scholarly journals How to keep patients and staff safe from accidental SARS-CoV-2 exposure in the emergency room: Lessons from South Korea’s explosive COVID-19 outbreak

2020 ◽  
Vol 42 (1) ◽  
pp. 18-24
Author(s):  
Yun Jeong Kim ◽  
Jae Young Choe ◽  
Ki Tae Kwon ◽  
Soyoon Hwang ◽  
Gyu-Seog Choi ◽  
...  
Keyword(s):  
Emergency Room ◽  
Tertiary Care ◽  
Turnaround Time ◽  
Nosocomial Transmission ◽  
Care Hospital ◽  
Accidental Exposure ◽  
Radiographic Findings ◽  
Active Isolation ◽  
Polymerase Chain ◽  
Respiratory Coronavirus

AbstractObjectives:We report our experience with an emergency room (ER) shutdown related to an accidental exposure to a patient with coronavirus disease 2019 (COVID-19) who had not been isolated.Setting:A 635-bed, tertiary-care hospital in Daegu, South Korea.Methods:To prevent nosocomial transmission of the disease, we subsequently isolated patients with suspected symptoms, relevant radiographic findings, or epidemiology. Severe acute respiratory coronavirus 2 (SARS-CoV-2) reverse-transcriptase polymerase chain reaction assays (RT-PCR) were performed for most patients requiring hospitalization. A universal mask policy and comprehensive use of personal protective equipment (PPE) were implemented. We analyzed effects of these interventions.Results:From the pre-shutdown period (February 10–25, 2020) to the post-shutdown period (February 28 to March 16, 2020), the mean hourly turnaround time decreased from 23:31 ±6:43 hours to 9:27 ±3:41 hours (P < .001). As a result, the proportion of the patients tested increased from 5.8% (N=1,037) to 64.6% (N=690) (P < .001) and the average number of tests per day increased from 3.8±4.3 to 24.7±5.0 (P < .001). All 23 patients with COVID-19 in the post-shutdown period were isolated in the ER without any problematic accidental exposure or nosocomial transmission. After the shutdown, several metrics increased. The median duration of stay in the ER among hospitalized patients increased from 4:30 hours (interquartile range [IQR], 2:17–9:48) to 14:33 hours (IQR, 6:55–24:50) (P < .001). Rates of intensive care unit admissions increased from 1.4% to 2.9% (P = .023), and mortality increased from 0.9% to 3.0% (P = .001).Conclusions:Problematic accidental exposure and nosocomial transmission of COVID-19 can be successfully prevented through active isolation and surveillance policies and comprehensive PPE use despite longer ER stays and the presence of more severely ill patients during a severe COVID-19 outbreak.

scholarly journals Impact of Rapid PCR Influenza Testing on the Rate of Inpatient Admissions During Influenza Season at a Tertiary-Care Center

2020 ◽  
Vol 41 (S1) ◽  
pp. s263-s264
Author(s):  
Jordan Polistico ◽  
Avnish Sandhu ◽  
Teena Chopra ◽  
Erin Goldman ◽  
Jennifer LeRose ◽  
...  
Keyword(s):  
Influenza Season ◽  
Care Center ◽  
Tertiary Care ◽  
The United States ◽  
Turnaround Time ◽  
Care Hospital ◽  
Tertiary Care Center ◽  
Pediatric Hospital ◽  
Rapid Pcr ◽  
The Impact

Background: Influenza causes a high burden of disease in the United States, with an estimate of 960,000 hospitalizations in the 2017–2018 flu season. Traditional flu diagnostic polymerase chain reaction (PCR) tests have a longer (24 hours or more) turnaround time that may lead to an increase in unnecessary inpatient admissions during peak influenza season. A new point-of-care rapid PCR assays, Xpert Flu, is an FDA-approved PCR test that has a significant decrease in turnaround time (2 hours). The present study sought to understand the impact of implementing a new Xpert Flu test on the rate of inpatient admissions. Methods: A retrospective study was conducted to compare rates of inpatient admissions in patients tested with traditional flu PCR during the 2017–2018 flu season and the rapid flu PCR during the 2018–2019 flu season in a tertiary-care center in greater Detroit area. The center has 1 pediatric hospital (hospital A) and 3 adult hospitals (hospital B, C, D). Patients with influenza-like illness who presented to all 4 hospitals during 2 consecutive influenza seasons were analyzed. Results: In total, 20,923 patients were tested with either the rapid flu PCR or the traditional flu PCR. Among these, 14,124 patients (67.2%) were discharged from the emergency department and 6,844 (32.7%) were admitted. There was a significant decrease in inpatient admissions in the traditional flu PCR group compared to the rapid flu PCR group across all hospitals (49.56% vs 26.6% respectively; P < .001). As expected, a significant proportion of influenza testing was performed in the pediatric hospital, 10,513 (50.2%). A greater reduction (30% decrease in the rapid flu PCR group compared to the traditional flu PCR group) was observed in inpatient admissions in the pediatric hospital (Table 1) Conclusions: Rapid molecular influenza testing can significantly decrease inpatient admissions in a busy tertiary-care hospital, which can indirectly lead to improved patient quality with easy bed availability and less time spent in a private room with droplet precautions. Last but not the least, this testing method can certainly lead to lower healthcare costs.Funding: NoneDisclosures: None

Nosocomial Transmission of Methicillin-Resistant Staphylococcus aureus: A Blinded Study to Establish Baseline Acquisition Rates

2003 ◽  
Vol 24 (6) ◽  
pp. 415-421 ◽  
Author(s):  
Joel T. Fishbain ◽  
Joseph C. Lee ◽  
Honghung D. Nguyen ◽  
Jeffery A. Mikita ◽  
Cecilia P. Mikita ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Transmission Rate ◽  
Tertiary Care ◽  
Pediatric Intensive Care ◽  
Nosocomial Transmission ◽  
Surveillance Culture ◽  
Care Hospital ◽  
Average Hospital ◽  
Methicillin Resistant ◽  
History Of

AbstractObjective:To define the extent of nosocomial transmission of methicillin-resistant Staphylococcus aureus (MRSA) in patients admitted to a tertiary-care hospital.Design:A blinded, prospective surveillance culture study of patients admitted to the hospital to determine the transmission (acquisition) rate of MRSA Risk factors associated with the likelihood of MRSA colonization on admission were investigated.Setting:Tertiary-care military medical facility.Participants:All patients admitted to the medicine, surgery, and pediatric wards, and to the medical, surgical, and pediatric intensive care units were eligible for inclusion.Results:Five hundred thirty-five admission and 374 discharge samples were collected during the study period. One hundred forty-one patients were colonized with methicillin-susceptible S. aureus (MSSA) and 20 patients (3.7%) were colonized with MRSA on admission. Of the 354 susceptible patients, 6 acquired MRSA during the study for a transmission rate of 1.7%. Patients colonized with MRSA on admission were more likely to be older than non-colonized or MSSA-colonized patients, to have received antibiotics within the past year, to have been hospitalized within the prior 3 years, or to have a known history of MRSA. Patients acquiring MRSA had an average hospital stay of 17.7 days compared with 5.3 days for those who did not acquire MRSA. Pulsed-field gel electrophoresis of the 6 MRSA isolates from patients who acquired MRSA revealed 4 distinct band patterns.Conclusions:Most patients colonized with MRSA were identified on admission samples. Surveillance cultures of patients admitted may help to prevent MRSA transmission and infection.

scholarly journals Neurological diagnoses in the emergency room: differences between younger and older patients

2011 ◽  
Vol 69 (2a) ◽  
pp. 212-216 ◽  
Author(s):  
Marcos C. Lange ◽  
Vera L. Braatz ◽  
Carolina Tomiyoshi ◽  
Felipe M. Nóvak ◽  
Artur F. Fernandes ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Emergency Room ◽  
Older Patients ◽  
Tertiary Care Hospital ◽  
Neurological Diseases ◽  
Tertiary Care ◽  
Primary Headache ◽  
Care Hospital ◽  
National Guidelines ◽  
And Training

Neurological diseases are prevalent in the emergency room (ER). The aim of this study was to compare the neurological diagnoses between younger and older patients evaluated in the ER of a tertiary care hospital. METHOD: Patients admitted to the ER who required neurological evaluation in the first 24 hours were separated into two groups based on age, <;50 years old and >50 years old. RESULTS: Cerebrovascular disease (59.6% vs. 21.8%, p<0.01) was most frequent in the >50 years old group. Seizures (8.1% vs. 18.6%, p<0.01) and primary headache (3.7% vs. 11.4%, p<0.01) were most frequent in the <;50 years old group. CONCLUSION: The current study demonstrated that these three neurological diagnoses represented the majority of the neurological evaluations in the ER. National guidelines for ER teams that treat these prevalent disorders must be included in clinical practice and training.

Norovirus in a Dutch tertiary care hospital (2002–2007): frequent nosocomial transmission and dominance of GIIb strains in young children

2009 ◽  
Vol 71 (3) ◽  
pp. 199-205 ◽  
Author(s):  
M.F.C. Beersma ◽  
M. Schutten ◽  
H. Vennema ◽  
N.G. Hartwig ◽  
T.H.M. Mes ◽  
...  
Keyword(s):  
Young Children ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Nosocomial Transmission ◽  
Care Hospital

scholarly journals Is it time to rethink how we page physicians? Understanding paging patterns in a tertiary care hospital

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Luke Witherspoon ◽  
Emily Nham ◽  
Hamidreza Abdi ◽  
Ali Dergham ◽  
Thomas Skinner ◽  
...  
Keyword(s):  
Emergency Room ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Temporal Trends ◽  
Care Hospital ◽  
Surgical Service ◽  
Physician Burnout ◽  
Ottawa Hospital ◽  
Hospital Units ◽  
Median Interval

Abstract Background Frequent pages can disrupt workflow, interrupt patient care, and may contribute to physician burnout. We hypothesized that paging volumes followed consistent temporal trends, regardless of the medical or surgical service, reflecting systems based issues present in our hospitals. Methods A retrospective review of the hospital paging systems for 4 services at The Ottawa Hospital was performed. Resident paging data from April 1 to July 31, 2018 were collected for services with a single primary pager number including orthopaedic surgery, general surgery, neurology, and neurosurgery. Trends in paging volume during the 4-month period were examined. Variables examined included the location of origin of the page (emergency room vs. inpatient unit), and day/time of the page. Results During the study period, 25,797 pages were received by the 4 services, averaging 211 (± Standard Deviation (SD) 12) pages per day. 19,371 (75%) pages were from in-patient hospital units, while 6426 (24%) were pages from the emergency room. The median interval between pages across all specialties was 22:30 min. Emergency room pages peaked between 16:30 and 20:00, while in-patient units peaked between 17:30 and 18:30. Conclusions Each service experienced frequent paging with similar patterns of marked increases at specific times. This study identifies areas for future study about what the factors are that contribute to the paging patterns observed.

Assessing Issues of Overcrowding in Emergency Room of a Tertiary Care Hospital

2014 ◽  
Vol 6 (2) ◽  
pp. 220
Author(s):  
Muslim Shah ◽  
Neelam Saleem Punjani ◽  
Shaista Rajani Meghani ◽  
Sahreen Malik Bhanji
Keyword(s):  
Emergency Room ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital

Profile of Patients Hospitalized through the Emergency Room to the Medicine Ward and their Short-term Outcome at a Tertiary Care Hospital in Delhi

2015 ◽  
Vol 30 (6) ◽  
pp. 593-598 ◽  
Author(s):  
Rahul Choudhary ◽  
Ashish Goel ◽  
Sonal Pruthi ◽  
Sarathi Kalra ◽  
Sunil Agarwal ◽  
...  
Keyword(s):  
Emergency Room ◽  
Tertiary Care Hospital ◽  
Mmse Score ◽  
Tertiary Care ◽  
Care Hospital ◽  
Short Term ◽  
Term Outcome ◽  
Arterial Blood ◽  
Short Term Outcome ◽  
Gcs Score

AbstractIntroductionWith an increasing number of sicker patients, limited hospital beds, and an emphasis on day care, the profile of patients hospitalized to medicine wards has undergone a radical re-definition. The increasing share of patients hospitalized through the emergency department for acute care to medicine wards has left little space for hospitalization through the outpatient department (OPD). There are some global data available on the profile of patients presenting to the emergency rooms (ERs) and their subsequent outcome. Data from developing countries, especially India, in this regard are lacking.MethodsThis cross-sectional study included all patients hospitalized to the medicine ward through the medical emergency services, provided by the Department of Medicine, each Wednesday and every sixth Sunday for the entire year (a total of 62 days), from November 2010 through October 2011, and followed their outcome up to seven days after hospitalization.ResultsOf the 3,618 cases presenting to medicine emergency on these days, 1,547 (42.3%) were advised admission. Nine hundred sixty-seven reported to the medicine wards. One hundred eleven (7.73%) expired within 24 hours; others absconded, were lost in transit, did not consent to participation, or were discharged. During the next seven days, 452 (46.7%) recovered sufficiently and were discharged to go home. Two hundred thirty (23.8%) left the hospital without informing the medical staff. Fourteen (1.4%) patients were transferred to other departments. One hundred thirty-seven (8.8%) patients died during the next six days of hospitalization. After Multivariate Logistic Regression analysis, abnormal Glasgow Coma Scale (GCS) score, high systolic blood pressure (BP), age, increased total leucocyte count, increased globulin, low bicarbonate in arterial blood, low Mini Mental Status Examination (MMSE) score, and a raised urea >40 mg/dL were found to be associated significantly with mortality.ConclusionOf the 1,547 patients who needed urgent hospitalization, 248 (16%) died within the first week, one-half of them within the first 24 hours. An advanced age, abnormal GCS score, low MMSE score, increased systolic BP, leukocytosis, acidosis, and uremia were found to be associated with a fatal outcome. Therefore, nearly one-half of the patients who would have a fatal short-term outcome were likely to do so within the first 24 hours, making the first day of presentation “the golden day” period.ChoudharyR, GoelA, PruthiS, KalraS, AgarwalS, KalraOP. Profile of patients hospitalized through the emergency room to the medicine ward and their short-term outcome at a tertiary care hospital in Delhi. Prehosp Disaster Med. 2015;30(6):593–598.

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