EP.WE.338Ambulatory Ultrasound Scans Reduce Inpatient Admissions During COVID-19: A Need for the Expansion of Ambulatory Services

Aim With the increased need to manage patients out of hospital during COVID-19, it was anticipated that need for ambulatory imaging would increase. This study aimed to assess the demand for ambulatory ultrasounds (US) during the COVID-19 pandemic and the impact on inpatient admissions. Methods A retrospective review of patients presenting to the Emergency Department (ED) between 12th July – 23rd August 2020 who required an US as first line imaging. Electronic Care Records were used to collect data regarding type of US i.e., inpatient, or ambulatory, time taken for ambulatory US and outcome after imaging. The same period in 2019 was assessed for comparison. Results In 2020, 100 patients required an US compared to 88 in 2019. 37% (37/100) of which were discharged for an ambulatory US, compared to 14.8% (13/88) in 2019 (p = 0.006). The average waiting time for an ambulatory US in 2019 was 2 days, this increased to 7 days in 2020. Following ambulatory US in 2020 43.2% (16/37) required further outpatient imaging or assessment; similar outcomes were seen in 2019 with 46.2% (6/13). Overall, there was a 150% increase in the use of ambulatory US, with a 26% decrease in admissions in 2020 vs. 2019. Conclusions There was a significant increase in the number of patients discharged from ED to undergo an ambulatory US resulting in reduced inpatient admissions. This increase in demand is reflected by the prolonged waiting time highlighting the requirement for expansion of ambulatory services to meet this clinical need.

Autonomic dysfunction in post-COVID patients with and witfhout neurological symptoms: a prospective multidomain observational study

The autonomic nervous system (ANS) can be affected by COVID-19, and dysautonomia may be a possible complication in post-COVID individuals. Orthostatic hypotension (OH) and postural tachycardia syndrome (POTS) have been suggested to be common after SARS-CoV-2 infection, but other components of ANS function may be also impaired. The Composite Autonomic Symptom Scale 31 (COMPASS-31) questionnaire is a simple and validated tool to assess dysautonomic symptoms. The aim of the present study was to administer the COMPASS-31 questionnaire to a sample of post-COVID patients with and without neurological complaints. Participants were recruited among the post-COVID ambulatory services for follow-up evaluation between 4 weeks and 9 months from COVID-19 symptoms onset. Participants were asked to complete the COMPASS-31 questionnaire referring to the period after COVID-19 disease. Heart rate and blood pressure were manually taken during an active stand test for OH and POTS diagnosis. One-hundred and eighty participants were included in the analysis (70.6% females, 51 ± 13 years), and OH was found in 13.8% of the subjects. Median COMPASS-31 score was 17.6 (6.9–31.4), with the most affected domains being orthostatic intolerance, sudomotor, gastrointestinal and pupillomotor dysfunction. A higher COMPASS-31 score was found in those with neurological symptoms (p < 0.01), due to more severe orthostatic intolerance symptoms (p < 0.01), although gastrointestinal (p < 0.01), urinary (p < 0.01), and pupillomotor (p < 0.01) domains were more represented in the non-neurological symptoms group. This study confirms the importance of monitoring ANS symptoms as a possible complication of COVID-19 disease that may persist in the post-acute period.

Preserving Geo-Indistinguishability of the Emergency Scene to Predict Ambulance Response Time

Emergency medical services (EMS) provide crucial emergency assistance and ambulatory services. One key measurement of EMS’s quality of service is their ambulances’ response time (ART), which generally refers to the period between EMS notification and the moment an ambulance arrives on the scene. Due to many victims requiring care within adequate time (e.g., cardiac arrest), improving ARTs is vital. This paper proposes to predict ARTs using machine-learning (ML) techniques, which could be used as a decision-support system by EMS to allow a dynamic selection of ambulance dispatch centers. However, one well-known predictor of ART is the location of the emergency (e.g., if it is urban or rural areas), which is sensitive data because it can reveal who received care and for which reason. Thus, we considered the ‘input perturbation’ setting in the privacy-preserving ML literature, which allows EMS to sanitize each location data independently and, hence, ML models are trained only with sanitized data. In this paper, geo-indistinguishability was applied to sanitize each emergency location data, which is a state-of-the-art formal notion based on differential privacy. To validate our proposals, we used retrospective data of an EMS in France, namely Departmental Fire and Rescue Service of Doubs, and publicly available data (e.g., weather and traffic data). As shown in the results, the sanitization of location data and the perturbation of its associated features (e.g., city, distance) had no considerable impact on predicting ARTs. With these findings, EMSs may prefer using and/or sharing sanitized datasets to avoid possible data leakages, membership inference attacks, or data reconstructions, for example.

Development of a provincial interactive antibiogram tool for Ontario

Background: Antimicrobial resistance (AMR) is a public health issue with significant impact on health care. Antibiogram development and deployment is a key strategy for managing and preventing AMR. Our objective was to develop an Ontario antibiogram as part of a larger provincial initiative aimed at advancing antimicrobial stewardship in the province. Methods: As part of a voluntary provincial online survey, antibiogram data from 100 of 201 (49.8%) Ontario hospitals were collected and included. All hospitals in Ontario were eligible to participate except those providing only mental health or ambulatory services. Weighted provincial and regional antibiotic susceptibilities (percentages) were conducted using descriptive statistical analyses, and an interactive antibiogram spreadsheet was developed. Respondent-identified barriers to collecting and interpreting antibiogram data are presented descriptively. Results: There was wide regional variability in antimicrobial-resistant organisms across Ontario. Provincial methicillin-resistant Staphylococcus aureus prevalence was 24.6%, ranging from 5.9% to 43.7% regionally. Provincial Escherichia coli resistance to ceftriaxone and ciprofloxacin was 13.8% (regional range 6.0%–25.1%) and 22.5% (regional range 9.8–37.8%), respectively. Klebsiella spp. resistance to ceftriaxone and ciprofloxacin was similar across all health regions, with overall provincial rates of 7.5% and 5.6%, respectively. Conclusions: We have demonstrated that integrating hospital AMR tracking and reporting as part of a larger voluntary provincial antimicrobial stewardship program initiative is a feasible approach to capturing AMR data. The provincial antibiogram serves as a benchmark for the current state of AMR provincially and across health regions.

38 Adapting an Emergency General Surgery Service in Response to the COVID-19 Pandemic

Introduction In response to the COVID-19 pandemic, our emergency general surgery (EGS) service established an enhanced ambulatory service and undertook non-operative management of selected pathologies. This study compares the activity of our service before and after these changes. Method Patients referred by the emergency department were prospectively identified over a four-week period beginning from the date of reconfiguration (COVID) and compared to patients retrospectively identified from the same period the previous year (Pre-COVID) and followed up for 30 days. Data was extracted from handover documents and electronic care records. Results There were 281 and 283 patients during the Pre-COVID and COVID periods, respectively. Rates of admission decreased (78.1% to 41.7%) whilst there were increased rates of ambulation (7.1% to 17.3%) and discharge (6% to 22.6%). Duration of admission decreased (6.9 to 4.8 days), and there were fewer operative and endoscopic interventions (78 to 40). There were increased ambulatory investigations (11 to 39), telephone reviews (0 to 39), and use of early CT to facilitate discharge (5% to 34.7%). There were no differences in 30-day readmission or mortality in any group. Conclusions Restructuring of our EGS service in response to COVID-19 facilitated an increased use of ambulatory services and imaging, whilst maintaining patient safety.

A Review of Canadian Cancer-Related Clinical Practice Guidelines and Resources during the COVID-19 Pandemic

(1) Background: Preventive measures taken in response to the coronavirus disease 2019 (COVID-19) pandemic have adversely affected an entire range of cancer-related medical activities. The reallocation of medical resources, staff, and ambulatory services, as well as critical shortages in pharmaceutical and medical supplies have compelled healthcare professionals to prioritize patients with cancer to treatment and screening services based on a set of classification criteria in cancer-related guidelines. Cancer patients themselves have been affected on multiple levels, and addressing their concerns poses another challenge to the oncology community. (2) Methods: We conducted a Canada-wide search of cancer-related clinical practice guidelines on the management and prioritization of individuals into treatment and screening services. We also outlined the resources provided by Canadian cancer charities and patient advocacy groups to provide cancer patients, or potential cancer patients, with useful information and valuable support resources. (3) Results: The identified provincial guidelines emphasized cancer care (i.e., treatment) more than cancer control (i.e., screening). For cancer-related resources, a clear significance was placed on knowledge & awareness and supportive resources, mainly relating to mental health. (4) Conclusion: We provided a guidance document outlining cancer-related guidelines and resources that are available to healthcare providers and patients across Canada during the COVID-19 pandemic.

Associations between Subsequent Hospitalizations and Primary Ambulatory Services Utilization within the First Year after Acute Myocardial Infarction and Long-Term Mortality

Healthcare resource utilization peaks throughout the first year following acute myocardial infarction (AMI). Data linking the former and outcomes are sparse. We evaluated the associations between subsequent length of in-hospital stay (SLOS) and primary ambulatory visits (PAV) within the first year after AMI and long-term mortality. This retrospective analysis included patients who were discharged following an AMI. Study groups: low (0–1 days), intermediate (2–7) and high (≥8 days) SLOS; low (<10) and high (≥10 visits) PAV, throughout the first post-AMI year. All-cause mortality was set as the primary outcome. Overall, 8112 patients were included: 55.2%, 23.4% and 21.4% in low, intermediate and high SLOS groups respectively; 26.0% and 74.0% in low and high-PAV groups. Throughout the follow-up period (up to 18 years), 49.6% patients died. Multivariable analysis showed that an increased SLOS (Hazard ratio (HR) = 1.313 and HR = 1.714 for intermediate and high vs. low groups respectively) and a reduced number of PAV (HR = 1.24 for low vs. high groups) were independently associated with an increased risk for mortality (p < 0.001 for each). Long-term mortality following AMI is associated with high hospital and low primary ambulatory services utilization throughout the first-year post-discharge. Measures focusing on patients with increased SLOS and reduced PAV should be considered to improve patient outcomes.

FAKTOR – FAKTOR PENGHAMBAT PELAYANAN DI TEMPAT PENDAFTARAN PASIEN BPJS RAWAT JALAN DI RUMAH SAKIT SARI MUTIARA, LUBUK PAKAM TAHUN 2019

Pelayanan rawat jalan (ambulatory services) adalah salah satu bentuk dari pelayanan kedokteran. Secara sederhana yang dimaksud dengan pelayanan rawat jalan adalah pelayanan kedokteran yang disediakan untuk pasien tidak untuk rawat inap (hospitalization). Penelitian ini bertujuan untuk mengetahui faktor – faktor penghambat pelayanan di tempat pendaftaran pasien BPJS rawat jalan di RSU Sari Mutiara Lubuk Pakam. Jenis penelitian ini menggunakan metode deskriptif dilaksan dengan sampel sebanyak 64 orang pasien BPJS rawat jalan. Dari hasil penelitian dari 64 orang pasien BPJS rawat jalan yang diteliti menunjukkan bahwa sebanyak 38 orang (59,4 %) telah mengetahui berkas pendaftaran pasien BPJS rawat jalan. Berdasarkan waktu penyediaan dokumen rekam medis didapatkan bahwa rata – rata waktu yang dibutuhkan untuk pendaftaran adalah 7 menit..Penyediaan dokumen rekam medis > 10 menit sebanyak 11 orang (17,2 %). Berdasarkan hasil penelitian tersebut, diharapkan agar selalu dilakukan keterbukaan atas informasi berkas persyaratan pendaftaran dan pelayanan kesehatan terhadap peserta BPJS Kesehatan. Bentuk penyimpanan dokumen rekam medis sebaiknya menggunakan dua sistem yaitu sentralisasi dan desentralisasi juga tracer agar keberadaan dokumen rekam medis dapat diketahui yaitu dipinjam atau sudah dikembalikan tetapi tidak sesuai dengan urutan nomor rekam medisnya.