Non-urgent Cases Research Articles

Post-Acute Admission Mortality Rates for Nursing Home Residents

Abstract Background Nursing home residents (NHRs) constitute a vulnerable demographic with intricate healthcare requirements, often burdened by multiple comorbidities. A specialised geriatrician-led acute care team for NHRs was established in a University Teaching Hospital. This service prioritises the unique needs of NHRs, delivering tailored treatments in environments conducive to their well-being, while also striving to mitigate the adverse effects associated with avoidable hospitalizations. Methods An analysis of NHR admissions to a University Teaching Hospital in 2023, showed that 307 out of 343 (89.5%) were discharged back to the community. All discharged NHRs were followed up. Their 3 and 6 month mortality rate post discharge was 8% (n=24) and 13% (n=40) respectively. Majority of these frail NHRs survived beyond six months following hospital admissions, indicative of the potential impact of a specialized gerontological care follow-up. Results This specialist team has a post-discharge follow-up protocol for all admitted NHR residents, aimed to detect potential deteriorations and offer alternative avenues of review, minimizing unnecessary emergency department visits, particularly in non-urgent cases. Interventions such as the FastTrack Fracture service, direct ED reviews, and facilitating outpatient appointments were instrumental in this endeavour. Conclusion In summary, the establishment of this specialised geriatrician-led acute care team for NHRs marks a substantial stride in addressing the multifaceted needs of frail older adults in nursing homes. By leveraging the expertise of gerontologically attuned practitioners and emphasizing person-centered care approaches, these services provide a holistic and individualized solution to enhance outcomes and elevate the quality of life for this vulnerable population. Sustained investment in the development and expansion of such services is paramount for advancing care standards for older adults and fostering a more age-friendly healthcare milieu.

Extended scope audiology clinic – a review of its outcomes and re-presentation to the ear nose and throat service

Objective To evaluate the role of Extended Scope (ES) audiologists in managing adult Ear Nose and Throat (ENT)/Otology waitlists and analyse patient re-presentation rate to the ENT service within 12 months of being discharged from the clinic. Design A retrospective cohort study assessing the efficacy of ES audiologists, measuring the discharge rate from ENT waitlists, the rate of escalation to ENT care, and the rate and reasons for any re-presentations to care. Study sample 394 adult patients. Results Of the referred patients, 95% (n = 374) were deemed suitable for ES care. Of these, 75% were discharged without further ENT intervention, 20% required escalation to ENT, and 5% were returned to the waitlist. Only one patient re-presented for care within 12 months. The inclusion of patients with CHL/MHL and vestibular symptoms marked an expansion from our previous work. The re-presentation rate was notably lower compared to other allied health ES clinics. Conclusion The ES Audiology clinic demonstrates a high discharge rate with a low incidence of patient re-presentation, highlighting the ES audiologists’ efficiency in managing non-urgent ENT cases. The study supports the continued use and expansion of ES roles to ensuring timely and quality care for patients on ENT waitlists.

Prophylactic phenylephrine infusion versus treatment with vasopressor bolus as needed during non-urgent cesarean delivery and neonatal acidemia: a retrospective cohort study (2016–2021)

IntroductionProphylactic vasopressor administration reduces spinal hypotension during cesarean delivery, however the effects of vasopressor administration on neonatal acidemia remain uncertain. We examined the occurrence of neonatal acidemia in the setting of non-urgent cesarean delivery and compared outcomes between cases receiving prophylactic phenylephrine infusion versus cases treated with boluses of phenylephrine. MethodsRetrospective cohort study with ethical approval, comparing non-urgent cesarean delivery cases performed under spinal anesthesia (2016 to 2021), receiving either prophylactic phenylephrine infusion or boluses as needed.Data were collected from anesthesia and labor ward electronic medical records. Records with missing pH or missing blood pressure data were excluded. The independent variable was prophylactic phenylephrine administration, a strategy implemented following international recommendations in 2018. The main outcome was neonatal acidemia, defined as umbilical artery pH < 7.1. The secondary outcome was maternal hypotension, defined as at least one systolic blood pressure (SBP) measurement below 100 mmHg or below 80% baseline. ResultsA total of 4392 patients were included in the final analysis; 1318 (30.0%) received prophylactic phenylephrine infusion. Neonatal acidemia (umbilical artery pH < 7.1) occurred in 28 (2.1%) cases receiving prophylactic phenylephrine versus 50 (1.6%) treated with boluses as needed (p = 0.188). Prophylactic phenylephrine infusion was not associated with occurrence of neonatal acidemia (aOR 0.83; 95% CI 0.52 to 1.33, p = 0.435). Prophylactic phenylephrine infusion was associated with a reduced spinal hypotension rate when defined as SBP < 100 mmHg (OR 0.47; 95% CI 0.37 to 0.57; p < 0.001), with similar results when hypotension was defined as a drop below 80% or 90% of baseline SBP. ConclusionIn this pragmatic study, prophylactic phenylephrine infusion was associated with a reduction in maternal spinal hypotension, but not reduced neonatal acidemia.

Solve the medical specimen collection problem by Ant Colony Optimization

This research presents a multi-depot vehicle routing problem in which some freight is time-sensitive. It is inspired by the medical sample collection problem in which some specific medical samples (such as blood and urine) must be returned to the hospital or laboratory within a specific time in order to preserve the specimen’s efficacy. The medical specimen collection problem is emerging for a society with a rapidly aging population, which implies an increase in people requiring long-term care. This problem aims to determine the number of trucks needed and their associated routes in which the total cost is optimised. A solving process based on Ant Colony Optimization is proposed and used to solve two sets of benchmarks to verify its performance. Other scenarios, including non-urgent, all-urgent, and mixed-specimens cases, are also resolved. The study demonstrates a problem-solving process. The outcomes show that the proposed solving method can produce competitive solutions.

A Nationwide Study on Emergency Department Utilization among Pediatric Patients in Korea: A Special Focus on Pediatric Emergency Medical Centers

Objective: Despite Korea’s low birth rate, pediatric emergency medical centers (PEMCs) are grappling with overcrowding. This study evaluates the use of PEMCs in Korea amid a declining birth rate and increased overcrowding.Methods: Data from 176 emergency medical centers (EMCs, 2018–2021) was analyzed using the National Emergency Department Information System, focusing on demographics, Korean Triage and Acuity Scale (KTAS) scores, and pediatric patient outcomes. The most common complaints and diagnoses were identified by the EMC level. This study also examined the characteristics of patients visiting PEMCs.Results: There was a 48% drop in pediatric visits to EMCs during the coronavirus disease 2019 (COVID-19) pandemic. The majority of patients were boys aged 1–4, primarily visiting in the evenings and weekends. The breakdown of cases included 66% disease-related and 34% injury-related. Notably, 8.5% of these visits were via ambulance, 36% were high-acuity according to KTAS, 88% resulted in discharge, and 11% in hospitalization. The median stay was 85 minutes, with 83% utilizing local emergency services. Fever, abdominal pain, and vomiting were the most common complaints, comprising 40% of all visits.Conclusion: Despite a decrease in birth rates, PEMC usage in Korea saw an initial rise followed by a significant decrease during the COVID-19 pandemic. Children aged 1–4 were the most frequent users. The majority of cases were medical rather than trauma-related, and resulted in patient discharge. Strategic redirection of non-urgent cases may help alleviate overcrowding in emergency departments.

The effect of the COVID-19 pandemic on pediatric emergency department utilization in three regions in Switzerland.

The COVID-19 pandemic was associated with a decrease in emergency department (ED) visits. However, contradictory, and sparse data regarding children could not yet answer the question, how pediatric ED utilization evolved throughout the pandemic. Our objectives were to investigate the impact of the pandemic in three language regions of Switzerland by analyzing trends over time, describe regional differences, and address implications for future healthcare. We conducted a retrospective, longitudinal cohort study at three Swiss tertiary pediatric EDs (March 1st, 2018-February 28th, 2022), analyzing the numbers of ED visits (including patients` age, triage categories, and urgent vs. non-urgent cases). The impact of COVID-19 related non-pharmaceutical interventions (NPIs) on pediatric ED utilization was assessed by interrupted time series (ITS) modelling. Based on 304'438 ED visits, we found a drop of nearly 50% at the onset of NPIs, followed by a gradual recovery. This primarily affected children 0-4years, and both non-urgent and urgent cases. However, the decline in urgent visits appeared to be more pronounced in two centers compared to a third, where also hospitalization rates did not decrease significantly during the pandemic. A subgroup analysis showed a significant decrease in respiratory and gastrointestinal diseases, and an increase in the proportion of trauma patients during the pandemic. The COVID-19 pandemic had substantial effects on number and reasons for pediatric ED visits, particularly among children 0-4years. Despite equal regulatory conditions, the utilization dynamics varied markedly between the three regions, highlighting the multifactorial modification of pediatric ED utilization during the pandemic. Furthermore, future policy decisions should take regional differences into account.

Abstract PO3-23-02: Delays in breast cancer surgery during the COVID-19 pandemic: A population-based analysis

Abstract BACKGROUND: At various times during the COVID-19 pandemic, access to operating room resources were restricted in Ontario, Canada. This resulted in triaging of all non-urgent cases, including breast cancer (BC) surgery. Recent single institution studies have identified treatment delays during the immediate pandemic time period. The objective of this study was to assess the impact of the pandemic on wait times for breast cancer surgery at a population level. METHODS: We identified patients with a BC diagnosis between January 1, 2018 and November 30, 2021 in Ontario, Canada. Three cohorts were defined based on the following time periods: pre-pandemic (baseline) (January 2018 to 14 March 2020), immediate pandemic (March 15, 2020 to June 13, 2020), and peri-pandemic (June 14, 2020 to November 30, 2021). Time to event analysis was conducted for time to a patient’s first BC surgery. A subgroup analysis was conducted for patients who underwent neoadjuvant chemotherapy (NAC). RESULTS: The study cohort consisted of 36,639 patients with a new diagnosis of BC. Of them 30,862 patients underwent surgery (84.2%) within 18 months after diagnosis. The probability of BC patients undergoing surgery each month from their date of diagnosis was significantly lower (i.e. longer wait times) for patients diagnosed in the immediate and peri-pandemic period compared to patients diagnosed in the pre-pandemic period (log-rank P &amp;lt; 0.001). At eight weeks from date of diagnosis, the probability of having had surgery was 65.1% (95% CI: 64.5-65.8%) for patients diagnosed in the pre-pandemic period, 56.1% (95% CI: 53.6-58.6%) for immediate pandemic and 59.0% (95% CI: 58.2-59.8%) for peri-pandemic. Time for 80% of patients to have BC surgery was 5.4 months in the pre-pandemic, 5.9 months in the immediate pandemic, and 6.0 months in the peri-pandemic period. Among patients who received NAC (N=6,121; 16.7% of cohort), the probability of undergoing surgery in each month from the date of diagnosis was similar for patients diagnosed in the pre and peri-pandemic periods, but was higher (i.e. shorter wait time) for the cohort of patients diagnosed during the immediate pandemic time period (log-rank P &amp;lt; 0.001). At six months from date of diagnosis, the probability of surgery for patients who received NAC was 50.7% (95% CI: 48.9-52.5%), 61.6% (95% CI: 56.6-66.6%), and 50.9% (95% CI: 49.0-52.8%) for patients diagnosed in the pre-, immediate, and peri-pandemic periods respectively. Time for 80% NAC patients to have a surgery was 7.2 months in the immediate pandemic period, shorter than the 8.2 months in the pre-pandemic and 8.0 months in the peri-pandemic periods. CONCLUSIONS: In this large population-based study of BC patients in Ontario, we identified a delay in time to surgery in the immediate pandemic period that persisted into the peri-pandemic period. However, among patients receiving NAC there was a shorter wait time during the immediate pandemic and wait times for this group have returned to pre-pandemic levels. This is likely due to surgical prioritization of this group, despite pandemic related resource restrictions. Further research is needed to explore the regional variability and how use of neoadjuvant endocrine therapy interacted with surgical treatment timelines. Citation Format: Gary Ko, Amanda Roberts, Qing Li, Ning Liu, Toni Zhong, Eitan Amir, Anne Koch, Andrea Covelli, Vivianne Freitas, Emma Reel, Antoine Eskander, Tulin Cil. Delays in breast cancer surgery during the COVID-19 pandemic: A population-based analysis [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO3-23-02.

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.

Advancing Pediatric Care: The virtualKIDS Experience in Nursing-Led Audio-Visual Clinical Services.

During the COVID-19 pandemic, the escalating trend of pediatric patients, particularly non-urgent cases, going to the emergency departments (EDs) in New South Wales, Australia, prompted the establishment of virtualKIDS, a nursing-led telehealth service. This service, initiated in June 2021, operates 24/7 and provides comprehensive care through audio-visual consultations emphasizing a patient-centered approach. Three elements-COVID-19 Outpatient Response Team (CORT), virtualKIDS Acute Review (vKAR), and Virtual Urgent Care (VUC)-addressed specific needs during and beyond the pandemic, showcasing the adaptability and impact of virtual care. vKAR focuses on post-discharge support, allowing families access to telehealth for up to three days. Preliminary data indicates a 44% reduction in ED visits within 48 h. VUC employs nursing-led triaging paired with audiovisual assessment, demonstrating a 69% hospitalization avoidance rate. Hybrid ambulatory models such as a sleep study at home project, day-only tonsillectomies, and arthroscopic knee surgeries showcase innovative approaches to reducing hospital admissions and enhancing patient outcomes. This paper presents the evolution and diverse models of care implemented by the virtualKIDS service, offering insights into its potential as a nursing-led alternative to ED visits in acute-care pediatrics.

Presentation and management of true aneurysms of the pancreaticoduodenal arcade with concomitant celiac artery stenosis using the endovascular approach

True aneurysms of the pancreaticoduodenal artery (PDA) arcade are rare but require intervention due to the high risk of rupture. Historically, these aneurysms have been managed with open surgical methods. In this study, we describe a contemporary series of aneurysms treated using a modern approach that includes endovascular and hybrid techniques. All the patients with aneurysms of the PDA arcade in an institutional database were identified between 2008 and 2022. Patients with history of pancreatic resection were excluded. Data on demographics, presenting symptoms, imaging findings, operative approach, and outcomes were collected and reviewed. There were nine patients diagnosed with a PDA aneurysm, and all nine underwent endovascular intervention. Most were men (n = 5; 55.6%) and White (n = 7; 77.8%) and had American Society of Anesthesiologists class II or III. The median aneurysm size was 21 mm (range, 6-42 mm), and five (55.5%) were symptomatic. Of the five symptomatic cases, two presented with rupture and were treated urgently. The median time to intervention for the nonurgent cases was 30 days. All but one patient had concomitant celiac artery stenosis and two of the eight cases (25%) were due to extrinsic compression from median arcuate ligament syndrome. Both patients underwent median arcuate ligament syndrome release before endovascular intervention. Another patient required open surgical bypass before endovascular repair from the supraceliac aorta to hepatic artery using a Dacron graft to maintain hepatic perfusion. Among the eight patients with celiac axis stenosis, five (62.5%) required celiac stent placement within the same operation. Coil embolization of the aneurysm was used for all except for two patients (n = 7 of 9; 77.8%), with one patient receiving embolic plugs and another receiving an 8 × 38-mm balloon-expandable covered stent for aneurysm exclusion. The median operating room time was 134 minutes. All repairs were technically successful without any intraoperative or postoperative complications. The mean follow-up was 30 months. There was no morbidity, mortality, or unplanned secondary reinterventions within 6 months after aneurysm repair. Stent patency and aneurysm size remained stable at 2 years of follow-up. True pancreaticoduodenal artery arcade aneurysms can be safely and effectively treated using endovascular and hybrid techniques. Because many of these aneurysms have concomitant celiac artery stenosis, the use of endovascular technology allows for simultaneous treatment of both the aneurysm and the stenosis with exceptional results.

Long-term outcomes in the smoking claudicant after peripheral vascular interventions

ObjectiveEmphasis on tobacco cessation, given the urgent and emergent nature of vascular surgery, is less prevalent than standard elective cases such as hernia repairs, cosmetic surgery, and bariatric procedures. The goal of this study is to determine the effect of active smoking on claudicating individuals undergoing peripheral vascular interventions (PVIs). Our goal is to determine if a greater emphasis on education should be placed on smoking cessation in nonurgent cases scheduled through clinic visits and not the Emergency Department. MethodsThis study was performed using the multi-institution de-identified Vascular Quality Initiative/Medicare-linked database (Vascular Implant Surveillance and Interventional Outcomes Network [VISION]). Claudicants who underwent PVI for peripheral arterial occlusive disease between 2004 and 2019 were included in our study. Our final sample consisted of a total of 18,726 patients: 3617 nonsmokers (19.3%) (NSs), 9975 former smokers (53.3%) (FSs), and 5134 current smokers (27.4%) (CSs). We performed propensity score matching on 29 variables (age, gender, race, ethnicity, treatment setting [outpatient or inpatient], obesity, insurance, hypertension, diabetes, coronary artery disease, congestive heart failure, chronic obstructive pulmonary disease, chronic kidney disease, previous coronary artery bypass graft, carotid endarterectomy, major amputation, inflow treatment, prior bypass or PVI, preoperative medications, level of treatment, concomitant endarterectomy, and treatment type [atherectomy, angioplasty, stent]) between NS vs FS and FS vs CS. Outcomes were long-term (5-year) overall survival (OS), limb salvage (LS), freedom from reintervention (FR), and amputation-free survival (AFS). ResultsPropensity score matching resulted in 3160 well-matched pairs of NS and FS and 3750 well-matched pairs of FS and CS. There was no difference between FS and NS in terms of OS (hazard ratio [HR], 0.94; 95% confidence interval [CI], 0.82-1.09; P = .43), FR (HR, 0.96; 95% CI, 0.89-1.04; P = .35), or AFS (HR, 0.90; 95% CI, 0.79-1.03; P = .12). However, when compared with CS, we found FS to have a higher OS (HR, 1.18; 95% CI, 1.04-1.33; P = .01), less FR (HR, 0.89; 95% CI, 0.83-0.96; P = .003), and greater AFS (HR, 1.16; 95% CI, 1.03-1.31; P = .01). ConclusionsThis multi-institutional Medicare-linked study looking at elective PVI cases in patients with peripheral artery disease presenting with claudication found that FSs have similar 5-year outcomes in comparison to NSs in terms of OS, FR, and AFS. Additionally, CSs have lower OS and AFS when compared with FSs. Overall, this suggests that smoking claudicants should be highly encouraged and referred to structured smoking cessation programs or even required to stop smoking prior to elective PVI due to the perceived 5-year benefit.

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.

Catastrophic complications following microvascular free tissue transfer: A 10-year review of NSQIP data

IntroductionThere is an absence of literature regarding the risks of catastrophic medical outcomes (CMOs) such as stroke, cardiac arrest, and pulmonary embolism in microvascular free tissue transfer. This study aims to determine the CMO and mortality rates, as well as risk factors, associated with microvascular reconstruction of the head and neck, extremity, and breast. MethodsThis study uses data from the American College of Surgeons National Surgical Quality Improvement Program. Cases of microvascular free tissue transfer from 2012 to 2021 were analyzed to assess the 30-day rates of CMOs, including death, as well as associated risk factors. ResultsOf the 22,839 included patients, 785 (3.44%) experienced 1043 CMOs, including 99 (0.43%) deaths. Pulmonary complications of prolonged respiratory failure and pulmonary embolism were the most common. Independent risk factors included age, male sex, underweight status, longer operation times, American Society of Anesthesiologists (ASA) class of III or above, wound classification other than clean, and underlying conditions such as diabetes, hypertension, chronic obstructive pulmonary disorder, dyspnea, metastatic cancer, and ventilator dependence. CMOs were associated with an average 10-day delay in hospital discharge. Multivariate regression analysis revealed that head and neck reconstructions were associated with increased risk of CMO (OR 4.96; p < 0.0001). ConclusionThis is the largest study to examine CMOs following microvascular free tissue transfer. Compared to previous literature spanning the period between 2006 and 2011, we observed a decreased rate of CMOs but a slight increase in 30-day mortality. Our data provide updated and comprehensive criteria for risk stratification and patient counseling. The modifiable risk factors reported in our study should be considered in elective, non-urgent cases of microvascular reconstruction.

Awareness of importance of triaging in emergency department in Kingdom of Saudi Arabia

The emergency department (ED) is an important component of a healthcare system. Increased rates of visiting the ED, even for non-urgent cases, makes it necessary to prioritize patients who require immediate care over those who can wait. This process is called triage. However, although triage helps to deliver efficient service for the more needy patients, it results in delays for others, who may be left unsatisfied as a result. The aim of this research is therefore to assess the public awareness about triage in the ED and its importance in delivering improvements in healthcare in the Kingdom of Saudi Arabia. To this end, a cross-sectional research method was adopted to conduct a study on the Saudi population between the periods from 01 November 2022 to 31 November 2022. The study used a self-administrated, validated and translated electronic questionnaire. SPSS software version 23 was used for data analysis. The study included 2056 participants, who reported the major causes for the last ED visit to be abdominal pain (26.4%) and headaches (14.4%). The mean ± standard deviation (SD) score of knowledge was 8.79 ± 2.13. Moreover, this mean significantly differed between educational levels (p ˂ 0.001), current jobs (p = 0.001), and residence (p ˂ 0.001). The majority (82.9%) reported that increasing the working hours of primary healthcare (PHC) centers would reduce the ED’s crowdedness. The data thus showed there was inadequate knowledge and some gaps regarding triage in the ED among the public population in Saudi Arabia. Educational level, current job and residence were determinants for the level of knowledge. Allocating specialized physicians, improving the primary health care centers facilities, as well as increasing the working

The Role of Transcranial-Color-Doppler in the Management of Basilar Artery Stenosis: Case Series and Systematic Review of Literature

Managing vertebrobasilar (VB) stroke, particularly basilar artery occlusion (BAO), presents challenges due to diverse clinical presentations and intricate diagnostics, risking delays in acute-phase reperfusion therapies. The diagnostic complexities of VB stroke prompt questions about whether presentation tempo influences outcomes. For non-urgent cases of basilar artery stenosis (BAS) lacking guidelines, clinical management becomes case-dependent. Current options include aggressive medical therapy (AMT) and percutaneous transluminal angioplasty and/or stenting (PTAS). However, the choice of PTAS remains debated, with recent trials observing higher-than-expected recurrence rates, particularly in intracranial stenosis. Understanding hemodynamic status is crucial in predicting stroke risk, especially in atherosclerotic VB disease. Recent studies highlighted the role of distal flow status in predicting stroke risk, emphasizing the importance of hemodynamic assessment beyond anatomic measures. Neurosonology, especially transcranial color-coded duplex sonography (TCCS), emerges as a valuable tool for assessing hemodynamics. Despite TCCS being operator-dependent and technically challenging for BAS evaluation, it effectively detects significant hemodynamic changes, providing real-time information on collateral flow. This review explores the potential role of TCCS in managing BA hemodynamic failure in VB stroke, with particular regard to the selection of BAS patients who may benefit from PTAS.

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.

Diagnostic Accuracy of the World Health Organization Pediatric Emergency Triage, Assessment and Treatment Tool Plus Among Patients Seeking Care in Nairobi, Kenya: A Cross-sectional Study.

The World Health Organization developed Emergency Triage Assessment and Treatment Plus (ETAT+) guidelines to facilitate pediatric care in resource-limited settings. ETAT+ triages patients as nonurgent, priority, or emergency cases, but there is limited research on the performance of ETAT+ regarding patient-oriented outcomes. This study assessed the diagnostic accuracy of ETAT+ in predicting the need for hospital admission in a pediatric emergency unit at Kenyatta National Hospital in Nairobi, Kenya. This was a secondary analysis of a cross-sectional study of pediatric emergency unit patients enrolled over a 4-week period using fixed random sampling. Diagnostic accuracy of ETAT+ was evaluated using receiver operating curves (ROCs) and respective 95% confidence intervals (CIs) with associated sensitivity and specificity (reference category: nonurgent). The ROC analysis was performed for the overall population and stratified by age group. A total of 323 patients were studied. The most common reasons for presentation were upper respiratory tract disease (32.8%), gastrointestinal disease (15.5%), and lower respiratory tract disease (12.4%). Two hundred twelve participants were triaged as nonurgent (65.6%), 60 as priority (18.6%), and 51 as emergency (15.8%). In the overall study population, the area under the ROC curve was 0.97 (95% CI, 0.95-0.99). The ETAT+ sensitivity was 93.8% (95% CI, 87.0%-99.0%), and the specificity was 82.0% (95% CI, 77.0%-87.0%) for admission of priority group patients. The sensitivity and specificity for the emergency patients were 66.0% (95% CI, 55.0%-77.0%) and 98.0% (95% CI, 97.0%-100.0%), respectively. ETAT+ demonstrated diagnostic accuracy for predicting patient need for hospital admission. This finding supports the utility of ETAT+ to inform emergency care practice. Further research on ETAT+ performance in larger populations and additional patient-oriented outcomes would enhance its generalizability and application in resource-limited settings.

Factors influencing the occurrence of ambulatory care sensitive conditions in the emergency department - a single-center cross-sectional study.

The differentiation between patients who require urgent care and those who could receive adequate care through ambulatory services remains a challenge in managing patient volumes in emergency departments (ED). Different approaches were pursued to characterize patients that could safely divert to ambulatory care. However, this characterization remains challenging as the urgency upon presentation is assessed based on immediately available characteristics of the patients rather than on subsequent diagnoses. This work employs a core set of Ambulatory Care Sensitive Conditions (core-ACSCs) in an ED to describe conditions that do not require inpatient care if treated adequately in the ambulatory care sector. It subsequently analyzes the corresponding triage levels and admission status to determine whether core-ACSCs relevantly contribute to patient volumes in an ED. Single center cross-sectional analysis of routine data of a tertiary ED in 2019. The proportion of core-ACSCs among all presentations was assessed. Triage levels were binarily classified as "urgent" and "non-urgent," and the distribution of core-ACSCs in both categories was studied. Additionally, the patients presenting with core-ACSCs requiring inpatient care were assessed based on adjusted residuals and logistic regression. The proportion being discharged home underwent further investigation. This study analyzed 43,382 cases of which 10.79% (n = 4,683) fell under the definition of core-ACSC categories. 65.2% of all core-ACSCs were urgent and received inpatient care in 62.8% of the urgent cases. 34.8% of the core-ACSCs were categorized as non-urgent, 92.4% of wich were discharged home. Age, triage level and sex significantly affected the odds of requiring hospital admission after presenting with core-ACSCs. The two core-ACSCs that mainly contributed to non-urgent cases discharged home after the presentation were "back pain" and "soft tissue disorders." Core-ACSCs contribute relevantly to overall ED patient volume but cannot be considered the primary drivers of crowding. However, once patients presented to the ED with what was later confirmed as a core-ACSC, they required urgent care in 65.2%. This finding highlights the importance of effective ambulatory care to avoid emergency presentations. Additionally, the core-ACSC categories "back pain" and "soft tissue disorders" were often found to be non-urgent and discharged home. Although further research is required, these core-ACSCs could be considered potentially avoidable ED presentations. The study was registered in the German trials register (DRKS-ID: DRKS00029751) on 2022-07-22.

Efficacy of AI Chats to Determine an Emergency: A Comparison Between OpenAI's ChatGPT, Google Bard, and Microsoft Bing AI Chat.

Background The escalating overload and saturation of emergency services, primarily caused by non-urgent cases overwhelming the system, have spurred a critical necessity for innovative solutions that can effectively differentiate genuine emergencies from situations that could be managed through alternative means, such as using AI chatbots.This study aims to evaluate and compare the accuracy in differentiating between a medical emergency and a non-emergency of three of the most popular AI chatbots at the moment. Methods In this study, patient questions from the online forum r/AskDocs on Reddit were collected to determine whether their clinical cases were emergencies. A total of 176 questions were reviewed by the authors, with 75 deemed emergencies and 101 non-emergencies. These questions were then posed to AI chatbots, including ChatGPT, Google Bard, and Microsoft Bing AI, with their responses evaluated against each other and the authors' responses. A criteria-based system categorized the AI chatbot answers as "yes," "no," or "cannot determine." The performance of each AI chatbot was compared in both emergency and non-emergency cases, and statistical analysis was conducted to assess the significance of differences in their performance. Results In general, AI chatbots considered around 12-15% more cases to be an emergency than reviewers, while they considered a very low number of cases as non-emergency compared to reviewers (around 35% fewer cases). Google Bard detected the most true emergency cases (87%) and true non-emergency cases (36%). However, no real difference in performance between the three AI chatbots was found in detecting true emergencies (p-value = 0.35) and non-emergency cases (p-value = 0.16). Conclusions These AI systems require further refinement to identify emergency situations accurately, but they could potentially be an innovative tool for emergency care and improving patient outcomes. The integration of AI chatbots like ChatGPT, Google Bard, and Microsoft Bing Chat offers a promising avenue to mitigate ED strain and enhance emergency management.

Impact of the coronavirus disease 2019 pandemic on neurosurgical patients in Taif city, Saudi Arabia

ABSTRACT Background: During the coronavirus disease 2019 (COVID-19) pandemic, the healthcare systems were obligated to work at more than maximum capacity for time due to the high transmission rate and incidence of newly infected cases. During the pandemic, all priority was given to COVID-19 cases, as the pandemic stream may exceed the health-care system’s available resources, affecting many other patients, including those with neurosurgical disorders. Aim: This study was designed to assess how COVID-19 affected neurosurgical patients. Materials and Methods: A retrospective study included all patients who were admitted to the neurosurgical department at King Abdulaziz Specialist Hospital, King Faisal Medical Complex, and Al-Hada Armed Forces Hospital during the COVID-19 pandemic. The data were collected in 5 months (April–August 2022) from the records of accessible patients. Results: A total of 777 neurosurgical patients were included 474 (61%) patients were male and 303 (39%) were female. The mean age of the patients was 41.2 ± 13.9 years old. A total of 481 (61.9%) patients were admitted before the pandemic, and 120 (15.4%) were admitted during the lockdown, 176 (22.7%) were admitted after the lockdown. The patient’s length of stay ranged from 1 day to more than 1 year, where 307 (39.5%) stayed for 1 week, and only 87 (11.2%) stayed for more than 2 weeks. 338 (70.7%) cases were Priority 1A emergencies, 17.8% improved, 52 (6.7%) remained stationary, while 7 (0.9%) showed clinical deterioration, and 15 (1.9%) died. Conclusion: According to the results of this study, both the admission rate for cases and the clinical outcome for neurosurgical patients were adversely affected by the COVID-19 pandemic. Compared to nonurgent cases, urgently admitted cases showed greater improvement.