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10 pages, 1283 KiB

Open AccessArticle

Development of a Bamlanivimab Infusion Process in the Emergency Department for Outpatient COVID-19 Patients

by Danny H. Pham, Sandy Wong, Christina T. Nguyen, Stephen C. Lee and Kimberly J. Won

Healthcare 2022, 10(1), 42; https://doi.org/10.3390/healthcare10010042 - 27 Dec 2021

Cited by 3 | Viewed by 2202

Abstract

The coronavirus disease 2019 (COVID-19) pandemic has prompted the creation of new therapies to help fight against the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Bamlanivimab is a SARS-CoV-2 monoclonal antibody that is administered as an intravenous infusion to ambulatory patients with [...] Read more.

The coronavirus disease 2019 (COVID-19) pandemic has prompted the creation of new therapies to help fight against the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Bamlanivimab is a SARS-CoV-2 monoclonal antibody that is administered as an intravenous infusion to ambulatory patients with mild or moderate COVID-19, but a concern that arose was deciding the optimal location for patients to receive the medication. This report describes the development and implementation of a bamlanivimab infusion center in the emergency department of three hospitals in Orange County, California, shortly after bamlanivimab received emergency use authorization. As a result, a total of 601 patients received bamlanivimab in one of these three emergency departments between December 2020 to April 2021. The emergency department was shown to be an optimal setting for administration of bamlanivimab due to its convenience, accessibility, and capabilities for monitoring patients. Full article

(This article belongs to the Special Issue Innovations in the Emergency Department)

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10 pages, 1102 KiB

Open AccessArticle

Risk Factors for Early Return Visits to the Emergency Department in Patients Presenting with Nonspecific Abdominal Pain and the Use of Computed Tomography Scan

by Fei-Fei Flora Yau, Ying Yang, Chi-Yung Cheng, Chao-Jui Li, Su-Hung Wang and I-Min Chiu

Healthcare 2021, 9(11), 1470; https://doi.org/10.3390/healthcare9111470 - 30 Oct 2021

Cited by 5 | Viewed by 1670 | Correction

Abstract

Over a quarter of patients presenting with abdominal pain at emergency departments (EDs) are diagnosed with nonspecific abdominal pain (NSAP) at discharge. This study investigated the risk factors associated with return ED visits in Taiwanese patients with NSAP after discharge. We divided patients [...] Read more.

Over a quarter of patients presenting with abdominal pain at emergency departments (EDs) are diagnosed with nonspecific abdominal pain (NSAP) at discharge. This study investigated the risk factors associated with return ED visits in Taiwanese patients with NSAP after discharge. We divided patients into two groups: the study group comprising patients with ED revisits after the index ED visit, and the control group comprising patients without revisits. During the study period, 10,341 patients discharged with the impression of NSAP after ED management. A regression analysis found that older age (OR [95%CI]: 1.007 [1.003–1.011], p = 0.004), male sex (OR [95%CI]: 1.307 [1.036–1.650], p = 0.024), and use of NSAIDs (OR [95%CI]: 1.563 [1.219–2.003], p < 0.001) and opioids (OR [95%CI]: 2.213 [1.643–2.930], p < 0.001) during the index visit were associated with increased return ED visits. Computed tomography (CT) scans (OR [95%CI]: 0.605 [0.390–0.937], p = 0.021) were associated with decreased ED returns, especially for those who were older than 60, who had an underlying disease, or who required pain control during the index ED visit. Full article

(This article belongs to the Special Issue Innovations in the Emergency Department)

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10 pages, 798 KiB

Open AccessArticle

The Feasibility of Using Machine Learning to Classify Calls to South African Emergency Dispatch Centres According to Prehospital Diagnosis, by Utilising Caller Descriptions of the Incident

by Tayla Anthony, Amit Kumar Mishra, Willem Stassen and Jarryd Son

Healthcare 2021, 9(9), 1107; https://doi.org/10.3390/healthcare9091107 - 27 Aug 2021

Cited by 2 | Viewed by 3932

Abstract

This paper presents the application of machine learning for classifying time-critical conditions namely sepsis, myocardial infarction and cardiac arrest, based off transcriptions of emergency calls from emergency services dispatch centers in South Africa. In this study we present results from the application of [...] Read more.

This paper presents the application of machine learning for classifying time-critical conditions namely sepsis, myocardial infarction and cardiac arrest, based off transcriptions of emergency calls from emergency services dispatch centers in South Africa. In this study we present results from the application of four multi-class classification algorithms: Support Vector Machine (SVM), Logistic Regression, Random Forest and K-Nearest Neighbor (kNN). The application of machine learning for classifying time-critical diseases may allow for earlier identification, adequate telephonic triage, and quicker response times of the appropriate cadre of emergency care personnel. The data set consisted of an original data set of 93 examples which was further expanded through the use of data augmentation. Two feature extraction techniques were investigated namely; TF-IDF and handcrafted features. The results were further improved using hyper-parameter tuning and feature selection. In our work, within the limitations of a limited data set, classification results yielded an accuracy of up to 100% when training with 10-fold cross validation, and 95% accuracy when predicted on unseen data. The results are encouraging and show that automated diagnosis based on emergency dispatch centre transcriptions is feasible. When implemented in real time, this can have multiple utilities, e.g. enabling the call-takers to take the right action with the right priority. Full article

(This article belongs to the Special Issue Innovations in the Emergency Department)

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9 pages, 1810 KiB

Open AccessCommunication

Use of a Unique Mobile Medical Asset in COVID Monoclonal Antibody Treatment

by Herman Morchel, David Clark, Leighanne Buenvenida and Chinwe Ogedegbe

Healthcare 2021, 9(8), 990; https://doi.org/10.3390/healthcare9080990 - 4 Aug 2021

Cited by 2 | Viewed by 1863

Abstract

The COVID-19 pandemic and the subsequent surge of patients presented to emergency departments has forever changed the paradigm of delivering emergency care. The highly infectious nature of the 2019 Novel Coronavirus, or COVID-19, mandated strict environmental changes, novel patient care, and flexible strategies [...] Read more.

The COVID-19 pandemic and the subsequent surge of patients presented to emergency departments has forever changed the paradigm of delivering emergency care. The highly infectious nature of the 2019 Novel Coronavirus, or COVID-19, mandated strict environmental changes, novel patient care, and flexible strategies to continue to deliver efficient emergency care while maintaining appropriate physical distancing between suspect and non-suspect COVID-19 patients. The engagement of a unique rapidly deployable Mobile Satellite Emergency Department (MSED) with scalable capability from prompt care to resuscitation level allowed the emergency care team to optimize patient care and throughput. The MSED was strategically located adjacent to the ambulance entrance. While initially deployed to increase Emergency Department surge capacity, the MSED was repurposed to cohort and treat COVID patients with the monoclonal antibody, Bamlanivimab, who were expected to be discharged after treatment. This allowed for more efficient use of Emergency Department resources, including physical space and staffing. Full article

(This article belongs to the Special Issue Innovations in the Emergency Department)

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5 pages, 990 KiB

Open AccessCommunication

Pattern of Visits in a Metropolitan Emergency Department in Lombardia (Italy): January 2019–December 2020

by Simone Gambazza, Alessandro Galazzi, Filippo Binda, Onorina Passeri, Paola Bosco, Giorgio Costantino and Dario Laquintana

Healthcare 2021, 9(7), 791; https://doi.org/10.3390/healthcare9070791 - 24 Jun 2021

Cited by 2 | Viewed by 1547

Abstract

During the Coronavirus disease 2019 (COVID-19), a general decrease in the presentations to emergency departments (ED) was reported. However, we suspect that there was a lower number but an unchanged pattern of ED visits for urgent conditions in 2020 compared to 2019. This [...] Read more.

During the Coronavirus disease 2019 (COVID-19), a general decrease in the presentations to emergency departments (ED) was reported. However, we suspect that there was a lower number but an unchanged pattern of ED visits for urgent conditions in 2020 compared to 2019. This retrospective study assessed the change in the number of presentations in the ED of a tertiary level university hospital in Milano (Lombardia, Italy). Compared to 2019, a significant drop in ED presentations occurred (−46.4%), and we recorded a −15.7% difference in the proportion of patients admitted with white codes. The pattern of hourly presentations to the ED was unchanged, with overcrowding during the working daytime. COVID-19 changed ED flows, likely causing an overall reduction in the number of deferrable conditions. However, the pattern associated with urgent conditions did not change abruptly in 2020. Full article

(This article belongs to the Special Issue Innovations in the Emergency Department)

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7 pages, 228 KiB

Open AccessArticle

In-Hospital Outcomes in Patients Admitted to the Intensive Care Unit after a Return Visit to the Emergency Department

by Chun-Fu Lin, Yi-Syun Huang, Ming-Ta Tsai, Kuan-Han Wu, Chien-Fu Lin and I-Min Chiu

Healthcare 2021, 9(4), 431; https://doi.org/10.3390/healthcare9040431 - 7 Apr 2021

Cited by 1 | Viewed by 1680

Abstract

Background: Intensive care unit (ICU) admission following a short-term emergency department (ED) revisit has been considered a particularly undesirable outcome among return-visit patients, although their in-hospital prognosis has not been discussed. We aimed to compare clinical outcomes between adult patients admitted to the [...] Read more.

Background: Intensive care unit (ICU) admission following a short-term emergency department (ED) revisit has been considered a particularly undesirable outcome among return-visit patients, although their in-hospital prognosis has not been discussed. We aimed to compare clinical outcomes between adult patients admitted to the ICU after unscheduled ED revisits and those admitted during index ED visits. Method: This retrospective study was conducted at two tertiary medical centers in Taiwan from 1 January 2016 to 31 December 2017. All adult non-trauma patients admitted to the ICU directly via the ED during the study period were included and divided into two comparison groups: patients admitted to the ICU during index ED visits and those admitted to the ICU during return ED visits. The outcomes of interest included in-hospital mortality, mechanical ventilation (MV) support, profound shock, hospital length of stay (HLOS), and total medical cost. Results: Altogether, 12,075 patients with a mean (standard deviation) age of 64.6 (15.7) years were included. Among these, 5.3% were admitted to the ICU following a return ED visit within 14 days and 3.1% were admitted following a return ED visit within 7 days. After adjusting for confounding factors for multivariate regression analysis, ICU admission following an ED revisit within 14 days was not associated with an increased mortality rate (adjusted odds ratio (aOR): 1.08, 95% confidence interval (CI): 0.89 to 1.32), MV support (aOR: 1.06, 95% CI: 0.89 to 1.26), profound shock (aOR: 0.99, 95% CI: 0.84 to 1.18), prolonged HLOS (difference: 0.04 days, 95% CI: −1.02 to 1.09), and increased total medical cost (difference: USD 361, 95% CI: −303 to 1025). Similar results were observed after the regression analysis in patients that had a 7-day return visit. Conclusion: ICU admission following a return ED visit was not associated with major in-hospital outcomes including mortality, MV support, shock, increased HLOS, or medical cost. Although ICU admissions following ED revisits are considered serious adverse events, they may not indicate poor prognosis in ED practice. Full article

(This article belongs to the Special Issue Innovations in the Emergency Department)

13 pages, 247 KiB

Open AccessArticle

The Meaning of Boarding in a Swedish Accident & Emergency Department: A Qualitative Study on Patients’ Experiences of Awaiting Admission

by Andreas Rantala, Sören Nordh, Mergime Dvorani and Anna Forsberg

Healthcare 2021, 9(1), 66; https://doi.org/10.3390/healthcare9010066 - 12 Jan 2021

Cited by 6 | Viewed by 3518

Abstract

The number of in-hospital beds in Sweden has decreased during recent decades, resulting in the smallest number (2.2 available beds/1000 inhabitants) within the European Union. At the same time, the number of patients attending Accident and Emergency (A&E) departments has increased, resulting in [...] Read more.

The number of in-hospital beds in Sweden has decreased during recent decades, resulting in the smallest number (2.2 available beds/1000 inhabitants) within the European Union. At the same time, the number of patients attending Accident and Emergency (A&E) departments has increased, resulting in overcrowding and boarding. The aim of this study was to explore the meaning of being subjected to boarding at an A&E department, as experienced by patients. A phenomenological-hermeneutic approach was chosen to interpret and understand the meaning of boarding at A&E. The study was carried out at a hospital in the south of Sweden. Seventeen participants with a mean age of 64 years (range: 35–86 years) were interviewed. The thematic structural analysis covers seven themes: Being in a state of uncertainty, Feeling abandoned, Fearing death, Enduring, Adjusting to the circumstances, Being a visitor in an unsafe place, and Acknowledging the staff, all illustrating that the participants were in a state of constant uncertainty and felt abandoned with no guidance or support from the clinicians. The conclusion is that the situation where patients are forced to wait in A&E, i.e., boarding, violates all conditions for professional ethics, presumably causing profound ethical stress in the healthcare professionals involved. Thus, boarding should be avoided. Full article

(This article belongs to the Special Issue Innovations in the Emergency Department)

10 pages, 262 KiB

Open AccessArticle

Comparison of Long-Term Effects between Chest Compression-Only CPR Training and Conventional CPR Training on CPR Skills among Police Officers

by Byung-Jun Cho and Seon-Rye Kim

Healthcare 2021, 9(1), 34; https://doi.org/10.3390/healthcare9010034 - 2 Jan 2021

Cited by 7 | Viewed by 2280

Abstract

Despite of the changes of out-of-hospital cardiac arrest (OHCA) survival rise when bystander CPR is provided, this was only conducted in about 23% of OHCA patients in Korea in 2018. Police officers acting as first responders have a high chance of witnessing situations [...] Read more.

Despite of the changes of out-of-hospital cardiac arrest (OHCA) survival rise when bystander CPR is provided, this was only conducted in about 23% of OHCA patients in Korea in 2018. Police officers acting as first responders have a high chance of witnessing situations requiring CPR. We investigated long-term effects on CPR quality between chest compression-only CPR training and conventional CPR training in police officers to find an efficient CPR training method in a prospective, randomized, controlled trial. Police officers underwent randomization and received different CPR training. With the Brayden Pro application, we compared the accuracy of CPR skills immediately after training and the one after 3 months. Right after training, the conventional CPR group presented the accuracy of the CPR skills (compression rate: 74.6%, compression depth: 66.0%, recoil: 78.0%, compression position: 96.1%) and chest compression-only CPR group presented the accuracy of the CPR skills (compression rate: 74.5%, compression depth: 71.6%, recoil: 79.2%, compression position: 99.0%). Overall, both groups showed the good quality of CPR skills and had no meaningful difference right after the training. However, three months after training, overall accuracy of CPR skills decreased, a significant difference between two groups was observed for compression position (conventional CPR: 80.0%, chest compression only CPR: 95.0%). In multiple linear regression analysis, three months after CPR training, chest compression-only CPR training made CPR skills accuracy 28.5% higher. In conclusion, police officers showed good-quality CPR right after CPR training in both groups. But three months later, chest compression-only CPR training group had better retention of CPR skills. Therefore, chest compression-only CPR training is better to be a standard training method for police officers as first responders. Full article

(This article belongs to the Special Issue Innovations in the Emergency Department)

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1 pages, 154 KiB

Open AccessCorrection

Correction: Yau et al. Risk Factors for Early Return Visits to the Emergency Department in Patients Presenting with Nonspecific Abdominal Pain and the Use of Computed Tomography Scan. Healthcare 2021, 9, 1470

by Fei-Fei Flora Yau, Ying Yang, Chi-Yung Cheng, Chao-Jui Li, Su-Hung Wang and I-Min Chiu

Healthcare 2022, 10(1), 136; https://doi.org/10.3390/healthcare10010136 - 11 Jan 2022

Viewed by 812

Abstract

The authors would like to make corrections to their published paper [...] Full article

(This article belongs to the Special Issue Innovations in the Emergency Department)

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