Impacts of COVID-19 on Global Healthcare Management and Research

The Coronavirus Infectious Disease 2019 (COVID-19) pandemic has affected most nations at all levels of functioning, individual to governmental. Therefore, it is imperative to evaluate the effects the virus has had on one of the most important socioeconomic global sectors, healthcare. This literature review explores key, recent research and management strategies that have been undertaken in healthcare systems around the world in order to make meaningful attempts at identifying the etiology, diagnosis, and treatment of the disease, and combating the spread of this deadly virus. Healthcare facilities have implemented a variety of changes, all geared towards reducing non-emergency patient visits and preventing transmission of the infection; this includes shifting appointments to online modality via telecommunication use, altering remedial options and procedures, and developing more effective personal protective equipment (PPE). Efforts have also been made to define appropriate treatment methods as well as a potential cure for COVID-19; many vaccines and antiviral drugs have been designed or are continuing to undergo clinical testing, and symptom management approaches are being employed along with careful evaluation or recommendation of already available medications to counter the disease. Our comprehensive analysis provides insights into prominent consequences as well as implications of COVID-19 in contemporary global healthcare research and management, and would help this crucial sector be better prepared for pandemics in the future.

The emergency patient

This chapter discusses the management of the emergency patient. It begins with tracheal intubation of critically ill adults then discusses sepsis and septic shock, the emergency laparotomy, the ICU patient going to theatre and transferring the critically ill.

Trends of Antibiotic Use and Expenditure After an Intensified Antimicrobial Stewardship Policy at a 2,200-Bed Teaching Hospital in China

Objective: This study aimed to evaluate the effects of intensified Chinese special rectification activity on clinical antibiotic use (CSRA) policy on a tertiary-care teaching hospital.Methods: A 48-month longitudinal dataset involving inpatients, outpatients, and emergency patients were collected. Study period included pre-intervention stage (adopting soft measures like systemic training) and post-intervention stage (applying antibiotic control system to intensify CSRA policy). Antibiotic use was evaluated by antibiotic use rate (AUR) or antibiotic use density (AUD). Economic indicator was evaluated by antibiotic cost in prescription or antibiotic expenditure in hospitalization. Data was analyzed by interrupted time series (ITS) analysis.Results: The medical quality indicators remained stable or improved during the study period. AUR of inpatients (AURI) declined 0.553% per month (P = 0.025) before the intervention and declined 0.354% per month (P = 0.471) after the intensified CSRA policy was implemented. AUD, expressed as defined daily doses per 100 patients per day (DDDs/100PD), decreased by 1.102 DDDs/100PD per month (P = 0.021) before and decreased by 0.597 DDDs/100PD per month (P = 0.323) thereafter. The ratio of antibiotic expenditure to medication expenditure (AE/ME) decreased by 0.510% per month (P = 0.000) before and fell by 0.096% (P = 0.000) per month thereafter. AE per patient decreased by 25.309 yuan per month (P = 0.002) before and decreased by 7.987 yuan per month (P = 0.053) thereafter. AUR of outpatient (AURO) decreased by 0.065% per month before (P = 0.550) and decreased by 0.066% per month (P = 0.994) thereafter. The ratio of antibiotic cost to prescription cost in outpatient (ACO/PCO) decreased by 0.182% per month (P = 0.506) before and decreased by 0.216% per month (P = 0.906) thereafter. AUR of emergency patient (AURE) decreased by 0.400% per month (P = 0.044) before and decreased by 0.092% per month (P = 0.164) thereafter. The ratio of antibiotic cost to prescription cost in emergency patient (ACE/PCE) decreased by 0.616% per month (P < 0.001) before and decreased by 0.151% per month (P < 0.001) thereafter.Conclusions: Implementation of CSRA policy was associated with declining antibiotic use and antibiotic expenditure in inpatients, outpatients, and emergency patients. However, it is also important to note that the declining trend of antibiotic consumption slowed due to the limited capacity for decline in the later stages of CSRA intervention.

The Impact of the COVID-19 Outbreak on Intensive Care in Northern Saitama Japan

Background We examined and compared the actual impact of COVID-19 on local medical care in northern Saitama Japan, especially in intensive care units (ICUs), before (2019) and during (2020) the pandemic. Methods The impact of COVID-19 on emergency care responses was compared with acceptances and refusals in 2019 and 2020. We also examined the number of surgeries performed by ICU surgical departments. The impact on intensive care was examined regarding the numbers of incident reports and the severity percentage calculated from the integrated team medical care and safety system. We also compared the overtime work of physicians working. Results In 2019, there were 2,136 emergency patient requests, and 1,811 patients were received. In contrast, in 2020, there were 2,371 emergency patient requests, and 1,822 patients were accepted, representing a decrease of 76% (p = 0‧931). There were significantly more refusals in 2020, 303 (14‧1%) in 2019 and 506 (21‧3%) in 2020 (p = 0‧0004). In 2020, the number of surgeries increased in neurosurgery, cardiac surgeries, and vascular surgeries and over time increased in all surgical units. There were 396 incidents reported in ICUs in 2019; this increased significantly to 510 in 2020 (p = 0‧001). Conclusion Even though intensive care management was restricted, the number of patients and doctors’ overtime work increased compared to before the spread of COVID-19, and the surrounding environment led to an increase in the number of incidents. The environments in ICUs must be actively improved to prepare for an even more severe situation in the future.