Nonemergent Visits Research Articles

Obstacles and Challenges Affecting Quality Indicators in a Complex Tertiary Emergency Center.

Hospital performance is significantly affected by external factors (political and economic) rather than internal factors (effectiveness and efficiency). Emergency department (ED) overcrowding is a significant issue for emergency care services globally, characterized by a rising number of visits and persistent unsolved issues, resulting in increased challenges faced by ED staff and decreased patient satisfaction. This study aimed to explore the obstacles and challenges that cause variation in ED quality indicators (QIs) based on five domains: infrastructure, population, workflow, workforce, and administration. A tertiary emergency center in Saudi Arabia administered a questionnaire with standardized measures to 180 nurses, using a cross-sectional descriptive design. Most nurses (75.5%) believed that crowded waiting rooms in the ED were the most influential factor affecting QIs. Many other challenges were identified, including bed capacity, triage area/workflow, increased volume during peak periods, demand for nonemergency visits, staff and shortages. Significant differences in nurses' responses were found on the basis of education level (for infrastructure only, p = 0.004), specialty (for nursing administration only, p = 0.052), and ED experience (for all variables, p = 0.008-0.039). The analysis uncovered various critical aspects of infrastructure, workflow, population, workforce, and nursing administration that have a major effect on patient flow in the ED. Comprehending these aspects will greatly affect the quality measures of ED performance and assist policymakers in formulating strategic plans to enhance ED performance. Therefore, successful implementation and optimization of ED resources depend greatly on considering the right decision variables and resource restrictions.

Public Preferences for Surgeon Gender in Saudi Arabia: A Cross-Sectional Analysis.

Gender equity in healthcare ensures equal access to services and resources for all individuals, regardless of gender. Studies show that patients' gender influences their healthcare experiences and decisions, and societal gender preferences impact surgeon selection. Therefore, the objective of this study was to address the surgeons' gender preferences among Saudi Arabia's population. This study used a cross-sectional research design and survey methodology to gather data from a representative sample of adults aged 18 and older from the general population in Saudi Arabia. This study used SPSS version 26 for statistical data entry and analysis, employing descriptive and inferential statistics, frequency distributions, descriptive statistics, and multivariate analysis using multiple logistic regression for variables significantly associated with population gender in univariate analysis. This study involved 2085 participants, with 51.2% aged 18-25, 18.4% aged 26-35, 16.7% aged 36-45, and 13.8% aged 45 and above. The majority were Saudi Arabian, with a majority holding a university degree. The majority worked in the healthcare sector, while the remaining 29.7% were unemployed. This study found that there were significant gender preferences among survey respondents for different types of surgical procedures. Male participants preferred male surgeons for routine non-emergency visits and sensitive obstetric, genital, sexual, and minor procedures (p < 0.001). Female participants, on the other hand, had no preference for emergency surgeries and major surgical procedures (p < 0.001). This study found that participants were more likely to prefer female surgeons for regular non-emergency visits to the surgery clinic (p < 0.001; aOR = 2.344). Additionally, participants had a high preference for female surgeons for sensitive cases (p < 0.001; aOR = 7.064) and minor surgical procedures (p < 0.001; aOR = 2.489). This study underscores the significance of cognizance and the incorporation of a patient's gender preferences when selecting surgical procedures, thus fostering an environment that is more accommodating and focused on the patient.

Use of Recommended Neurodiagnostic Evaluation Among Patients With Drug-Resistant Epilepsy

Interdisciplinary practice parameters recommend that patients with drug-resistant epilepsy (DRE) undergo comprehensive neurodiagnostic evaluation, including presurgical assessment. Reporting from specialized centers suggests long delays to referral and underuse of surgery; however, longitudinal data are limited to characterize neurodiagnostic evaluation among patients with DRE in more diverse US settings and populations. To examine the rate and factors associated with neurodiagnostic studies and comprehensive evaluation among patients with DRE within 3 US cohorts. A retrospective cross-sectional study was conducted using the Observational Medical Outcomes Partnership Common Data Model including US multistate Medicaid data, commercial claims data, and Columbia University Medical Center (CUMC) electronic health record data. Patients meeting a validated computable phenotype algorithm for DRE between January 1, 2015, and April 1, 2020, were included. No eligible participants were excluded. Demographic and clinical variables were queried. The proportion of patients receiving a composite proxy for comprehensive neurodiagnostic evaluation, including (1) magnetic resonance or other advanced brain imaging, (2) video electroencephalography, and (3) neuropsychological evaluation within 2 years of meeting the inclusion criteria. A total of 33 542 patients with DRE were included in the Medicaid cohort, 22 496 in the commercial insurance cohort, and 2741 in the CUMC database. A total of 31 516 patients (53.6%) were women. The proportion of patients meeting the comprehensive evaluation main outcome in the Medicaid cohort was 4.5% (n = 1520); in the commercial insurance cohort, 8.0% (n = 1796); and in the CUMC cohort, 14.3% (n = 393). Video electroencephalography (24.9% Medicaid, 28.4% commercial, 63.2% CUMC) and magnetic resonance imaging of the brain (35.6% Medicaid, 43.4% commercial, 52.6% CUMC) were performed more regularly than neuropsychological evaluation (13.0% Medicaid, 16.6% commercial, 19.2% CUMC) or advanced imaging (3.2% Medicaid, 5.4% commercial, 13.1% CUMC). Factors independently associated with greater odds of evaluation across all 3 data sets included the number of inpatient and outpatient nonemergency epilepsy visits and focal rather than generalized epilepsy. The findings of this study suggest there is a gap in the use of diagnostic studies to evaluate patients with DRE. Care setting, insurance type, frequency of nonemergency visits, and epilepsy type are all associated with evaluation. A common data model can be used to measure adherence with best practices across a variety of observational data sources.

Epidemiology of Non-Emergent Cancer-Related Emergency Department Visits in Korea between 2016 and 2020.

As people living with cancer increase in the aging society, cancer-related emergency department (ED) visits are also increasing. This study aimed to investigate the epidemiologic characteristics of non-emergent cancer-related ED visits using a nationwide ED database. A cross-sectional study was conducted using the National Emergency Department Information System (NEDIS) database. All cancer-related ED visits between 2016 and 2020 were included. The study outcome was non-emergent ED visits, defined as patients triaged into non-emergent condition at both the time of arrival at ED and discharge from ED and were discharged without hospitalization. Among 1185871 cancer-related ED visits over 5 years, 19.0% (n=225491) were classified as non-emergent visits. While abdominal pain and fever are the top chief complaints in both emergent and non-emergent visits, non-emergent visits had high proportions of abdomen distension (4.8%), ascite (2.4%), and pain in lower limb (2.0%) compared with emergent visits. The cancer types with a high proportion of non-emergent visits were thyroid (32.4%) and prostate cancer (30.4%). Adults compared with children or older adults, female, medical aid insurance, urban/rural ED, direct-in compared with transfer-in, and weekend visit were associated with high odds for non-emergent visits. Approximately 20% of cancer-related ED visits may be potentially non-emergent. A significant number of non-emergent patients visited the ED due to cancer-related symptoms. To improve the quality of care for people living with cancer, the expansion of supportive care resources besides of ED, including active symptom control, is necessary.

The impact of COVID-19 pandemic on treatment adherence, access to care, and disease control in diabetic patients in Jordan, an online survey

This study aimed to assess the impact of the COVID-19 pandemic on treatment adherence, access to care, and disease control in diabetic patients. Methods: An online survey design was utilized to collect data from a convenient sample of diabetic patients in Jordan. The developed survey collected data on sociodemographic characteristics, COVID-19 impact on access to care in diabetic patients, COVID-19 impact on diabetic patients’ adherence to their medications, and patients’ level of knowledge of COVID-19 impact on their health. Results: Nearly three-quarters of the participants reported that they avoided going to the physician for regular non-emergent visits during the outbreak, and 69.5% stated that their access to insulin, other diabetic medications, and supplies was not affected by the pandemic situation. The majority of patients reported that COVID-19 did not affect their adherence to their medications. Almost 42% reported that COVID-19 has negatively affected their physical activity level and their healthy lifestyle habits, while 60% stated that it did not affect their diet. Additionally, 56.6% reported that they have noticed less control in their blood glucose readings. Conclusion: The findings may reflect that the patients high adherence rate to their medications and that they avoided going to the doctor’s clinic to avoid contracting the virus.

Community healthcare appointments as an alternative to emergency department assessment: an exploration of family acceptability and preferences.

Pediatric emergency departments are overcrowded, in part due to many non-emergent visits. We aimed to assess the proportion of parents interested in leaving the pediatric emergency department (ED) prior to physician assessment if they could be offered a scheduled community healthcare appointment. We explored differences in care children received in the ED stratified by interest in a community healthcare appointment and parents' reasons when they were not interested. We conducted a 14-item survey within the pediatric ED at a Canadian tertiary care teaching hospital to assess parents' interest if a program offered community healthcare appointments and we determined preferred appointment characteristics. All parents presenting with children triaged as CTAS 2-5 who met eligibility criteria were approached by a research assistant prior to physician assessment. Surveys were paired with the medical chart outlining the care received. Descriptive statistics and a regression model were used to describe characteristics of families and care received among those who were and were not interested in a community healthcare appointment. In total, 403 surveys were completed. Overall, 236 participants (58.6%; 95% CI 53.8-63.4) were interested in a community healthcare appointment. In general, parents who were interested in a community healthcare appointment were younger and presented with younger children compared to those who were not interested. Among those interested, there was a preference to have the appointment with a pediatrician or family physician, timely access to an appointment, and appointments scheduled outside of regular business hours. Our study provides evidence that there is interest in an alternative care access model positioned to reduce pediatric ED congestion. We found that parents would be interested in leaving the pediatric ED in favor of a community healthcare appointment, provided it was with a physician and available in a timely manner.

Reducing Nonemergent Visits to the Emergency Department in a Veterans Affairs Multistate System

Study ObjectiveThe purpose of this quality improvement study was to reduce nonemergent visits to the emergency department attendance within a multistate Veterans Health Affairs network. MethodsTelephone triage protocols were developed and implemented for registered nurse staff to triage selected calls to a same-day telephonic or video virtual visit with a provider (physician or nurse practitioner). Calls, registered nurse triage dispositions, and provider visit dispositions were tracked for 3 months. ResultsThere were 1606 calls referred by registered nurses for provider visits. Of these, 192 were initially triaged as emergency department dispositions. Of these, 57.3% of calls that would have been referred to the emergency department were resolved via the virtual visit. Thirty-eight percent fewer calls were referred to the emergency department following licensed independent provider visit compared to the registered nurse triage. ConclusionTelephone triage services augmented by virtual provider visits may reduce emergency department disposition rates, resulting in fewer nonemergent patient presentations to the emergency department and reducing unnecessary emergency department overcrowding. Reducing nonemergent attendance to emergency departments can improve outcomes for patients with emergent dispositions.

Non-emergent care visits in a turkish tertiary care emergency department after 2008 health policy changes: review and analysis

BackgroundThe Turkish government liberalized national healthcare policies in 2008 enabling Turkish citizens to seek general care in hospital emergency departments (ED). The number of ED visits has exceeded the total population every year for the last ten years. To explain this phenomenon and to identify trends and risk factors for non-emergent visits, we retrospectively reviewed the ED records of a tertiary hospital and the Turkish Ministry of Health bulletin.MethodsThis retrospective record-based study was conducted at a tertiary hospital in Samsun province of Turkey. A total of 87,528 records of adult patients who visited the ED between January 1 and December 31, 2017, were included in this study. We evaluated the pattern of ED use for non-emergent patients by age, gender, nationality, time of visit, means of arrival, ICD (International Classification of Diseases) diagnostic codes, triage codes, number of repeated and out-of-hours visits. We used the Turkish Ministry of Health statistics bulletins to compare the number of ED visits across the country by year.ResultsThe non-emergent visit rate in ED was found 9.9%. The rate of non-emergent ED visits was significantly higher in the 18-44 age group, in the female gender, and in those who arrived at the ED without an ambulance. The number of non-emergent visits was very similar between weekends and weekdays but was significantly higher in working hours on weekdays than out-of-hours (p<0.001). The most frequent diagnostic code was “Pain, unspecified” (R52) and the rate of repeat visits was 14.8% of non-emergent ED visits. According to binary logistic analysis, non-emergency visits were associated with 18-44 age group (OR = 2.75), female gender (OR = 1.11) and non-ambulance transportation (OR = 9.86).ConclusionsOur results showed that the 18-44 age group and female gender seek care in the ED for non-emergent problems more than the other parts of the population. The numbers of ED visits in the last decade continued to increase regardless of population growth. The health policy changes may have facilitated access to rapid physical and laboratory examination but also an exacerbation of the free-rider problem in ED services.

Impact on an Urgent Care Clinic of a New Freestanding Emergency Department in a Resource-Scarce Area.

Background: Convenience clinics—such as urgent care centers (UCCs), retail clinics, and freestanding emergency departments (FSEDs)—where patients can receive treatment for a variety of medical conditions have increased in number and popularity. We quantify the impact an FSED had on UCC visits in an underserved area in North Baton Rouge, Louisiana.Methods: All FSED and UCC visits were abstracted from 2015 to 2020. Visits were classified using International Classification of Diseases, Tenth Revision codes. We used a time series analysis to evaluate the association of nonemergent and emergent visits to the UCC after the opening of the FSED. Visits were also aggregated at the census block group (neighborhood) level. Demographic characteristics and the neighborhood Area Deprivation Index were used to compare UCC utilization before and after the FSED opened and to describe the visits to the UCC and the FSED.Results: We found a difference in the demographic composition of patients presenting to the UCC after the FSED opened. Emergent visits decreased at the UCC, but nonemergent visits did not change after the FSED opened. The majority of visits to the FSED were nonemergent, and the proportion of nonemergent visits to the FSED increased during the hours that the UCC was closed. The majority of visits to the FSED came from neighborhoods with a high Area Deprivation Index.Conclusion: The opening of an FSED resulted in a reduction of emergent visits to the UCC without impacting the number of nonemergent visits. The opening of an FSED in a poor, healthcare-resource-scarce area resulted in significantly more patients from deprived neighborhoods being treated at the FSED and UCC.

Impact of the COVID-19 pandemic on the dental service: A narrative review.

This article describes what changes have had to be made to the functioning of dental practices due to the COVID-19 pandemic and how the pandemic has affected dental staff. Dentists are at high risk of infection and this is associated with fear, including the fear of being infected by their co-workers and patients, or that they will infect their families. The introduced changes include increased protective measures, and the introduction of additional questionnaires and procedures. In dental practices, the use of personal protective equipment (PPE) has been increased and changes have been introduced in the functioning of surgeries in accordance with the recommendations of dental associations and governments. The aforementioned changes have significantly reduced the comfort of dental work, increased the costs of treatment and reduced the availability of dental treatment. A novel solution to this situation has been the implementation of teledentistry, which helps to reduce the number of non-emergency visits. This process involves the remote facilitation of dental treatment by means of technology (i.e., phone or the Internet) without direct contact with the patient. Due to the restrictions implemented during the pandemic, many universities have introduced remote or hybrid teaching for both didactic and practical classes.

Ocular related emergencies in Spain during the COVID-19 pandemic, a multicenter study

PurposeTo evaluate ophthalmological emergencies (OE) during the COVID-19 pandemic comparing them with the same period of the previous year.MethodsRetrospective observational study of all OE visits in four tertiary hospitals in Spain comparing data from March 16th to April 30th, 2020 (COVID-19 period) and the same period of 2019 (pre-COVID-19 period). Severity of the conditions was assessed following Channa et al. publication. Data on demographics, diagnosis and treatments were collected from Electronic Medical Records.ResultsDuring lockdown, OE significantly declined by 75.18%, from 7,730 registered in the pre-COVID-19 period to 1,928 attended during the COVID-19 period (p < 0.001). In 2019, 23.86% of visits were classified as emergent, 59.50% as non-emergent, and 16.65% could not be determined. In 2020, the percentage of emergent visits increased up to 29.77%, non-emergent visits significantly decreased to 52.92% (p < 0.001), and 17.31% of the visits were classified as “could not determine”. During the pandemic, people aged between 45 and 65 years old represented the largest attending group (37.89%), compared to 2019, where patients over 65 years were the majority (39.80%). In 2019, most frequent diagnosis was unspecified acute conjunctivitis (11.59%), followed by vitreous degeneration (6.47%), and punctate keratitis (5.86%). During the COVID-19 period, vitreous degeneration was the first cause for consultation (9.28%), followed by unspecified acute conjunctivitis (5.63%) and punctate keratitis (5.85%).ConclusionsOE visits dropped significantly during the pandemic in Spain (75.18%), although more than half were classified as non-urgent conditions, indicating a lack of understanding of the really emergent ocular pathologies among population.

Impact of COVID-19 on Dental Care during a National Lockdown: A Retrospective Observational Study.

The coronavirus disease 19 (COVID-19) has challenged dental health professions. This study analyzes its impact on urgent dental care in the Department of Conservative Dentistry and Periodontology, University Hospital Munich and Bavaria, Germany. Patient numbers without and with positive/suspected COVID-19 infection, their reasons for attendance, and treatments were retrospectively recorded (February–July 2020) and linked to local COVID-19 infection numbers, control measures, and numbers/reasons for closures of private dental practices in Bavaria, Germany. Patient numbers decreased within the urgent care unit and the private dental practices followed by a complete recovery by the end of July. While non-emergency visits dropped to almost zero during the first lockdown, pain-related treatments were administered invariably also in patients with positive/suspected COVID-19 infections. Reasons for practice closures were lack of personal protective equipment (PPE), lack of employees, staff’s increased health risks, and infected staff, which accounted for 0.72% (3.6% closures in total). Pain-driven urgent dental care remains a constant necessity even in times of high infection risk, and measures established at the beginning of the pandemic seem to have provided a safe environment for patients as well as oral health care providers. PPE storage is important to ensure patients’ treatment under high-risk conditions, and its storage and provision by regulatory units might guarantee a stable and safe oral health care system in the future.

The impact of the COVID-19 pandemic and governor mandated stay at home order on emergency department super utilizers.

BackgroundDespite the trend of rising Emergency Department (ED) visits over the past decade, researchers have observed drastic declines in number of ED visits due to the COVID-19 pandemic. The purpose of the current study was to examine the impact of the COVID-19 pandemic and governor mandated Stay at Home Order on ED super utilizers.MethodsThis was a retrospective chart review of patients presenting to the 12 emergency departments of the Franciscan Mission of Our Lady Hospital System in Louisiana between January 1, 2018 and December 31, 2020. Patients who were 18 years of age or older and had four ED visits within a one-year period (2018, 2019, or 2020) were classified as super-utilizers. We examined number and category of visits for the baseline period (January 2018 – March 2020), the governor's Stay at Home Order, and the subsequent Reopening Phases through December 31, 2020.ResultsThe number of visits by super utilizers decreased by over 16% when the Stay at Home Order was issued. The average number of visits per week rose from 1010.63 during the Stay at Home Order to 1198.09 after the Stay at Home Order was lifted, but they did not return to Pre-COVID levels of approximately 1400 visits per week in 2018 and 2019. When categories of visits were examined, this trend was found for emergent visits (p < 0.001) and visits related to injuries (p < 0.001). Non-emergent visits declined during the Stay at Home Order compared to the baseline period (p < 0.001), and did not increase significantly during reopening compared to the Stay at Home Order (p = 0.87). There were no changes in number of visits for psychiatric purposes, alcohol use, or drug use during the pandemic.ConclusionsSignificant declines in emergent visits raise concerns that individuals who needed ED treatment did not seek it due to COVID-19. However, the finding that super utilizers with non-emergent visits continued to visit the ED less after the Stay at Home Order was lifted raises questions for future research that may inform policy and interventions for inappropriate ED use.

Pediatric emergency department utilization during the COVID-19 pandemic in New York City.

ObjectivesThis study describes the utilization of a pediatric emergency department (ED) during the early months of the COVID-19 pandemic in the initial U.S. epicenter, including the impact on visit acuity and incidences of common diagnoses.Study DesignWe performed an observational retrospective review of patients younger than 18 years old seen in a New York City pediatric ED from March 7th to May 6th 2020, and during the same time period in 2018 and 2019. Demographics, visit details, diagnoses, and dispositions were compared. Validated algorithms were utilized to create practical diagnosis groupings and to determine the probability of a visit requiring emergent evaluation.ResultsED visits during the pandemic decreased by 56% to an average daily census of 67 patients, from an anticipated 152. Admission rates rose from 13.3% to 17.4% (p<0.001), and the proportion of triage Emergency Severity Index level 1 and 2 patients increased by 23.7% (p<0.001). Non-emergent visits dropped from 32.3% to 27.5% (p<0.001). Several common, often low-acuity diagnoses saw disproportionate reductions in visits including headache, chest pain, and minor injuries. Concerningly, visits for suicidal ideation, suicide attempt, or self-harm increased by 100% (p<0.001) and visits for evaluating abuse or neglect decreased by 89% (p=0.01).ConclusionsPediatric ED utilization substantially deceased during the early months of the COVID-19 pandemic in New York City, but left relatively higher patient acuity. Healthcare systems in early epicenters must also prepare for the disproportionate impact a pandemic has on the most vulnerable pediatric patients, particularly those at risk for self-harm or abuse.

Impact of the Coronavirus Pandemic on Emergency Department (ED) Visits for Ob/Gyn Care

The COVID-19 pandemic has disrupted currently held norms and best practices for women who require evaluations and interventions for Obstetrics and gynecology (Ob/Gyn) emergency care. The resulting paradigm shifts have demonstrated a reassessment of how Ob/Gyn emergency care is provided in an acute setting while avoiding potential short and long-term harm. The objective of this study is to retrospectively evaluate if patients self-selected to avoid Emergency Department (ED) visits for perceived minor complaints and if postponing such care increased morbidity. Patients accessing Ob/Gyn ED care during the Covid-19 "lockdown period" (group A) in New York State were compared with those during a similar time frame in 2019 (group B). Primary outcomes were the number of ED visits and admission diagnoses. Secondary outcomes were the number of surgeries and clinical acuity on presentation. There was a 72% reduction in the total number of ED visits in group A compared to group B. Although the majority of the visits were for abdominal pain and vaginal bleeding in both groups, among patients who presented with vaginal bleeding in group A, a significantly higher number was due to early pregnancy loss rather than non-pregnancy-related uterine bleeding. The number of visits for non-emergency visits such as vulvovaginitis and contraceptive management was significantly lower and absent respectively. There were 61.5% fewer cases requiring emergency surgery in group A, however, the case acuity remained high with many patients being clinically unstable at presentation. There was a nonsignificant trend of an increased number of surgeries for ectopic pregnancy and pregnancy loss in group A compared to group B. Non-emergency surgeries, and visits for pain control, wound infections or ileus were absent in group A. We conclude that the decline in the ED visits and total number of emergency surgeries during the “lockdown period “were secondary to patients’ choices. This decrease was more pronounced for minor indications; however, many patients with serious conditions had delayed ED visits until they were clinically unstable. Therefore a reassessment of how patients access Ob/Gyn care via ED is indicated, with the goal being to avoid visits for minor indications while preventing potential life-threatening complications.

NYU-EDA in modelling the effect of COVID-19 on patient volumes in a Finnish emergency department

BackgroundEmergency departments (EDs) worldwide have been in the epicentre of the novel coronavirus disease (COVID-19). However, the impact of the pandemic and national emergency measures on the number of non-COVID-19 presentations and the assessed acuity of those presentations remain uncertain.MethodsWe acquired a retrospective cohort containing all ED visits in a Finnish secondary care hospital during years 2018, 2019 and 2020. We compared the number of presentations in 2020 during the national state of emergency, i.e. from March 16 to June 11, with numbers from 2018 and 2019. Presentations were stratified using localized New York University Emergency Department Algorithm (NYU-EDA) to evaluate changes in presentations with different acuity levels.ResultsA total of 27,526 presentations were observed. Compared to previous two years, total daily presentations were reduced by 23% (from 113 to 87, p < .001). In NYU-EDA classes, Non-Emergent visits were reduced the most by 42% (from 18 to 10, p < .001). Emergent presentations were reduced by 19 to 28% depending on the subgroup (p < .001). Number of injuries were reduced by 25% (from 27 to 20, p < .001). The NYU-EDA distribution changed statistically significantly with 4% point reduction in Non-Emergent visits (from 16 to 12%, p < .001) and 0.9% point increase in Alcohol-related visits (from 1.6 to 2.5%, p < .001).ConclusionsWe observed a significant reduction in total ED visits in the course of national state of emergency. Presentations were reduced in most of the NYU-EDA groups irrespective of the assessed acuity. A compensatory increase in presentations was not observed in the course of the 3 month lockdown. This implies either reduction in overall morbidity caused by decreased societal activity or widespread unwillingness to seek required medical advice.

Abstract 15660: Impact of Telemedicine on Pediatric Cardiac Center’s Ambulatory Response to the 2019 Novel Coronavirus Disease (covid-19) Pandemic

Background: The 2019 novel coronavirus disease (COVID-19) pandemic puts cardiology patients at high risk for worsening of their underlying disease due to a decrease in non-emergent outpatient visits and social distancing concerns. Our aim was to assess the impact of telemedicine on ambulatory cardiology. Our hypothesis was that telemedicine would bridge the drop in ambulatory visits thus allowing surveillance visits to continue. Methods: Retrospective study from 3/2 to 6/12/2020 utilizing an administrative ambulatory database. Weekly telemedicine and in-person visits were extracted from EMR schedules. A telemedicine orientation session and individualized in-service sessions were provided to all cardiology staff by an expert in telemedicine. Logistics of scheduling, consenting, conducting the visit, documenting and billing were reviewed. To maximize physical distancing, in-person visits were relocated to regional outpatient centers. Prior to COVID-19, 37 cardiologists and 2 nurse practitioners conducted an average of 350 ambulatory visits/week. Results: The number of providers conducting telemedicine visits increased from 3 (8%) pre-COVID-19 to 31 (79%) during the pandemic. Compared to pre-COVID average, the median (IQR) weekly total ambulatory visits during the pandemic was 62% (57-90%). During the COVID-19 pandemic, the median frequency of telemedicine visits was 18% (11-32%). (Figure 1) Conclusion: Ambulatory in-person cardiology visits decreased during the COVID-19 pandemic; however telemedicine visits partially compensated for this drop. At the height of stay-at-home orders, cardiology in-person outpatient visits decreased to 25%, but rapidly increased back up to 88% the usual in-person visit volume. Future study is needed to assess the impact on patient outcomes, family satisfaction, cost-effectiveness and revenue of telemedicine visits during the COVID-19 pandemic.

Utilization trends of an ophthalmology-specific emergency department: the Massachusetts Eye and Ear experience.

To describe the utilization trends of a dedicated ophthalmology emergency department (ED) in Boston, Massachusetts. The medical records of 500 randomly selected patients who presented at the Massachusetts Eye and Ear (MEE) Emergency Department (ED) from January 2015 to March 2016 were reviewed retrospectively. Data were analyzed using the Pearson χ2 test and multiple logistic regression. The primary study outcome measure was whether a patient's visit was emergent or nonemergent. Emergent or nonemergent conditions were classified based on the diagnosis and treatment required at follow-up appointments. Nonemergent diagnoses were classified as conditions that could have been seen as an outpatient without negative consequences for vision. Of the 500 cases, 252 were males and 248 were females. The median age was 45 years (range, 2-101 years). The most common diagnoses were posterior vitreous detachment (8.6%), corneal abrasion (8.4%), dry eye syndrome (7%), and viral conjunctivitis (5.4%). Of the total, 92.6% of patients originated from within Massachusetts. The majority of patients were self-referred (78.6%) or referred from another hospital (12.8%). Nonemergent visits accounted for 49.4% of patients seen. Compared to patients who presented with duration of symptoms for ≥1 week, patients who presented with symptoms of <1 week were more likely to present with an emergent condition (8.8% vs 41.8%). Referrals from an outside ophthalmologist or hospital were predictive of emergent patient visits (OR, resp., 1.971 [95% CI, 0.478-3.462; P = 0.01]; 1.040 [95% CI, 0.462-1.616; P < 0.001]). In our study, nonemergent patient visits comprised nearly half of all ophthalmology ED visits. Emergent visits were associated with acute symptoms and referrals from outside healthcare providers.

Is Telemedicine Suited for Lower Extremity Pathologies? An Analysis of Non-Urgent Follow-Up in a Foot and Ankle Practice

Category:Other; Ankle; Hindfoot; Midfoot/ForefootIntroduction/Purpose:A lack of access to care is predictably associated with negative outcomes in foot and ankle surgery. Despite recent advances in telecommunication technologies, the field of orthopaedics has been slow to adopt these resources in offsetting barriers to care. The COVID-19 pandemic has forced departments to change their clinical approach, lending unprecedented opportunity to better understand how telehealth may bridge this care gap in foot and ankle practices. The purpose of this study was to assess patient-reported outcomes of telemedicine encounters, including comfort and patient satisfaction. Our hypothesis was that patients would be significantly less satisfied with telemedicine when compared to in-office appointments for all non-emergent visit types.Methods:Retrospective analysis of patients seen via telemedicine between April 13, 2020, to June 19, 2020, by one surgeon in the Emory Orthopedics Foot and Ankle department was conducted. Patients were contacted by one of the study authors via telephone to complete a questionnaire; satisfaction and other visit characteristics were assessed with a modified Likert scale from 1 to 5. Patients were designated as either ‘New’ or ‘Established’ based on whether or not they had completed an in-office clinic visit within the last year. Anatomy and pathology of disorder were determined by chief complaint and billing code. Patient demographics were recorded, and data were analyzed using paired and independent t-tests for parametric continuous data, Fisher’s exact and chi-square tests for non-continuous data.Results:338 eligible patients were contacted via telephone, with 216 (63.9%) completing the telemedicine questionnaire. The patient cohort had an average age of 50.6 (19-84) years old and was 73.6% female (n=159). Overall mean satisfaction for telemedicine visits (4.69) was significantly lower than in-office visits (4.86) (p<0.001). In a subgroup analysis of patient satisfaction, patients seeking fracture care had significantly higher telemedicine satisfaction when compared to those receiving non-fracture care (4.90 vs. 4.64, p=0.001). Telemedicine satisfaction was also significantly greater in patients traveling more than 50 miles from their home to clinic (4.96 vs. 4.67, p<0.001). Patients with median household income less than the Georgia state median ($55,679) were more satisfied with their telemedicine visits than those with greater income, though the difference was non-significant.Conclusion:our data suggest those with significantly hindered mobility such as increased distance from clinic, lower socioeconomic status, and those seeking care for fractures had higher telemedicine satisfaction than their peers. Further study is needed to detail the precise and safe use of telemedicine in practice, but these data illuminate the high ceiling telemedicine offers in expanding patient care. Our hope is that this study aids as a supportive rationale for the continued use of telehealth visits past the period of the pandemic and encourages a more nuanced view of what visit types may be best-suited for telehealthcare

The continuing impact of COVID-19 on dermatology practice: Office workflow, economics, and future implications

The continuing impact of COVID-19 on dermatology practice: Office workflow, economics, and future implications