ABSTRACT
Objective: The primary objective of this study is to describe associations between emergency department (ED)-to-skilled nursing facility (SNF) transition and ED length-of-stay (LOS). The secondary objective is to explore how social determinants of health (SDOH) influence ED-to-SNF transition visit parameters. In 2020, The Centers for Medicare & Medicaid Services issued the "COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers" eliminating the requirement of a 3-day qualifying hospital stay before SNF placement. The waiver allowed ED patients to be transitioned directly to an SNF from the ED. Methods: We conducted a descriptive retrospective case-control study of adult patients who sought care in the University of North Carolina Hospitals (UNCH) ED between March 1, 2020, and March 1, 2022, lived in a non-SNF residence before their ED visit, and were transitioned directly to an SNF from the ED (n 1 = 27), compared with a group seen in the ED and admitted to hospital for SNF placement (n 2 = 54). Results: The ED-to-SNF group experienced a significantly longer ED LOS compared to the ED-to-Inpatient-to-SNF group: 72.8 hours (95% confidence interval [CI], 59.2-86.4) compared to 14.5 hours (95% CI, 12.1-16.9). We found no significant differences in SDOH between the ED-to-SNF group and the ED-to-Inpatient-to-SNF group. Conclusion: Patients who transition from the ED to an SNF experience long ED stays that may adversely affect health and well-being. Transitioning directly from the ED to an SNF may contribute to ED boarding and overcrowding.
ABSTRACT
Characterizing the asymptomatic spread of SARS-CoV-2 is important for understanding the COVID-19 pandemic. This study was aimed at determining asymptomatic spread of SARS-CoV-2 in a suburban, Southern U.S. population during a period of state restrictions and physical distancing mandates. This is one of the first published seroprevalence studies from North Carolina and included multicenter, primary care, and emergency care facilities serving a low-density, suburban and rural population since description of the North Carolina state index case introducing the SARS-CoV-2 respiratory pathogen to this population. To estimate point seroprevalence of SARS-CoV-2 among asymptomatic individuals over time, two cohort studies were examined. The first cohort study, named ScreenNC, was comprised of outpatient clinics, and the second cohort study, named ScreenNC2, was comprised of inpatients unrelated to COVID-19. Asymptomatic infection by SARS-CoV-2 (with no clinical symptoms) was examined using an Emergency Use Authorization (EUA)-approved antibody test (Abbott) for the presence of SARS-CoV-2 IgG. This assay as performed under CLIA had a reported specificity/sensitivity of 100%/99.6%. ScreenNC identified 24 out of 2,973 (0.8%) positive individuals among asymptomatic participants accessing health care during 28 April to 19 June 2020, which was increasing over time. A separate cohort, ScreenNC2, sampled from 3 March to 4 June 2020, identified 10 out of 1,449 (0.7%) positive participants.IMPORTANCE This study suggests limited but accelerating asymptomatic spread of SARS-CoV-2. Asymptomatic infections, like symptomatic infections, disproportionately affected vulnerable communities in this population, and seroprevalence was higher in African American participants than in White participants. The low, overall prevalence may reflect the success of shelter-in-place mandates at the time this study was performed and of maintaining effective physical distancing practices among suburban populations. Under these public health measures and aggressive case finding, outbreak clusters did not spread into the general population.
