Emergency Department Workload Research Articles

Summer alcohol-related emergency department workload and occupancy in Australasia 2019-2022.

Alcohol is a major public health issue and the ACEM funds regular 'snapshot' surveys of the prevalence of alcohol-related presentations in EDs. The present study uses these data to investigate ED occupancy and alcohol- and methamphetamine-related presentations at the time of the COVID-19 pandemic. Survey-based point prevalence study of EDs in Australia and New Zealand conducted at 02:00 hours local time on the Saturday of the weekend before Christmas in 2019-2022. Primary outcomes were ED occupancy, the number of alcohol-related presentations and methamphetamine-related presentations in each ED at the time of survey. Seventy eight of a possible 152 hospitals answered all four surveys (51%, 95% confidence interval 43-59, individual yearly response rates ranged from 70.5% to 83.3%). The mean number of alcohol-related presentations in EDs at the snapshot time was 4.2 (95% confidence interval 3.2-5.2) in the 2019 survey and 3.8 (3.1-4.6) in 2022 with no significant variation over time. There was also no change in methamphetamine-related presentations which occurred at a lower level. There was a major increase in reported total ED occupancy - from 31.4 to 43.5 in Australia (P < 0.0001, paired t test) and from 22.8 to 38.7 in New Zealand (P = 0.0001). Subgroup analysis showed that both the number being treated and the number waiting to be seen increased, with little change in the number in observation units. The present study demonstrates that the COVID-19 pandemic did not affect summer alcohol-related ED presentations in Australasia but was associated with an unsustainable increase in ED crowding.

Adapting Teaching to the Workload in Emergency departments: Two minutes to Learn

Adapting Teaching to the Workload in Emergency departments: Two minutes to Learn

Measuring Emergency Department Workload Perception Using Electronic Medical Record Measures of Patient Volume and Acuity

BackgroundWorkload in the emergency department (ED) fluctuates and there is no established model for measurement of clinician-level ED workload. ObjectiveThe aim of this study was to measure perceived ED workload and assess the relationship between perceived workload and objective measures of workload from the electronic medical record (EMR). MethodsThis study was conducted at a tertiary care, academic ED from July 1, 2020 through April 13, 2021. Attending workload perceptions were collected using a 5-point scale in three care areas with variable acuity. We collected eight EMR measures thought to correlate with perceived workload. EMR values were compared across areas of the department using ANOVA and correlated with attending workload ratings using linear regression. ResultsWe collected 315 unique workload ratings, which were normally distributed. For the entire department, there was a weak positive correlation between reported workload perception and mean percentage of inpatient admissions (r = 0.23; p < 0.001), intensive care unit admissions (r = 0.2; p < 0.001), patient arrivals per shift (r = 0.14; p = 0.017), critical care billed visits (r = 0.22; p < 0.001), cardiopulmonary resuscitation code activations (r = 0.2; p < 0.001), and level 5 visits (r = 0.13; p = 0.02). There was weak negative correlation for ED discharges (r = –0.23; p < 0.001). Several correlations were stronger in individual care areas, including percent admissions in the lowest-acuity area (r = 0.43; p = 0.033) and patient arrivals in the highest-acuity area (r = 0.44; p < .01). No significant correlation was found in any area for observation admissions or trauma activations. ConclusionsIn this study, EMR measures of workload were not closely correlated with ED attending physician workload perception. Future study should examine additional factors contributing to physician workload outside of the EMR.

Assessing the reliability of pediatric emergency medicine billing code assignment for future consideration as a proxy workload measure.

Prediction of pediatric emergency department (PED) workload can allow for optimized allocation of resources to improve patient care and reduce physician burnout. A measure of PED workload is thus required, but to date no variable has been consistently used or could be validated against for this purpose. Billing codes, a variable assigned by physicians to reflect the complexity of medical decision making, have the potential to be a proxy measure of PED workload but must be assessed for reliability. In this study, we investigated how reliably billing codes are assigned by PED physicians, and factors that affect the inter-rater reliability of billing code assignment. A retrospective cross-sectional study was completed to determine the reliability of billing code assigned by physicians (n = 150) at a quaternary-level PED between January 2018 and December 2018. Clinical visit information was extracted from health records and presented to a billing auditor, who independently assigned a billing code-considered as the criterion standard. Inter-rater reliability was calculated to assess agreement between the physician-assigned versus billing auditor-assigned billing codes. Unadjusted and adjusted logistic regression models were used to assess the association between covariables of interest and inter-rater reliability. Overall, we found substantial inter-rater reliability (AC2 0.72 [95% CI 0.64-0.8]) between the billing codes assigned by physicians compared to those assigned by the billing auditor. Adjusted logistic regression models controlling for Pediatric Canadian Triage and Acuity scores, disposition, and time of day suggest that clinical trainee involvement is significantly associated with increased inter-rater reliability. Our work identified that there is substantial agreement between PED physician and a billing auditor assigned billing codes, and thus are reliably assigned by PED physicians. This is a crucial step in validating billing codes as a potential proxy measure of pediatric emergency physician workload.

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.

Optimizing Patient-Centered Stroke Care and Research in the Prehospital Setting.

Over the past decades, continuous technological advances and the availability of novel therapies have enabled treatment of more acute medical conditions than ever before. Many of these treatments, such as intravenous thrombolysis and mechanical thrombectomy for acute ischemic stroke, are highly time sensitive. This has raised interest in shifting advanced acute care from hospitals to the prehospital setting. Key objectives of advanced prehospital stroke care may include (1) early targeted treatments in the prehospital setting, for example, intravenous thrombolysis for acute stroke, and (2) advanced prehospital diagnostics such as prehospital large vessel occlusion and intracranial hemorrhage detection, to help inform patient triage and potentially reduce subsequent workload in emergency departments. Major challenges that may hamper a swift transition to more advanced prehospital care are related to conducting clinical trials in the prehospital setting to provide sufficient evidence for emergency interventions, as well as ambulance design, infrastructure, emergency medical service personnel training and workload, and cost barriers. Utilizing new technologies such as telemedicine, mobile stroke units and portable diagnostic devices, customized software applications, and smart storage space management may help surmount these challenges and establish efficient, targeted care strategies that are achievable in the prehospital setting. In this article, we delineate the paradigm of shifting advanced stroke care to the prehospital setting and outline future directions in providing evidence-based, patient-centered prehospital care. While we use acute stroke as an illustrative example, these principles are not limited to stroke patients and can be applied to prehospital triage for any time-critical disease.

Probabilistic Forecasting of Patient Waiting Times in an Emergency Department

Problem definition: We study the estimation of the probability distribution of individual patient waiting times in an emergency department (ED). Whereas it is known that waiting-time estimates can help improve patients’ overall satisfaction and prevent abandonment, existing methods focus on point forecasts, thereby completely ignoring the underlying uncertainty. Communicating only a point forecast to patients can be uninformative and potentially misleading. Methodology/results: We use the machine learning approach of quantile regression forest to produce probabilistic forecasts. Using a large patient-level data set, we extract the following categories of predictor variables: (1) calendar effects, (2) demographics, (3) staff count, (4) ED workload resulting from patient volumes, and (5) the severity of the patient condition. Our feature-rich modeling allows for dynamic updating and refinement of waiting-time estimates as patient- and ED-specific information (e.g., patient condition, ED congestion levels) is revealed during the waiting process. The proposed approach generates more accurate probabilistic and point forecasts when compared with methods proposed in the literature for modeling waiting times and rolling average benchmarks typically used in practice. Managerial implications: By providing personalized probabilistic forecasts, our approach gives low-acuity patients and first responders a more comprehensive picture of the possible waiting trajectory and provides more reliable inputs to inform prescriptive modeling of ED operations. We demonstrate that publishing probabilistic waiting-time estimates can inform patients and ambulance staff in selecting an ED from a network of EDs, which can lead to a more uniform spread of patient load across the network. Aspects relating to communicating forecast uncertainty to patients and implementing this methodology in practice are also discussed. For emergency healthcare service providers, probabilistic waiting-time estimates could assist in ambulance routing, staff allocation, and managing patient flow, which could facilitate efficient operations and cost savings and aid in better patient care and outcomes.Supplemental Material: The online supplement is available at https://doi.org/10.1287/msom.2023.1210 .

Comparative Evaluation of Dermatological Emergency Consultations in the Coronavirus Pandemic Era: Tertiary Clinic Experience.

Due to the increase in COVID-19 patients during the pandemic, the workload of emergency departments has increased. The profile of patients seeking non-COVID medical care has changed significantly because of the pandemic; this includes dermatological emergencies. The aim was to evaluate and compare adult dermatological emergency consultations during the COVID-19 period with the pre-pandemic period. Consulted patients from ED to dermatology between March 11, 2019, and March 11, 2021 were included (Pre-pandemic and pandemic). Age, gender, zone of triage, consultation hour, consultation date, consultation response time, ICD-10 codes were recorded. The total number of consultations was 639. The mean age of the patients was 44.4 in the pre-pandemic period and 46.1 in the pandemic period. The mean consultation response time was 44.4 minutes in the pre-pandemic period and 60.3 minutes in the pandemic. In the pre-pandemic period, the most common consulted diseases were herpes zoster, urticaria, and allergic contact dermatitis. During the pandemic, the most common consulted diseases were herpes zoster, other dermatitis, and urticaria. There was a statistically significant difference in the incidence of other dermatitis, impetigo/folliculitis, cutaneous vasculitis, and pruritus (p<0.05) CONCLUSIONS: Emergency departments are the busiest and fastest areas of the hospital. Pandemics such as COVID-19 may also occur in the coming years. Informing society about dermatological emergencies and adding adequate dermatology training to the training of emergency physicians will facilitate appropriate patient management in emergency departments.

“I think we still do too little”: measures to prevent violence and aggression in German emergency departments – a qualitative study

BackgroundHealthcare workers employed in emergency departments (EDs) are particularly affected by physical and verbal violence. Violent assaults can be committed by both patients and their attendants. Research on interventions for violence prevention is limited and previous studies report that ED employees feel unprepared for violent incidents. Thus, the current study aims to explore ED staff’s perceptions regarding available prevention measures, their effectiveness, barriers, and further needs in terms of violence prevention.MethodsIn accordance with the qualitative study design, 27 semi-structured interviews were conducted via telephone with doctors and nurses working in direct contact with patients in German EDs. Main subjects were advantages and disadvantages of currently available measures, barriers regarding their implementation, their perceived effectiveness, as well as further needs concerning violence prevention. The transcribed interviews were analysed according to Mayring’s qualitative content analysis.ResultsParticipants described environmental (e.g., alarm systems), organisational (e.g., security service), and individual-focused measures (staff training, verbal de-escalation). Measures perceived as effective were, for instance, communication and security service. Both demands and barriers were often related to financial constraints, e.g., staff shortage led to higher workloads and less time to consider violence prevention. In most cases, guidelines or standard operating procedures (SOPs) regarding violence prevention were missing, unknown, or not perceived as helpful in their current form. Furthermore, screening tools were not applied in any of the EDs.ConclusionsThe workload in EDs needs to be decreased in order to enable violence prevention, e.g., by reducing patient inflow or by increasing personnel. In addition, violence prevention guidelines tailored to the requirements of the respective ED need to be developed. Hospitals should supply ED staff with such guidelines, e.g., in the form of SOPs, but more importantly, prevention measures have to be practiced and communicated. Furthermore, there is a need for research on the implementation of screening tools for violent behaviour, so that the focus would shift from managing violence to preventing violence.

Work Experience of Surgical Technologists Under the COVID-19 Disaster: A Qualitative Study

Background: Due to the crisis of shortage of specialized nurses and high workload in intensive care units and emergency departments of hospitals during the COVID-19 pandemic, hospital managers had to use nurses and staff in other departments as reinforcements despite their lack of necessary competency to work in those departments. Hence, this study investigated surgical technologists' work experiences during the COVID-19 disaster. Methods: This qualitative study was conducted using the conventional content analysis method at Alborz University of Medical Sciences. The participants were 42 surgical technologists selected using purposive sampling from 14 hospitals in 10 cities of Iran. Data were collected through semi-structured interviews and analyzed in MaxQDA2 software using the content analysis method. Results: The results of this study were classified into two main categories, "challenges" and "coping strategies. The first main category consists of three subcategories, "psychological-emotional stress," "managerial crises," and "physical injuries." The second main category also includes three subcategories, "emotion-based strategy," "cognition-based strategy," and "problem-based strategy." Conclusions: The surgical technologists' experience indicated that the COVID-19 crisis posed serious challenges, mostly related to the shortage of protective facilities and the lack of adequate training about self-care and patients in wards with no work experience. Therefore, managers of hospitals should offer appropriate purposive training courses to sufficiently develop their staff's knowledge and competence to manage the crisis in pandemics or epidemics.

Patient profile and outcomes of traumatic injury: The impact of mode of arrival to the emergency department

BackgroundTraumatic injuries are of global health concern and significant contributors to Emergency Department (ED) and hospital workload. AimTo compare patterns of traumatic injuries among patient presentations to the ED across different modes of arrival (ambulance, police, or private transport) and to examine the predictors of an ED length of stay (LOS) exceeding 4 hours and hospital admission requirement. MethodsA retrospective observational study using 6 months of health data (8th October 2012–7th April 2013) of ED patient presentations made to one large, regional ED in Queensland, Australia, with a diagnosis code related to trauma. FindingsOver 6 months, 24.2% (n = 6,668) of adult patient presentations were trauma-related; most (60.9%) arrived via privately arranged transport (PAT); 38.7% were brought in by ambulance (BIBA) and 0.4% were brought in by police (BIBP). Demographics, clinical profile and patient outcomes differed based on mode of arrival. One in four patient presentations required hospital admission and 25% had an ED length of stay of >4 hours. Factors influencing hospital admission included older age, night shift, more emergent priority, and being BIBA. An ED length of stay of >4 hours was associated with older age, being BIBA, emergent nature of presentation, and hospital admission. ConclusionThe profile and outcomes of ED patient presentations with traumatic injury differs based on their mode of arrival to the ED. People BIBA were more likely to require hospital admission and have longer ED LOS, compared with those BIBP or PAT, even when controlling for covariates. Our findings may be used to inform nursing resource allocation when considering mode of arrival, especially for older people and people BIBA.

Does What Happens in the ED Stay in the ED? The Effects of Emergency Department Physician Workload on Post-ED Care Use.

Emergency department (ED) crowding has been a pressing concern in healthcare systems in the U.S. and other developed countries. As such, many researchers have studied its effects on outcomes within the ED. In contrast, we study the effects of ED crowding on system performance outside the ED-specifically, on post-ED care utilization. Further, we explore the mediating effects of care intensity in the ED on post-ED care use. We utilize a dataset assembled from more than four years of microdata from a large U.S. hospital and exhaustive billing data in an integrated health system. By using count models and instrumental variable analyses to answer the proposed research questions, we find that there is an increasing concave relationship between ED physician workload and post-ED care use. When ED workload increases from its 5th percentile to the median, the number of post-discharge care events (i.e., medical services) for patients who are discharged home from the ED increases by 5% and it is stable afterwards. Further, we identify physician test-ordering behavior as a mechanism for this effect: when the physician is busier, she responds by ordering more tests for less severe patients. We document that this "extra" testing generates "extra" post-ED care utilization for these patients. This paper contributes new insights on how physician and patient behaviors under ED crowding impact a previously unstudied system performance measure: post-ED care utilization. Our findings suggest that prior studies estimating the cost of ED crowding underestimate the true effect, as they do not consider the "extra" post-ED care utilization.

Determining the Predictors of Self-Management Behaviors in Patients With Type 2 Diabetes: An Application of Socio-Ecological Approach.

BackgroundType 2 diabetes complications are responsible for 2% of hospital emergency visits. Self-management practices are one of the most essential approaches to control type 2 diabetes. The goal of this study was to use an ecological approach to investigate the predictors of self-management behaviors in diabetes patients referred to the emergency department in Ardabil in 2020.MethodsIn this cross-sectional study, 273 individuals with type 2 diabetes who were sent to the emergency department of Imam Khomeini Educational and Medical Center in Ardabil were included using the available sample method. Demographic information questionnaires, including the Diabetes Distress Screening Tool (DDS2), General Diabetes Knowledge (DKT2), Diabetes Empowerment Questionnaire (DES-SF), Patient Health Questionnaire 9 (PHQ 9), Beliefs to Treatment Effectiveness Scale (BTES), Diabetes Self-Efficacy Scale (DSES), Chronic Illness Resources Survey (CIRS), Situational Effects Questionnaire, and Diabetes self-management support (DSMS), were all used to collect data. The independent t-test, one-way ANOVA, Pearson correlation coefficient, and multiple regression were used to analyze the data.ResultsThe results of the study showed that in the framework of ecological approach, predictors of self-management behaviors at the four levels are as follows: at the individual level—gender (p = 0.025), education (p = 0.002), duration of diabetes (p = 0.38), having a glucometer at home (p < 0.001), diabetes empowerment (p < 0.001), personal support (p = 0.002), and self-efficacy (p = 0.047); at the interpersonal level—the main health support (p < 0.001), membership in social networks (p < 0.005), family/friends support (p < 0.001), and neighborhoods support (p < 0.001); at the group and organizational level—organizational support (p = 0.013); at the community and policy level—the impact of mass media in health (p < 0.001) and situational influence (p < 0.001).ConclusionThe impact of non-individual levels, such as the environment, on a person's decision to manage diabetes is crucial. Diabetes management necessitates a significant amount of effort, which involves maintaining the health of diabetes patients and the community while also minimizing emergency department workload.

Hospital Disaster and Emergency Plan in Biological Disasters (HDEP): Coronavirus (SARS-CoV-2) COVID-19 Pandemic System Model Example

Introduction and Objectives: Man-made disasters can be grouped as technology and violence origin such disasters occur as a result of conscious or unconscious mistakes where chemical, biological, radiological, and nuclear threats are used. It has become significant for hospitals to prepare a plan, which includes information and practical actions, including all situations that require urgency and actions to be taken in emergencies that may occur in workplaces. Coronaviruses are a diverse group of viruses that infect many different animals and can cause mild to severe respiratory infections in humans. Two highly pathogenic coronaviruses of zoonotic origin, the severe acute respiratory syndrome coronavirus (SARS-CoV) and the Middle East respiratory syndrome coronavirus (MERS-CoV), emerged in humans in 2002 and 2012, respectively. At the end of 2019, the emergence of a new coronavirus, SARS-CoV-2, in the Chinese city of Wuhan caused an unusual viral pneumonia epidemic. In this study, hospital emergency management plan is examined to the currently effective pandemic element of COVID-19 disease. Methods: It reviews the current situation and recommended actions to improve the preparedness of hospitals in five critical hospital roles during disasters: executing planning and coordination, maintaining disaster capacity, training and disaster drills with the broader health and public safety communities, protection hospital and staff, and surveillance as showing. In this context, coranavirus (SARS-CoV-2) COVID-19 hospital disaster emergency plan system model has been tried to be created. While creating the system method, it proposes a model of how the primary diagnosis and intermediate treatments will be handled in the risk method for the emergency room cases and the clinic, by handling confirmed and suspected cases through both the healthcare personnel and the medical supply system. Results and Conclusions: As a result, the hospital emergency management plan can ease the emergency department workload, protect healthcare personnel, and control cross infection during the COVID-19 outbreak. Each hospital needs to create an emergency plan suitable for its own conditions. Hospitals can take interim measures, including online consultation, zoning, and epidemic priority to relieve pressure on clinical trials, reduce cross-infection, and strengthen protection of high-risk personnel.

Rationalizing the Pediatric Emergency Department Workload: an Epidemiological Profile of Presentations Before and During the COVID-19 Pandemic

Background: Infectious respiratory disease in children provides a significant seasonal workload burden to paediatric emergency departments. Studies from the Southern hemisphere during the first wave of COVID-19 had shown a decrease in seasonal paediatric respiratory infections. During the COVID-19 pandemic, predicted drops in infectious disease circulating in children led to redeployment of junior doctors in paediatric services to adult services. Methods: We extracted data on children presenting to a tertiary emergency department with a respiratory illness, comparing winter 2019-2020 (pre-COVID-19) to winter 2020-2021 (post-COVID-19). We compiled demographic and epidemiological data and compared the two groups with regards to number and type of infectious respiratory presentations, admissions, days spent in hospital, and whether intensive or high dependency support was required. Results: We have found a reduction in respiratory disease presentations post-COVID-19 compared to pre-COVID-19. These patients were more likely to be admitted but their stay was reduced, and there was a trend towards a reduction in requirement for intensive or high dependency support during their admission. Conclusion: This work supports the redeployment of junior doctors in paediatric departments to adult departments given increased demand in other areas of medical care at that time. In view of the changing landscape, we suggest the introduction of a flexible staffing format to ensure adequate support to areas with higher demand.

Impact of Emergency Department Workload on Triage Behavior

Impact of Emergency Department Workload on Triage Behavior

Rethinking preparedness planning in disaster emergency care: lessons from a beyond-surge-capacity event

BackgroundLarge-scale burn disasters can produce casualties that threaten medical care systems. This study proposes a new approach for developing hospital readiness and preparedness plan for these challenging beyond-surge-capacity events.MethodsThe Formosa Fun Coast Dust Explosion (FFCDE) was studied. Data collection consisted of in-depth interviews with clinicians from four initial receiving hospitals and their relevant hospital records. A detailed timeline of patient flow and emergency department (ED) workload changes of individual hospitals were examined to build the EDs' overload patterns. Data analysis of the multiple hospitals' responses involved chronological process-tracing analysis, synthesis, and comparison analysis in developing an integrated adaptations framework.ResultsA four-level ED overload pattern was constructed. It provided a synthesis of specifics on patient load changes and the process by which hospitals' surge capacity was overwhelmed over time. Correspondingly, an integrated 19 adaptations framework presenting holistic interrelations between adaptations was developed. Hospitals can utilize the overload patterns and overload metrics to design new scenarios with diverse demands for surge capacity. The framework can serve as an auxiliary tool for directive planning and cross-check to address the insufficiencies of preparedness plans.ConclusionsThe study examined a wide-range spectrum of emergency care responses to the FFCDE. It indicated that solely depending on policies or guidelines for preparedness plans did not contribute real readiness to MCIs. Hospitals can use the study's findings and proposal to rethink preparedness planning for the future beyond surge capacity events.

Impact of the COVID-19 Pandemic on Emergency Department Workload and Emergency Care Workers' Psychosocial Stress in the Outbreak Area.

Background and Objectives: Due to the unexpected spread of coronavirus disease 2019 (COVID-19), there was a serious crisis of emergency medical system collapse. Healthcare workers working in the emergency department were faced with psychosocial stress and workload changes. Materials and Methods: This was a cross-sectional survey of healthcare workers in the emergency department in Daegu and Gyeongbuk, Korea, from November 16 to 25, 2020. In the survey, we assessed the general characteristics of the respondents; changes in the working conditions before and after the COVID-19 pandemic; and resulting post-traumatic stress disorder, depression and anxiety statuses using 49 questions. Results: A total of 529 responses were collected, and 520 responses were included for the final analyses. Changes in working conditions and other factors due to COVID-19 varied by emergency department level, region and disease group. Working hours, intensity, role changes, depression and anxiety scores were higher in the higher level emergency department. Isolation ward insufficiency and the risk of infection felt by healthcare workers tended to increase in the lower level emergency department. Treatment and transfer delay were higher in the fever and respiratory disease groups (M = 3.58, SD = 1.18; M = 4.08, SD = 0.95), respectively. In all the disease groups, both treatment and transfer were delayed more in Gyeongbuk than in Daegu. Conclusions: Different goals should be pursued by the levels and region of the emergency department to overcome the effects of the COVID-19 pandemic and promote optimal care.

Impact of a digital care logistics system on care duration, consumer satisfaction and shift leaders' workload in emergency departments

The primary goal of introducing digital information systems in healthcare organisations is to improve care processes and outcomes, however, studies that investigate the impact of digital information systems on the day-to-day operations management from the perspective of workflow and consumer satisfaction in emergency departments are scarce. Therefore, this study aimed to explore the impact of a digital clinical logistics system on the duration of patient care, consumer satisfaction and shift leaders' experience of workload in emergency departments. A longitudinal prospective design was used. Three units participated in the study; an intervention unit, a control unit A (no implemented system) and a control unit B (system already in use). We collected data on care duration, consumer satisfaction and shift leaders' experience of workload for four weeks at five time points both before system implementation (summer 2015, spring 2016) and after system implementation (summer 2016, autumn 2016, winter 2016). The average care duration time increased in the postimplementation period in the intervention and control B units (p &lt; 0.001). Duration of care was higher in the intervention unit than control unit B in summer 2016 (p &lt; 0.001) and winter 2016 (p = 0.009). Similarly, duration of care in control unit A was higher than control unit B in spring 2016 (p &lt; 0.001). Consumer satisfaction decreased in the intervention unit, in winter 2016 (p &lt; 0.001) and the experience of workload increased in the intervention unit, in summer 2016 and autumn 2016 (p &lt; 0.05). However, the patients-to-nurses ratio was doubled in the intervention unit in the last time point postimplementation when compared to the first timepoint, while it remained similar in the control units throughout the study period. This work demonstrated that a digital care logistics system may support in increasing the number of patients treated with the same nursing resources. However, this seems to connect to other outcome variables such as increased care duration, increased experience of workload and decreased consumer satisfaction in some postimplementation time points.

Changing Admission Patterns in Pediatric Emergency Departments during the COVID-19 Pandemic in Italy Were Due to Reductions in Inappropriate Accesses.

During the initial phase of the national lockdown, we found that there were sharp decreases in admissions to two pediatric emergency departments (EDs) in northern Italy (Cremona and Novara). Here we present a detailed analysis of these admission patterns and types of admissions over a longer timeframe. ED admissions data were anonymously extracted from the departmental management software. Admissions data from 2019 and 2020 were analyzed and compared separately for each ED and combined. There was a 73.2% decrease in total admissions compared with the same period in 2019. With respect to admission diagnoses, there was a significant (p < 0.001) drop in infectious (−51%), respiratory (−25.5%), and nervous systems diseases (−50%) and injuries and poisoning (−17%) but not endocrine, metabolic, neoplastic, circulatory, or musculoskeletal diseases. White codes (patients with minor injuries for whom ED medical care is not required) significantly decreased by 56.3% (p < 0.001). Even if the COVID-19 pandemic represented an enormous healthcare burden in Italy, especially during the first months of the pandemic (late February to May), the workload of pediatric EDs was significantly reduced, especially for unnecessary accesses (white codes).