Non-urgent Conditions Research Articles

Prospective evaluation of the store-and-forward teledermatology service (eConsult) delivery at Townsville Hospital: A pilot study.

The shortage of dermatologists in rural and regional Australia is acutely felt in north Queensland where the population experiences a leading burden of skin cancer and tropical dermatoses. Store-and-forward teledermatology (SAFT) is recognised as a potential solution to improve accessibility of dermatology specialist care in rural communities. eConsult (a SAFT service) was piloted for the broader Townsville community in 2022. Evaluation was necessary to ensure wider implementation would meet stakeholder needs and improve patient care. To evaluate clinician perspectives and use of eConsult within the Townsville Hospital and Health service catchment over the pilot period (up to 9 months). Pre-engagement interviews with clinicians assessed their management of dermatoses and service expectations prior to eConsult usage. eConsult referrals identified case characteristics, outcomes and uptake of the service amongst clinicians. Post-engagement interviews assessed clinician perceptions and their suggestions for the service at the conclusion of the pilot period. In total, 24 and 17 clinicians participated in the pre- and post-engagement interviews respectively, and 38 referrals were submitted by clinicians. The service assisted diagnosis and management of non-urgent skin conditions for any age group. Clinicians generally had positive perceptions and appreciated timely access to local specialist advice. This study suggests a SAFT service can improve access to dermatology specialist opinion and increase management of dermatoses in primary care. Establishing sustainable teledermatology services with strong engagement from users is important for accessible care. Future research may investigate similar SAFT models involving more specialists and assess long-term cost-effectiveness.

Physician-to-Physician eConsultations to Ophthalmologists at an Academic Medical Center.

Physician-to-physician electronic consultation (eConsults) are used across specialties; however, their effectiveness in ophthalmology has not been reported. This study evaluated the feasibility and diagnostic accuracy of a physician-to-physician ophthalmology eConsult program, assessed the timeliness of in-person evaluation, and characterized the clinical questions of non-ophthalmology providers. Retrospective review of patients for whom an ophthalmology eConsult was placed to Massachusetts Eye and Ear from February 2019-August 2021. The eConsults were reviewed to identify submission-to-response time, primary diagnoses by eConsultant, and referral outcomes. The eConsults were categorized based on clinical question, urgency, and ophthalmic condition addressed. Demographic data on patients and referring providers were collected. One hundred ophthalmology eConsults were placed, and 100% were responded to by an ophthalmologist. An average of 1.6 ± 1.9 days elapsed from the time of eConsult to completion. Of the 30 patients who presented for in-person evaluation at an ophthalmology clinic, diagnostic concordance between eConsultant and in-person ophthalmologist was observed in 93% of cases (n = 28 of 30). An average of 28.9 ± 27.4 days from eConsult response to in-person follow-up was observed. The most common clinical inquiries were about appropriate triage/referral (24.4%), management (22%), and diagnosis (19.7%). All eConsults were non-urgent. The most common ophthalmic condition addressed was chalazia/hordeola (14%). Only 5% of patients presented to an emergency department for the same ophthalmic concern addressed by eConsult. Ophthalmology eConsults provide timely access to nonurgent ocular diagnosis, triage, and management and in our study seem to provide high rates of diagnostic accuracy for nonurgent ophthalmic conditions. Using ophthalmic eConsults can facilitate timely access to specialty care and reduce patient and provider burden.

CAN REFERRAL TO COMMUNITY-BASED EXERCISE PHYSIOLOGIST SERVICES REDUCE EMERGENCY DEPARTMENT BURDEN? A CHART AUDIT

INTRODUCTION & AIMS Despite the rapid growth of exercise physiology in Australia, its potential within the healthcare system remains underutilised. Healthcare system strain, characterised by increased emergency department (ED) waiting times and length-of-stay is exacerbated by preventable, non-urgent ED attendances. In 2022, musculoskeletal conditions constituted the majority of >800,000 non-urgent ED presentations. Community care and underutilised allied health services, such as exercise physiology, may offer better management options. This study aimed to examine characteristics of patients presenting to ED for musculoskeletal conditions, treatment advice provided on physical activity, and referral practices to community-based exercise physiology services. METHODS A retrospective chart audit (n=267) examined patient characteristics, referral patterns and treatment advice due to non-urgent musculoskeletal conditions at Eastern Health EDs. RESULTS Most (n=223, 84%) patients presented with conditions that had persisted for a mean (SD) duration of 9.3 (32.4) days. Conditions affecting the leg (n=92, 34%), lower back (n=59, 22%) and arm (n=44, 16%) were most common. Sharp pain was the most common descriptor of pain (n=33, 12%). Almost half (45%, n=119) had comorbid cardiovascular disease (n=59, 22%), metabolic conditions (n=31, 12%) or mental health issues (n=29, 11%). Treatment advice on physical activity was provided for 17% to patients with 12% advised to avoid physical activity (n=31, 12%) and 5% to stay active (n=12). Advice to return to (n=2, 1%) or take time off (n=47, 18%) work was provided for 19% (n=49) patients. No patients were referred to exercise physiology services. CONCLUSION Patients presenting to EDs for musculoskeletal conditions appeared suitable for referral to community-based exercise physiology services, yet no referrals were identified. Moreover, few patients received advice on whether to stay active or avoid physical activity. Strategies to increase external ED referral to exercise physiology are warranted to alleviate burden within this setting.

Implementation and impact of Fast-Track in an Emergency Department: pre-post study

Background: overcrowding and long waiting times are major problems in Emergency Departments (EDs). Fast-Track (FT) is a process developed to more effectively manage patients admitted to EDs with non-urgent conditions. The aim of the study was to evaluate the impact of the FT method regarding access in an ED. Materials and Methods: pre-post implementation study of the FT method. All patients attending the emergency department of the ASL of Barletta presenting minor emergencies with problems in the obstetric/gynaecological, ophthalmological, paediatric, otorhinolaryngological and orthopaedic areas were included. Results: of the 38,024 services performed in the ED, 1606 (4.22 %) were FT accesses. Analysing the data from the period May 2017 (pre) and calculating in minutes the waiting time from triage to discharge is 55 minutes; instead in the period May 2022 (post) it is 20 minutes. Conclusions: the FT method seems to be a useful and safe strategy to improve the management of patients admitted to emergency rooms with minor disorders.

Analyzing Non-urgent Emergency Department Visits: Patterns, Demographics, Motivations, and Triage System Awareness in Al-Qassim.

This cross-sectional descriptive study aimed to ascertain the prevalence of non-urgent cases, investigate gender and age preferences, and explore factors influencing individuals' selection of the emergency department (ED) for non-urgent cases in the Al-Qassim region of Saudi Arabia. From July 15, 2022, to December 31, 2022, a structured online questionnaire via a Google Docs survey collected data. The study sampled 425 patients from two prominent Al-Qassim healthcare institutions: Buraydah King Fahad Specialized Hospital and Buraydah Central Hospital. Encompassing patients aged 20 to 80 admitted to the ED between 8:00 and 16:00, concurrent with primary healthcare center availability, the study categorized participants by urgency using the Canadian Triage and Acuity Scale (CTAS) criteria. Data analysis employed descriptive statistics, chi-square tests, and probit regression in R version 4.3.3, with a significance level of p< 0.05 for result interpretation. In Al-Qassim in 2022, 82.4% of ED visitors sought care for non-urgent cases, while 17.6% sought care for urgent cases. No statistically significant relationship was found between age and gender and urgent ED visits. Among those with non-urgent conditions, the top reasons for bypassing primary healthcare services were slow treatment (52.7%), lack of knowledge about primary healthcare (PHC) services (33.9%), and appointment unavailability (5.5%). Evaluation of awareness of the ED triage system showed a significant difference only among patients with excellent awareness. The investigation found a higher prevalence of non-urgent cases, especially among females. Challenges in appointment booking, accessibility, and the perception of urgency were key factors leading patients to choose the emergency department over PHC centers. The study emphasized the crucial role of ED triage system awareness and the impact of satisfaction with PHC services on healthcare-seeking behavior, with younger individuals less likely to visit the ED and males more inclined at specific satisfaction levels.

Low-Acuity Pediatric Emergency Department Utilization: Caregiver Motivations.

Proper emergency department (ED) utilization is a hallmark of population health. Emergency department overcrowding due to nonurgent visits causes increased stress to healthcare staff, higher costs, and longer wait times for more urgent cases. This study sought to better understand post pandemic reasons caregivers have when bringing in their children for nonurgent visits and devise effective interventions to improve caregiver choice for non-ED care for nonurgent conditions. Surveys were conducted at an urban pediatric hospital for Emergency Severity Index (ESI) level 3 to 5 visits. A total of 602 surveys were completed with 8 being excluded from analysis. Survey responses and anonymized demographic information were collected. Responses were compared between surveys grouped by respondent age category, relation to child, child's race, insurance type, and ESI levels. Primary reasons given for nonurgent ED visits were perceived urgency (74.2%, n = 441), ED superiority to other locations (23.9%, n = 142), and referral to the ED by a third party (17.7%, n = 105). Of those who cited perceived urgency as a reason, 80.5% (n = 355) wanted to lessen their child's pain/discomfort as soon as possible, but only 13.6% said that their child was too ill to be seen anywhere else (n = 60). Demographic differences occurred in the proportions of respondents citing some of the primary and secondary reasons for bringing their child to the ED. This study highlights 3 key findings. An immediate desire for care plays a key role in caregiver decision making for low-acuity visits. There is potential socioeconomic and racial bias in where care is recommended that needs to be further explored in this region. Cross community interventions that target key reasons for seeking low-acuity care have the highest likelihood of impacting the use of the ED for low-acuity conditions.

Understanding the Diagnostic Odyssey of Women with Mayer-Rokitansky-Küster-Hauser (MRKH) Syndrome in Denmark: A Qualitative Interview Study

The diagnosis of Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome is often a lengthy process that typically occurs during late adolescence. To support optimized and patient-centered care, this study aimed to investigate how women with MRKH syndrome experience the diagnostic process. From January 2021 to March 2021, we conducted in-depth interviews with 18 Danish women (≥25 years) diagnosed with MRKH syndrome. The interviews lasted a median of 92 minutes (range: 67-117). Data were analyzed using thematic analysis. As teenagers or young women at the time, all women had experienced the diagnostic process in the nonspecialized healthcare sector as deeply upsetting due to distressing gynecological examinations, use of inappropriate language, and considerable diagnostic delay. When reaching the specialized health care sector, questions could finally be answered, but this information and support did not significantly alter their feelings of being "deviant" or "flawed". The women continued their diagnostic odyssey beyond the health care system and found online communities that gave them valuable support in living with MRKH syndrome. Women experience the diagnostic odyssey of MRKH syndrome as upsetting and potentially traumatizing beyond the diagnosis. Healthcare professionals can influence young women's understanding and experience of MRKH syndrome by using inclusive language (eg, avoiding "deformity") and addressing all that is normal and functioning (eg, external genitalia and potential for sexual pleasure). In nonurgent conditions, young women should be given the choice to delay a genital examination.

Breaking the Emergency Room Cycle: The Impact of Telemedicine on Emergency Department Utilization.

Background Telemedicine has gained prominence in healthcare, and understanding its impact on diverting non-urgent cases from the emergency room (ER) has become crucial. This study delves into the dynamic relationship between telemedicine utilization and ERvisits, seeking to understand the transformative impact of telehealth on breaking the traditional ER cycle. Method To explore the awareness and utilization of telemedicine services in the broader population of Saudi Arabia, we adopted a cross-sectional design utilizing the convenience sampling method. Data collection was facilitated through a self-administered online survey comprising four sections: demographic variables, ER visits, awareness of non-urgent cases, and suggestions. The collected data were entered into IBM SPSS Statistics for Windows, Version 21 (Released 2012; IBM Corp., Armonk, New York, United States) for descriptive analysis. Results Among the 1140 participants, the majority were females (56.8%), with 43.2% being males. Regarding age distribution, the highest percentage fell within the 18-25 age group (46.8%). Nationality-wise, a substantial proportion identified as Saudi (95.2%). Educational backgrounds varied, with 60.7% holding a bachelor's degree. Notably, 62.6% of the visits were classified as urgent. A significant portion (66.8%) demonstrated awareness of alternative options for non-urgent care, such as outpatient clinics and telemedicine services. Specifically regarding telemedicine, 82.8% of respondents believed that video consultations and prescription refills could effectively address non-urgent conditions. Furthermore, 89.6% of participants agreed that educating patients on self-care and home remedies could help manage symptoms and deter unnecessary ER visits. Conclusions The positive reception of telemedicine, as evidenced by high satisfaction rates among participants, further reinforces its role in reshaping the landscape of healthcare delivery.

Ultrasound imaging of bowel obstruction in neonates.

Bowel obstruction (BO) in children has a wide differential diagnosis, ranging from non-urgent conditions to surgical emergencies. Abdominal radiographs are most often used as the first imaging modality for the evaluation of obstruction. However, for some indications, ultrasound can be the primary imaging modality. Therefore, it is incumbent on radiologists to recognize the types of bowel obstruction that can be recognized with US. Key sonographic features of BO include differential dilation of bowel loops, bowel wall thickening, and free fluid. "Do Not Miss" findings that indicate need for emergent treatment include volvulus, pneumoperitoneum, and/or signs of ischemia (bowel wall thinning and/or absent perfusion). The aim of this pictorial essay is to provide guidance on the sonographic technique and findings that enable identification of BO on US. Examples of neonatal BO on US, including common and less frequently encountered etiologies, are illustrated in this pictorial essay.

Is it possible to safely increase the number of patients classified as non-urgent in triage? A prospective observational study

Triage systems, calibrated to discriminate acute conditions, seem unable to deal with minor non-urgent conditions. The aim of the present study to verify whether some level 4 priority codes can be safely declassified to level 5 priority codes. A prospective observational study was performed between 1° October 2022 to 31° March 2023. All patients with a code 5 according to the Manchester Triage System (MTS) were compared with patients with a priority level 4 code but with a general indicator that was downgraded to a code 5 after the triage nurse's assessment. Of the 2032 patients enrolled, 58.6% were part of the 'blue from MTS' group while 41.4% were part of the 'blue after re-evaluation' group. There was no statistical difference in the rate of hospitalisation and discharge between the two groups (p=0.928). There was also no difference between the two groups in the comparisons of short- and medium-term death. This study highlights the need to rethink strategies to declassify patients through MTS, especially given the continuous increase of non-urgent patients presenting in the ED.

Orthopedic Treatment in the Era of COVID-19: Perspectives from a National Survey in Thailand

Purpose: The coronavirus disease 2019 (COVID-19) pandemic has affected the management of patients with non-emergent orthopedic conditions, resulting in postponed surgical intervention(s) and changes in hospital services. Specific guidelines have been issued for emergency orthopedic cases; however, no definitive guidelines have been proposed for the management of elective or non-urgent conditions during the pandemic. As such, physicians have been obliged to make decisions based on their judgment. This study aimed to analyze data regarding changes in general orthopedic practices during the pandemic, especially those pertaining to surgery, clinical procedures, follow-up periods, referrals, and protective equipment. Methods: This study investigated the impact of the COVID-19 pandemic on the management of non-urgent orthopedic conditions by outpatient orthopedists. A questionnaire was developed and shared with nationwide orthopedic social media groups and through e-mails. Results Of the 200 orthopedic surgeons invited to participate, 129 (64.5%) responded. Results revealed that 65.9% of the surgeons preferred conservative treatment to surgery among patients with the appropriate indications. Additionally, follow-up periods were extended in 69.0% of patients, and 70.5% were prescribed more medication. The N-95 mask and home delivery system for medications were the two most desirable protective equipment and innovations that surgeons needed (79.1% and 69.8% of respondents, respectively). Conclusions: The COVID-19 pandemic has led to changes in general orthopedic practices in outpatient clinics, such as a preference for more conservative treatment than surgery, extension of appointment periods, prescription of medicine for a longer period, and use of drug delivery to patients’ homes.

The increasing number of surgically excised chalazion during the COVID-19 pandemic

Abstract Purpose: Our goal is to determine the number of excised chalazion over the last 16 years to see if there is an increase in the last 36 months, particularly during the COVID-19 pandemic. Methods: In this retrospective study, 1772 surgically excised cases of chalazion were reviewed. The date range was between 2007 and 2021, and cases were grouped in intervals of 36 months. Information regarding age, sex, and location of the chalazion was also obtained. Results: Of all cases, 54% of the patients (n = 952) were male and 46% (n = 820) were female. The mean age was 46.26 years, ranging from 44.65 to 47.28 in the different groups. There was a relative increase in the number of excised chalazion over the last 36 months. From 2019 to 2021, 506 cases were diagnosed. There were fewer cases in the other groups, as follows: 2016–2018-455 cases; 2013–2015-283 cases; 2010–2012-302 cases; and 2007–2009-226 cases. Regarding location of the excised lesion, 1098 (62%) were in the upper eyelid and 674 (38%) were in the lower eyelid. Conclusion: In the onset of the COVID-19 pandemic, fewer patients sought medical care for nonurgent conditions, such as chalazion. However, our data showed that despite that decrease, there was an increased number in chalazion excisions. Among several possible explanations, we suggest that the use of oral protection, such as masks, could have an impact in the increased incidence of chalazion, particularly the ones that end up being surgically removed.

Variations in the intended utilization of emergency care in case of gastrointestinal diseases

Frequent utilization of emergency care and overcrowded emergency departments (EDs) are highly relevant topics due to their harmful consequences for patients and staff. The present study examines variations of intended health care use in urgent and non-urgent cases among the general population. In a cross-sectional telephone survey, a sample of N = 1,204 adults residing in Hamburg, Germany, was randomly drawn. At the beginning of the survey, one of 24 different vignettes (case stories) describing symptoms of inflammatory gastrointestinal diseases were presented to the participants. The vignettes varied in sex (male/female), age (15, 49, 72 years), daytime (Tuesday morning, Tuesday evening), and urgency (low, high). Participants were asked in an open-ended question about their primal intended utilization if they or their children would be affected by such symptoms. Overall, about 14 % chose emergency facilities (ED, ambulance, emergency practice) despite presentation of non-urgent conditions (n = 602). Intended emergency care use varied considerably even if the degree of urgency was comparable. Adolescence, male sex, and symptoms occurring in the evening were associated with increased ED and ambulance use. Inappropriate utilization of ED and ambulance (analyses regarding utilization due to non-urgent problems) was more often observed among male respondents and those with a migration background (1st generation). Information campaigns focused on emergency care use and reorganisation of emergency care wards are possible interventions.

Single points of access to fill the "GAP" for unattached patients in primary care: What makes paediatric users more likely to require a medical appointment?

Unattachment to a regular primary care professional can affect children's and adolescents' well-being, considering their unique health needs. Having no alternative, many turn to emergency departments for non-urgent conditions. To help unattached patients access healthcare services while on waitlists, Quebec's government implemented single access points in each administrative region across the province. Our study aimed to describe the paediatric population using single access points and identify associations between their characteristics and need for a medical appointment. Clinical-administrative data of 1,323 paediatric access point users in the Montérégie region from November 2022 to March 2023 were utilized to conduct bivariate and multivariable regression analyses. Our study showed that young age, assessment trajectory, and specific reasons for calling were more likely to necessitate a medical appointment. While access points improve accessibility to doctors, questions remain regarding the relevance of medical consultations, inequities, and possible security issues resulting from the overall process.

Rethinking non-urgent EMS conveyance to ED during night-time - a pilot study in Southwest Finland

BackgroundThe amount of emergency medical service missions has increased internationally in recent years, and emergency departments are overcrowded globally. Previous evidence has shown that patients arriving at the emergency department during nighttime (20 − 08) have to wait longer, are more likely to leave without being seen, and often have non-urgent conditions compared to patients arriving during the day. The objective of this pilot study was to examine what kind of patient groups are conveyed as non-urgent to the hospital by emergency medical service during nighttime and what kind of diagnostic tests and medical interventions those patients receive before morning to identify patient groups that could be non-conveyed or directed to alternative points of care.MethodsThis was a retrospective register study where the information of patients conveyed to university hospital during nighttime (20 − 08) were analyzed. Frequencies of the dispatch codes presenting complaints, medical treatments, and diagnostic tests were calculated. Age significance (under/over 70 years) was also tested.Results73.5% of the patients received neither medical treatment nor had diagnostic tests taken before morning. Most of these were patients with mental disorder(s), hip pain/complaint, or laceration/cut. Almost half of the patients with abdominal pain or fever had laboratory tests taken. Patients over 70 years old received more medications and had more diagnostic tests taken than younger patients.ConclusionsSome of the low-acuity patients could be non-conveyed or referred to alternative pathways of care to avoid impolitic use of emergency medical service and to reduce the workload of emergency departments. Further research is needed to ensure patient safety for patients who are not conveyed at night.

Emergency Department Use Across Income Groups Following an Increase in Cost-Sharing

To encourage the appropriate utilization of emergency care, cost-sharing for emergency care was increased from HK$100 (US $12.8) to HK$180 (US $23.1) per visit in June 2017 in all public hospitals in Hong Kong. However, there are concerns that this increase could deter appropriate emergency department (ED) visits and be associated with income-related disparities. To examine changes in ED visits after the fee increase. This retrospective cohort study used administrative data from June 2015 to May 2019 from all public hospitals in Hong Kong. Participants included all Hong Kong residents aged 64 years and younger, categorized into low-income, middle-income, and high-income groups according to the median household income in their district of residence. Data analysis was performed from May to June 2023. The primary outcome was the ED visit rate per 100 000 people per month, categorized into 3 severity levels (emergency, urgent, and nonurgent). Secondary outcomes include general outpatient (GOP) visit rate, emergency admission rate, and in-hospital mortality rate per month at public hospitals. Segmented regression analyses were used to estimate changes in the level and slope of outcome variables before and after the fee increase. This study included a total of 5 441 679 ED patients (2 606 332 male patients [47.9%]; 2 108 933 patients [38.5%] aged 45-64 years), with 2 930 662 patients (1 407 885 male patients [48.0%]; 1 111 804 patients [37.9%] aged 45-64 years) from the period before the fee increase. The fee increase was associated with an 8.0% (95% CI, 7.1%-9.0%) immediate reduction in ED visits after June 2017, including a 5.9% (95% CI, 3.3%-8.5%) reduction in urgent visits and an 8.9% (95% CI, 8.0%-9.8%) reduction in nonurgent visits. In addition, a 5.7% (95% CI, 4.7%-6.8%) reduction of emergency admissions was found, whereas no significant changes were observed in in-hospital mortality. Specifically, a statistically significant increase in GOP visits (4.1%; 95% CI, 0.9%-7.2%) was found within the low-income group, but this association became insignificant after controlling for the social security group, who were exempted from payment, as a control. In this cohort study, the fee increase was not associated with changes in ED visits for emergency conditions, but there was a negative and significant association with both urgent and nonurgent conditions across all income groups. Considering the marginal increase in public GOP services, further study is warranted to examine strategies to protect low-income people from avoiding necessary care.

Racial and Ethnic Disparities in Pediatric Musculoskeletal Care.

This article provides a review of recent published research studying racial, ethnic, and socioeconomic disparities in pediatric musculoskeletal care. Disparities in pediatric musculoskeletal care are demonstrated in two general realms: access to care and health outcomes. Though initiatives have been proposed or enacted to address disparities, underrepresented minorities and patients from lower socioeconomic statuses continue to face barriers across the spectrum of orthopedic care and poorer ultimate outcomes after both non-operative and operative management. Minority pediatric patients and those from lower socioeconomic statuses experience delays across the spectrum of orthopedic care for both urgent and non-urgent conditions. They wait longer between injury date and initial orthopedic evaluation, longer to receipt of diagnostic imaging, and longer to ultimate treatment than their counterparts. When finally able to obtain musculoskeletal care and treatment, they are at higher risk of poor in-hospital outcomes and inpatient complications, worse patient reported outcomes, and suboptimal pain management. In the outpatient setting, they receive less physical therapy and follow-up clinic visits, resulting in greater stiffness and strength deficits, and are ultimately less likely to meet return to sport criteria.

Pacific patients' reasons for attending the emergency department of Counties Manukau for non-urgent conditions.

To determine Pacific patients' reasons for Emergency Department (ED) use for non-urgent conditions by Pacific people at Counties Manukau Health. Patients who self-presented to Counties Manukau ED with a non-urgent condition in June 2019 were surveyed. Responses to open-ended questions were analysed using a general inductive approach, in discussion with key stakeholders. Of 353 participants with ethnicity reported, 139 (39%) were Pacific, 66 (19%) Māori and 148 (42%) were non-Māori non-Pacific, nMnP. A total of 58 (42%) of Pacific participants had been to their general practitioner prior to presenting to the ED; this proportion was similar for Māori (19 [30%]) and nMnP (59 [40%]) (p=0.215). The most common reasons for ED attendance among Pacific (as well as other) participants were 1) advice by a health professional (41%, 95% CI 33-50%), 2) usual care unavailable (28%, 20-36%), 3) symptoms not improving (21%, 14-28%), and 4) symptoms too severe to be managed elsewhere (19%, 12-26%). Multiple reasons underlie non-urgent use of EDs by Pacific and other ethnic groups. These reasons need to be considered simultaneously in the design, implementation, and evaluation of multi-dimensional initiatives that discourage non-urgent use of EDs to ensure that such initiatives are effective, equitable, and unintended consequences are avoided.

(019) Longitudinal Observation on the Prevalence and Impact of Psychological Distress Among Patients Treated for Erectile Dysfunction During the COVID Pandemic

Abstract Introduction The COVID global pandemic has significantly affected the delivery of the healthcare system with valued resources diverted to cope with more urgent clinical services. Erectile dysfunction (ED) is considered a non-urgent medical condition and hence, males with ED were not prioritised and invariably faced long delays in clinical management including postponement in surgical waitlist during this pandemic. Objective To assess the prevalence and impact of psychological distress among males with ED during the COVID pandemic based on changes in the outcomes of validated questionnaires such as the International Index of Erectile Function (IIEF), Depression and Anxiety Stress Scales (DASS-21), Sexual Distress Scale (SDS) and Decisional Engagement Scale (DES-10), as well as perceived availability of medical support. Methods Following ethics approval, this prospective longitudinal study tracked males with ED at a tertiary medical centre between June 2020 and June 2022. Inclusion criteria included males aged 20 to 70 years, who have pre-existing ED (greater than 6 months), receiving medical therapies for ED, and had enrolled in the prospective database at the time of the study. Exclusion criteria were those who have undergone penile prosthesis implantation or received major abdominopelvic surgery during the study period that may preclude sexual activity. All patients completed validated questionnaires at 0, 6, 12, 18 and 24 months with additional data collected during the peak periods of local COVID social measure lockdown. Results A total of 80 patients were identified during the 24 months and 20 patients dropped out due to surgery (15 patients) and incomplete follow-up (5 patients). The mean age of males was 46.8 (21-69) years, and the duration of ED was 14.5 (6-33) months. Almost one-third of the patients showed increased DASS scores on depression (38 patients) and anxiety (42 patients) subscales and one-quarter on stress (29 patients) subscales, with worse DASS scores during the peak periods of social measures. On the SDS questionnaire, higher concerns were registered across all domains apart from the question on regrets about your sexuality. The analyses showed a worsening of the IIEF scores (p&amp;lt;0.021), anxiety and stress (DASS score with p=0.045 and p=0.038, respectively) as well as SDS score (p=0.048) during this pandemic. However, the DES-10 scores were more positive with most patients reporting a score above 7 out of 10 in terms of items on accepting current arrangement (75%) and confidence in clinician decision-making about the treatment (80%) although most patients (92%) indicated the desire to be kept updated and provided with more detailed information on their clinical care. Conclusions The COVID pandemic has caused an adverse psychosexual impact on many patients’ erectile function and mental well-being, and social measures lockdown invariably heightened patient psychosexual distress. Our study showed regular clinical contact and medical reassurance coupled with an explanation of reasons for clinical delays in the non-urgent medical condition resulted in a high level of confidence in clinicians and potentially minimised emotional adjustment in the patients. Disclosure No

Exploring Primary Care Streaming Pathway in Emergency Departments in Saudi Arabia: A Qualitative Study.

Due to significant emergency department overcrowding, some hospitals implemented a system of directing certain patients who were deemed not in need of emergency care to other facilities called triage away. Pathways were developed as ways to stream patient from emergency departments to primary healthcare who is presenting with less urgent or nonurgent conditions. Thus, the purpose of this study was to explore the pathways (process) for streaming patients from emergency department to primary healthcare at three different sites across Western Region of Saudi Arabia and to identify the streaming criteria and guidance. This study used a qualitative observational design. Data were collected through an unstructured observational approach, with an in-depth case study observation involving three emergency departments in the Western Region. Data were collected over three months until data saturated and recorded in the form of filed notes. The results of this study explored that all CTAS-5 were streamed away either (off-site) or (on-site) from emergency department. The average of the sorting/triage cases were around 200 to 250 per shift, and about third to half of them were streamed to Primary Health Centre or Urgent Care Clinic. The total streamed patients were ranging from 50 to 60 per shift, which mean 15-20 case per hour. The study highlighted many factors that influence the practice and decision of streaming. In general, the term "streaming" was not as widely known among emergency clinicians, as was the term "triage." However, streaming was performed as an evidence-based practice, and clinicians routinely acted to direct patients based on hospital policies. Although, in one hospital, some nurses hack the system to manage the flow of patients based on their intuition. In contrast, the nurses in another hospital emphasised the importance of experience and confidence in streaming improvement.