-19) pandemic, many US clinics have shifted some or all of their practice from in-person to virtual visits. In this study, we assessed the use of telehealth among primary care and specialty clinics, by targeting healthcare administrators via multiple channels. Using an online survey, we assessed the use of, barriers to, and reimbursement for telehealth. Respondents included clinic administrators (chief executive officers, vice presidents, directors, and senior-level managers). A total of 85 complete responses were recorded, 79% of which represented solo or group practices and 63% reported a daily patient census >50. The proportion of clinics that delivered ≥50% of their consults using telehealth increased from 16% in March to 42% in April, 35% in May, and 30% in June. Clinics identified problems with telehealth reimbursement; although 63% of clinics reported that ≥75% of their telehealth consults were reimbursed, only 51% indicated that ≥75% of their telehealth visits were reimbursed at par with in-person office visits. Sixty-five percent of clinics reported having basic or foundational telehealth services, whereas only 9% of clinics reported advanced telehealth maturity. Value-based care participating clinics were more likely to report advanced telehealth services (27%), compared with non-value-based care clinics (3%). These findings highlight the adaptability of clinics to quickly transition and adopt telehealth. Uncertainty about reimbursement and policy changes may make the shift temporal, however.

Effect of Weather on Frequency of Vaso-Occlusive Crisis in Children With Sickle Cell Disease.

IntroductionSickle cell disease (SCD) is characterized by acute vaso-occlusive crisis (VOC) often manifested as painful episodes. Environmental factors are known to play a role in the frequency and severity of VOC.MethodsThe aim of this study is to analyze the relationship between weather changes and VOC in children with SCD. Data on daily temperature, humidity, and wind speed in Brooklyn, New York was collected over one year. Daily census data of children < 20 years of age with SCD presenting with VOC during the study period was retrieved from the Health Information Systems database. Data was analyzed to determine correlations of daily temperature, humidity, and wind speed with the number of VOCs using Pearson correlation co-efficient and time-series statistics.ResultsThe total number of episodes of VOC was 344, with 218 outpatients and 126 inpatients. Total episodes of VOC peaked during January (n=44), while they were lowest in July (n=16). We observed a negative correlation of VOC with temperature (r= -0.05, p=0.04) and no correlation with humidity (r=0.01, p=0.85) was noted. Analysis of wind speed showed a negative correlation with VOC which is not significant.ConclusionNo significant correlation was found between changes in humidity or wind speed and VOC. As this study was performed in an urban environment with extreme weather changes, results may be different in other geographic areas.

Multidisciplinary Approach for a Phase II Pediatric Pandemic Recovery Plan

<h3>Background Information</h3> Phoenix Children's Hospital (PCH) pediatric Post-Anesthesia Care Unit (PACU) is comprised of 16 bays, 4 being isolation rooms. This PACU area serves 10 OR/Endoscopy rooms. The daily census average is 26 patients with a range of acuity. The traditional model was to recover patients in Phase I and Phase II in the same area. The back log of cases from the COVID pandemic presented a challenge where we were seeing an increase in the daily census. Historically we have had challenges when the daily surgical patient census was more than 35 patients. Our multiple rapid, high turnover cases along with a lack of space in PACU, caused delays and a decrease in number of cases performed each day and dissatisfaction among surgeons, staff, and families. <h3>Objectives of Project</h3> Goal was to increase efficiency by freeing up space in the PACU department, create Phase II recovery with cross-trained Acute Care Nurses, maintain a revenue stream, and improve physician, staff, patient and family satisfaction. <h3>Process of Implementation</h3> Utilizing ASPAN's Practice Recommendation and American Society of Anesthesiologists Standards for Post-anesthesia Care, we developed criteria that identified patients who met criteria for transfer to Phase II supported by the Aldrete Scoring System. Through collaboration with nursing leaders, we cross-trained Acute Care nurses to Phase II. Leadership identified hours of Phase II operation, which patients we would send to Phase II, and developed a plan to support the Phase II staff. Department leadership reviewed the schedule one week in advance to determine the most appropriate days for Phase II. <h3>Statement of Successful Practice</h3> Successfully able to accommodate more ENT patients on a daily basis, increase efficiency, prevent delays related to PACU saturation. <h3>Implications for Advancing the Practice of Perianesthesia Nursing</h3> Using resources from multiple areas, AORN/ASPAN, perianesthesia nursing can increase productivity with this practice, by identifying patients that are appropriate to transfer to Phase II. Patient families can be with children earlier. It will decrease the RN's divided attention with a mix of patients and supports the mission of nursing as life-long learners, and improved PACU RN's efficiency with appropriately assessing the Aldrete scoring system.

Are Surgeons Enough? The Relationship between Increasing Surgical Demand and Access to Surgery in a Resource-Limited Environment

IntroductionThe relationship between increasing surgical demand and access to operative intervention remains unclear in delivering general surgical care in resource-limited settings, where demand often exceeds capacity. We sought to characterize the association between general surgery patient volume and operative intervention at a tertiary hospital in Malawi, which has an adequate surgical workforce. MethodsWe analyzed patients admitted to Kamuzu Central Hospital Lilongwe, Malawi, with a general surgery complaint from 2018-2020. We examined the relationship between the census at the time of admission, the use of operative intervention, and the time to operative intervention. The patient census was defined as low (≤30 patients), medium (31-49 patients), and high (≥50 patients), based on historical patterns. Results2,701 patients were included. The mean daily census was 46 patients (SD 10). For the medium and high census, the adjusted risk ratio of undergoing surgery was 0.86 (95% CI 0.78, 0.95) and 0.81 (95% CI 0.73, 0.90), respectively, adjusted for admission diagnosis. For patients requiring urgent abdominal exploration, at a census of 25, the adjusted mean time to operation was 0.8 days (95% CI 0.1, 1.5) compared to 2.8 days (95% CI 2.1, 3.5) at a census of 65 patients. ConclusionsDespite an adequate surgical workforce, an increasing mean daily census significantly reduced the use of operative intervention and increased time to operation for patients who needed urgent abdominal exploration. Additional improvements in the surgical ecosystem beyond surgeons are necessary to improve surgical access.

Analysis of pediatric emergency department patient volume trends during the COVID-19 pandemic.

During the early period of the COVID-19 pandemic there was a substantial decrease in pediatric emergency department (PED) visitation. The intent of this study is to report PED utilization during the COVID-19 pandemic in an urban pediatric referral center located close to the epicenter in the northeastern US.A retrospective analysis of medical records of patients visiting the PED at Robert Wood Johnson University Hospital (RWJUH) was performed. Data included: daily census, admission rate, Emergency Severity Index, and ICD-10 diagnosis codes for the period of February through July, 2018 to 2020.By the week of March 26th, visits had decreased by 70% compared to the average of the previous 2 years. This census nadir lasted for 6 weeks. At 5 weeks postnadir the average daily census recovered to levels 40% lower than prior year norms and remained at that level during subsequent months. The greatest decreases were seen in low-acuity visits. Visits for behavioral health and fractures decreased by approximately 50% and 70%, respectively, but recovered to prior year norms by June and July of 2020. Visits for asthma exacerbation decreased by as much as 87% and remained at record lows for the remainder of the study period.A substantial and persistent decrease in PED visitation was experienced during the COVID-19 pandemic. Whereas visits for behavioral health and fractures have recovered to prior year norms, visits for asthma exacerbation remain at record lows. Further research is needed to ascertain the causes of these changes, including patient perceptions of the PED.