Influence of post-COVID-19 deconfinement on psychiatric visits to the emergency department.

OBJECTIVE: During the deconfinement period after the coronavirus disease-2019 (COVID-19) pandemic, the number and characteristics of psychiatric visits changed in our emergency department (ED). We aimed to assess changes in the number of visits and characterize the profiles of these patients. METHODS: In this retrospective observational study, we examined the number of psychiatric ED visits and their proportion among the total number of ED visits. We also evaluated psychiatric visits characteristics during a one-month period after the declaration of deconfinement, and we compared those characteristics to characteristics observed during the same month over the previous 4 years. RESULTS: The number of psychiatric visits to our emergency department during deconfinement was similar to the number observed in the same month of previous years. However, the proportion of psychiatric visits to our emergency department among all visits to the ED rose during deconfinement to a level never before observed. The mean proportion of psychiatric admissions to all ED admissions rose from 3.5% in past years to 5.3% during deconfinement (p = 0.013). Moreover, during deconfinement, more visits (80%) were without an acute intoxication compared to past years (58.5%; p = 0.031). Also, in the deconfinement period, more visits lacked a follow-up consultation organized at discharge (40%) compared to the historical period (25%, p = 0.036). CONCLUSIONS: The deconfinement period after the first wave COVID-19 changed the number and type of psychiatric emergency medicine consultations at our hospital, suggesting a psychiatric impact of confinement during this pandemic. These findings will be of interest to practitioners and politicians in the coming months.

Severe influenza/respiratory syncytial virus infections and hospital antimicrobial stewardship opportunities: impact of a 4-year surveillance including molecular diagnosis.

OBJECTIVE: To assess the prevalence of influenza and respiratory syncytial virus (RSV) in adults hospitalized for a respiratory infection in the winter months and to evaluate the impact of a viral diagnosis on empirical antimicrobial management (antibiotics and antivirals). DESIGN: Observational cohort study. SETTING: Acute-care university hospital. PATIENTS: The study included 963 adult patients hospitalized over a 4-year surveillance period. METHODS: Annual surveillance timelines were defined according to epidemiological criteria related to the circulation of RSV and influenza viruses in the general population. Patients were screened following a severe acute respiratory infection (SARI) case definition at the emergency department and were enrolled for molecular assay targeting influenza/RSV viruses after oral informed consent. Epidemiological and clinical data were recorded prospectively, microbiological investigations, antimicrobial management, and outcome data were reviewed retrospectively. RESULTS: An influenza or RSV virus was documented in 316 of 963 patients (33%). Optimization of antimicrobial management (AM) was achieved in 162 of 265 patients (61%) with a positive viral diagnosis and no bacterial infection at admission (AM treatment not initiated, n = 111; discontinued, n = 51). In contrast, only 128 of 462 patients (28%) with negative microbiological investigations did not have AM treatment initiated (n = 116) or had such treatment discontinued (n = 12). Early, targeted antiviral treatment was prescribed in 235 of 253 patients (93%) confirmed with influenza. Epidemiological, clinical, and outcome data were similar in both groups. CONCLUSION: Epidemiological surveillance associated with influenza/RSV molecular diagnosis in adults hospitalized for severe winter respiratory infections dramatically enhanced antimicrobial management.

Does offering pricing information to resident physicians in the emergency department potentially reduce laboratory and radiology costs?

OBJECTIVES: The aim of this study was to establish whether price list information could reduce laboratory and radiological examination costs in emergency departments (EDs). MATERIALS AND METHODS: A prospective survey of adult (>16 years old) admissions was conducted at the ED of a university hospital in Belgium. Nine resident emergency physicians were followed for a span of 6 months, which was divided into 2-month periods: control (October and November 2011), intervention (December 2011 to January 2012), and washout (February and March 2012). Laboratory and radiological costs for each of the daily admissions were calculated during the respective periods and compared. RESULTS: A total of 3758 patients were registered: 1093 in period 1 (control), 1329 in period 2 (intervention), and 1336 in period 3 (washout). We observed significant reductions in examination costs: 10.73% (P=0.015) for laboratory and 33.66% (P<0.001) for radiological costs in period 2 versus period 1; 5.02% (P=0.014) for laboratory and 40.00% (P<0.001) for radiological costs in period 3 versus period 1. In addition, we found that laboratory examination costs increased slightly between periods 2 and 3 (+6.4%), whereas costs related to radiologic examinations continued to decrease (-10.16%); however, these differences were not statistically significant. CONCLUSION: We conclude that the distribution of price lists at EDs promotes cost awareness, which can result in significant decreases in examination costs.