Synergism of an Urgent Care Walk-in Clinic With an Emergency Department.

BACKGROUND: The overutilization of hospital emergency departments by low-urgency patients is seen as a growing problem in health-care delivery, and a variety of solutions are under discussion. We studied the change in utilization of a hospital emergency department (ED) by low-urgency patients after an urgent care walk-in clinic (WIC) was opened in the immediate vicinity. METHODS: A prospective, single-center pre-post comparative study was carried out at the University Medical Center Hamburg-Eppendorf (UKE). The ED patient collective consisted of adult walk-in patients who presented to the ED between 4 pm and midnight. The "pre" period consisted of August and September 2019, and the "post" period was from November 2019 (after the opening of the WIC) to January 2020. RESULTS: The study patients consisted of 4765 ED walk-in patients and 1201 WIC patients. 956 (80.5%) of the WIC patients had been referred onward to the WIC after initially presenting to the ED; from this group, 790 patients (82.6%) received definitive care in the WIC. The number of outpatients treated in the ED fell by 37.3% (95% confidence interval [30.9; 43.8]), from 851.5 to 536.7 per month. The most marked decreases were in the areas of dermatology (from 62.5 to 14.3 patients per month), neurology (45.5 to 25), ophthalmology (115 to 64.7), and trauma surgery (211 to 128.7). No decrease was seen in urology, psychiatry, or gynecology. For patients presenting without any referral document, the mean length of stay fell by a mean of 17.6 [7.4; 27.8] minutes from its "pre" value of 172.3 minutes. The rate of patients who left during treatment fell from 76.5 to 28.3 patients per month (p < 0.001). CONCLUSION: A GP-led urgent care walk-in clinic next door to an interdisciplinary hospital emergency department is a resource-saving treatment option for walk-in patients who present to the emergency department. Most of the patients referred from the ED to the WIC were able to receive definitive care there.

Association between patient-related factors and avoided consultations due to fear of COVID-19 during the first lockdown in northern Germany: Results of a cross-sectional observational study.

INTRODUCTION: During the COVID-19 pandemic, many people were anxious about a coronavirus infection due to the high infection rate and the mortality risk associated with the disease. Fear of COVID-19 might have influenced patients' utilisation of medical services, even if it meant that a postponed therapy had severe consequences. Our aims were to analyse (a) to what extent fear of COVID-19 contributes to forgone consultations, (b) if patient characteristics, health literacy and social support influence the effect of fear of COVID-19 on the utilisation behaviour and (c) whether interactions between these possible predictor variables are responsible for a higher extent of avoided consultations due to fear of COVID-19. METHODS: We conducted a retrospective, cross-sectional observational study in an emergency department. The study was based on personal standardized interviews of patients. The interviews took place between July 15 and August 5, 2020. Patients over the age of 18 were included if there was no urgent need for treatment on the day of the interview, no severe functional limitations, sufficient knowledge of German, ability to consent and health problems requiring treatment between March 13 and June 13, 2020. Differences between patient subgroups were described and analysed using the t-test and chi2 test. Data were analysed by logistic regression including socio-demographic data, health literacy and social support assessed by standardised instruments. Additionally, we assessed interactions between possible predictor variables by a descriptive tree analysis. RESULTS: 103 patients participated in personal standardized interviews. 46 patients (44.6%) reported that at least one necessary consultation did not take place in the observation period. Among those, 29 patients (63.0%) avoided consultations due to fear of COVID-19. Women had 3.36 times higher odds (95% confidence interval: 1.25 to 9.04, p = 0.017) for avoiding a consultation due to fear of COVID-19. There were no other statistically significant predictors in our analysis. DISCUSSION: Almost half of the required consultations did not take place. Avoidance of consultations needs to be closely monitored during the pandemic. Policy makers as well as health care providers should give consideration to the collateral effects of COVID-19 and COVID-19-related reactions of patients, especially women. CONCLUSION: In the course of the COVID-19 pandemic, physicians should ensure that their patients take advantage of necessary consultations in order to avoid negative effects of a delayed examination or treatment. Particular attention should be paid to anxious female patients. Studies are needed to analyse the association between health literacy, social support and avoidance of consultations triggered by fear of COVID-19.

[Emergency care: need for reform from the inpatient perspective]. / Notfallversorgung ­ Reformbedarf aus stationärer Sicht.

The interdisciplinary central emergency department is increasingly establishing itself as the new gold standard of inpatient emergency care. Not all emergency patients whose complaints need to be assessed with the resources of an emergency department are ultimately admitted as inpatients. For all other emergencies, correct allocation decisions must be made at an early stage and preferred paths for clarification and treatment that relieve hospital emergency rooms must be offered. Qualification requirements for emergency care staff have so far been highly inconsistent for the three sectors. It is also necessary to jointly establish quality assurance measures for the cooperation between the outpatient and inpatient sectors as well as the emergency medical services.

Time series analysis of the in-hospital diagnostic process in suspected pulmonary embolism evaluated by computed tomography: An explorative study.

PURPOSE: This retrospective study aims to analyze the distribution of demand and the duration of the diagnostic workup of suspected pulmonary embolism (PE) using computed tomography pulmonary angiography (CTPA). METHODS: Time data from physical examination to report creation were identified for each CTPA in 2013 and 2018 at a tertiary hospital. Multivariable multinomial logistic and linear regression models were used to evaluate differences between 3 time intervals (I1: 6am-2pm, I2: 2pm-10pm, I3: 10pm-6am). A cosinor model was applied to analyze the amount of CTPA per hour. RESULTS: The relative demand for CTPA from the emergency room was lower in l1 compared to l2 and l3 (I1/I2: odds ratio (OR) 0.84, 95 % confidence interval (CI) 0.78-0.91; I1/I3: OR 0.80, 95 % CI 0.72-0.89; peak 4:23 pm). Requests for in-patients displayed a tendency towards I1 (I1/2: OR 1.15, 95 % CI 1.06-1.24; l1/l3: OR 1.19, 95 % CI 1.07-1.33; peak 1:54 pm). The time from CTPA request to study was shorter in I3 compared to I1 and I2 in 2013 (I1/I3: ratio 5.23, 95 % CI 3.38-8.10; I2/I3: ratio 3.50, 95 % CI 2.24-5.45) and 2018 (I1/I3: ratio 2.27, 95 % CI 1.60-3.22; I2/I3: ratio 2.11, 95 % CI 1.50-2.97). This applied similarly to fatal cases (I1/I3: ratio 2.91, 95 % CI 1.78-4.75; I2/I3: ratio 2.45, 95 % CI1.52-3.95). CONCLUSIONS: The temporal distribution of demand for CTPA depends on the sector of patient care and the processing time differs substantially during the day. Time series analysis can reveal such coherences and may help to optimize workflows in radiology departments.

Clinical evaluation of a SARS-CoV-2 RT-PCR assay on a fully automated system for rapid on-demand testing in the hospital setting.

BACKGROUND: The ongoing SARS-CoV-2 pandemic presents a unique challenge for diagnostic laboratories around the world. Automation of workflows in molecular diagnostics is instrumental for coping with the large number of tests ordered by clinicians, as well as providing fast-tracked rapid testing for highly urgent cases. In this study we evaluated a SARS-CoV-2 LDT for the NeuMoDx 96 system, a fully automated device performing extraction and real-time PCR. METHODS: A publicly available SARS-CoV-2 RT-PCR assay was adapted for the automated system. Analytical performance was evaluated using in-vitro transcribed RNA and clinical performance was compared to the cobas 6800-based reference assay within the lab. RESULTS: The Envelope (E) Gene-LDT displayed good analytical performance with an LoD of 95.55 cp/mL and no false positives during evaluation of cross-reactivity. A total of 176 patient samples were tested with both the E-Gene-LDT and the reference assay. Positive and negative agreement were 100 % and 99.2 % respectively. Invalid-rate was 6.3 %. CONCLUSION: The E-Gene-LDT showed analytical and clinical performance comparable to the cobas6800-based reference assay. Due to its random-access workflow concept and rapid time-to-result of about 80 min, the system is very well suited for providing fast-tracked SARS-CoV-2 diagnostics for urgent clinical samples in the hospital setting.