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1.
Rev Bras Enferm ; 74(suppl 1): e20200687, 2021.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-33566955

RESUMEN

OBJECTIVE: To analyze the change in the clinical-epidemiological profile of patients attended at the specialized triage service for COVID-19 (COVID-19 tent) in the first three months of operation. METHODS: Cross-sectional study, with users attended from March 2020 to May 2020 (n=379) at the COVID-19 tent in the city of Ponta Grossa, Paraná. Data collection was retrieved from an electronic form fed by tent professionals, which included sociodemographic characteristics, symptoms, risk factors of exposure, means of search and clinical conduct. Trend tests and chi-square tests were performed. RESULTS: March showed a greater demand (n=197), motivated by mild symptoms and direct search (p<0.05). In the following months, there was a decrease in demand (n=93; n=89), however the search for referrals, ambulances and conditions that required medical attention, observation and hospitalization increased (p<0.05). The search resulting from exposure to risk factors has not changed (p>0.05). CONCLUSION: the profile has changed over time, reflecting, in the end, severe and critical symptoms, requiring intervention.


Asunto(s)
/diagnóstico , Servicio de Urgencia en Hospital/organización & administración , Servicio de Urgencia en Hospital/estadística & datos numéricos , Anamnesis/métodos , Anamnesis/estadística & datos numéricos , Triaje/métodos , Triaje/estadística & datos numéricos , Adulto , Anciano , Anciano de 80 o más Años , Brasil , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad
2.
J Korean Med Sci ; 36(5): e44, 2021 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-33527786

RESUMEN

BACKGROUND: Understanding the changes in emergency department (ED) visit patterns during the coronavirus disease 2019 (COVID-19) outbreak is important for effectively operating EDs during the pandemic. We aimed to analyze the changes in pediatric ED visits during the COVID-19 pandemic and examine the relationship between the number of ED visits and the stringency of government social distancing measures. METHODS: This multicenter retrospective study used data of pediatric (age < 18 years) ED visits in Seoul metropolitan area from June 1, 2018, to May 31, 2020. Patient demographics, ED results, and diagnoses were compared during the COVID-19 period and the previous year. To evaluate the effect of the stringency of social distancing measures on the number of ED visits, a Poisson regression model was developed with month, year, and the average monthly Government Response Stringency Index (GRSI) as fixed effects. RESULTS: In total, 190,732 patients were included. The number of pediatric ED visits during the COVID-19 period was 58.1% lower than in the previous year. There were disproportionate decreases in the numbers of ED visits for children in early childhood (66.5%), low-acuity children (55.2-63.8%), those who did not use an ambulance (59.0%), and those visiting the ED for noninjury complaints (64.9%). The proportion of admissions increased from 11.9% to 16.6%. For every 10-point increase in the GRSI, there was a 15.1% decrease in monthly ED visits. CONCLUSION: A striking decrease in pediatric ED visits was observed during the COVID-19 outbreak, the scale which was associated with the stringency of government policies. Changes in the number and characteristics of children visiting the ED should be considered to facilitate the effective operation of EDs during the pandemic.


Asunto(s)
/epidemiología , Servicio de Urgencia en Hospital/organización & administración , Servicio de Urgencia en Hospital/estadística & datos numéricos , Pediatría/organización & administración , Adolescente , Niño , Preescolar , Brotes de Enfermedades , Femenino , Hospitalización , Humanos , Lactante , Recién Nacido , Masculino , Distribución de Poisson , República de Corea/epidemiología , Estudios Retrospectivos , Seúl/epidemiología , Centros de Atención Terciaria
3.
Medicine (Baltimore) ; 100(3): e24290, 2021 Jan 22.
Artículo en Inglés | MEDLINE | ID: mdl-33546055

RESUMEN

ABSTRACT: This retrospective cohort study aimed to compare the effectiveness of conventional treatment and ultra-early application of negative pressure wound therapy (NPWT) in patients with snakebites.Patients who visited the emergency department within 24 hours after a snakebite were assigned to the non- NPWT or NPWT group. Swelling resolution time and rates of necrosis, infection, and operations were compared between the 2 groups. The Stony Brook Scar Evaluation Scale was used to measure short- and long-term wound healing results.Among the included 61 patients, the swelling resolution time was significantly shorter in the NPWT group than in non- NPWT group (P = .010). The NPWT group showed lower necrosis (4.3% versus 36.8%; P = .003) and infection (13.2% and 4.3%; P = .258) rates than the non- NPWT group. The median Stony Brook Scar Evaluation Scale scores were higher in the NPWT group than in the non- NPWT group (P< .001).These findings suggest that ultra-early application of NPWT reduces edema, promotes wound healing, and prevents necrosis in patients with snakebites.


Asunto(s)
Necrosis/prevención & control , Terapia de Presión Negativa para Heridas/normas , Piel/lesiones , Mordeduras de Serpientes/complicaciones , Anciano , Estudios de Cohortes , Servicio de Urgencia en Hospital/organización & administración , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Necrosis/terapia , Terapia de Presión Negativa para Heridas/métodos , Terapia de Presión Negativa para Heridas/estadística & datos numéricos , República de Corea/epidemiología , Estudios Retrospectivos , Piel/fisiopatología , Mordeduras de Serpientes/epidemiología , Mordeduras de Serpientes/enfermería , Resultado del Tratamiento
4.
Pediatr Emerg Care ; 37(1): 48-53, 2021 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-33394945

RESUMEN

OBJECTIVE: We aim to describe the current coronavirus disease 2019 (COVID-19) preparedness efforts among a diverse set of pediatric emergency departments (PEDs) within the United States. METHODS: We conducted a prospective multicenter survey of PED medical director(s) from selected children's hospitals recruited through a long established national research network. The questionnaire was developed by physicians with expertise in pediatric emergency medicine, disaster readiness, human factors, and survey development. Thirty-five children's hospitals were identified for recruitment through an established national research network. RESULTS: We report on survey responses from 25 (71%) of 35 PEDs, of which 64% were located within academic children's hospitals. All PEDs witnessed decreases in non-COVID-19 patients, 60% had COVID-19-dedicated units, and 32% changed their unit pediatric patient age to include adult patients. All PEDs implemented changes to their staffing model, with the most common change impacting their physician staffing (80%) and triaging model (76%). All PEDs conducted training for appropriate donning and doffing of personal protective equipment (PPE), and 62% reported shortages in PPE. The majority implemented changes in the airway management protocols (84%) and cardiac arrest management in COVID patients (76%). The most common training modalities were video/teleconference (84%) and simulation-based training (72%). The most common learning objectives were team dynamics (60%), and PPE and individual procedural skills (56%). CONCLUSIONS: This national survey provides insight into PED preparedness efforts, training innovations, and practice changes implemented during the start of COVID-19 pandemic. Pediatric emergency departments implemented broad strategies including modifications to staffing, workflow, and clinical practice while using video/teleconference and simulation as preferred training modalities. Further research is needed to advance the level of preparedness and support deep learning about which preparedness actions were effective for future pandemics.


Asunto(s)
/epidemiología , Planificación en Desastres , Servicio de Urgencia en Hospital/organización & administración , Encuestas de Atención de la Salud , Pandemias , Personal de Hospital/educación , Niño , Estudios Transversales , Planificación en Desastres/estadística & datos numéricos , Educación a Distancia , Servicio de Urgencia en Hospital/estadística & datos numéricos , Hospitales Pediátricos/estadística & datos numéricos , Humanos , Equipo de Protección Personal , Estudios Prospectivos , Entrenamiento Simulado , Telecomunicaciones , Triaje , Estados Unidos
6.
Ital J Pediatr ; 47(1): 19, 2021 Jan 29.
Artículo en Inglés | MEDLINE | ID: mdl-33514406

RESUMEN

BACKGROUND: COVID-19 pandemic has markedly affected emergency care, due to sudden limitation of health care capacity by general practitioners (GP) and urgent need for infection control strategies. We evaluated the activity of the Emergency Department (ED) during the national lockdown (March 8-April 30), as well as the outcomes of our infection control strategy. RESULTS: Despite a reduction in access by one fifth, a proportion of febrile patients comparable to 2019 was seen (829/2492, 33.3% vs 4580/13.342, 34.3%, p = 0.3). Diagnostic swab for COVID-19 was performed in 25% of patients, especially in subjects with co-morbidities or multiple access. Six infected cases were identified, all presenting with febrile disease. Only two positive patients fulfilled the criteria for diagnostic swab provided by the Italian Health Authorities, because of close contact with suspected or confirmed cases. The rate of admission for febrile or respiratory conditions was higher than the same period of 2019 (33.4% vs 25.9%, p < 0.0001). None of the 105 health-care professionals working during the study time lapse exhibited anti-SARS-CoV-2 seroconversion. Among the 589 patients with information available, 54.9% declared no medical consultation at all prior to coming to ED, while only 40 (of which 27 with fever) had been examined by their GP before coming to ED. Nevertheless, 35.6% of the cases were already taking medications. None of the 9 patients requiring intensive care reported recent pediatric consultation, despite symptoms duration up to 30 days. CONCLUSION: Our results provide evidence that the reduced capacity of primary care facilities during the national lockdown may have caused a high rate of self-medication as well as a delayed provision of care in some patients. Identification of pediatric patients affected with SARS-CoV-2 infection remains a challenge because of the absence of reliable predictive factors. Finally, the use of specific triage centers, with dedicated pathways to diagnose SARS-CoV-2 infection, trace contacts and allow adequate care after swabs, is effective in preventing spreading of the infection.


Asunto(s)
/prevención & control , Servicio de Urgencia en Hospital/organización & administración , Hospitales Pediátricos/organización & administración , Control de Infecciones/organización & administración , Pandemias/prevención & control , Neumonía Viral/prevención & control , /epidemiología , Niño , Femenino , Humanos , Italia/epidemiología , Masculino , Neumonía Viral/epidemiología , Neumonía Viral/virología , Estudios Retrospectivos , Tiempo de Tratamiento , Triaje
8.
Am J Nurs ; 121(2): 46-52, 2021 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-33497127

RESUMEN

PURPOSE: The purpose of this project was to examine whether initiating a standardized pressure injury (PI) assessment and prevention protocol early in adult patients' ED stay reduces hospital-acquired PIs (HAPIs) in those patients admitted from the ED to acute care inpatient medical units. METHODS: A nurse-led evidence-based practice team studied the problem of increasing HAPIs on four acute care inpatient units and found that, among patients who had been admitted to inpatient care from the ED, longer ED boarding times correlated with a higher rate of HAPIs. ED staff and acute care unit nurses collaborated to develop new protocols to prevent HAPIs in the ED, including staff education and standardized assessments and prevention care for at-risk patients. Data collection was performed at three time periods over approximately two and a half years: baseline, intervention, and postintervention. RESULTS: The incidence rate for HAPIs decreased from 3.56 per 1,000 patient-days at baseline to 1.31 per 1,000 patient-days during the intervention period. This reduction was sustained over the next five months, during which the HAPI incidence rate was 1.53 per 1,000 patient-days. IMPLICATIONS: At a time when ED length of stay is difficult to manage and continues to increase, the use of evidence-based interventions and protocols can reduce the rate of PIs in high-risk patients waiting for hospital admission, leading to a reduction in PI rates and overall hospital costs.


Asunto(s)
Admisión del Paciente/normas , Úlcera por Presión/prevención & control , Indicadores de Calidad de la Atención de Salud/estadística & datos numéricos , California , Servicio de Urgencia en Hospital/organización & administración , Servicio de Urgencia en Hospital/normas , Servicio de Urgencia en Hospital/estadística & datos numéricos , Humanos , Enfermedad Iatrogénica/prevención & control , Tiempo de Internación/estadística & datos numéricos , Admisión del Paciente/estadística & datos numéricos
13.
Nurs Open ; 7(6): 1902-1908, 2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-33346408

RESUMEN

AIM: To explore an effective personalized training model for nurses working in emergency isolation wards of COVID-19 in a short period. DESIGN: This study is a longitudinal study from 24 January 2020 to 28 February 2020. METHODS: There are 71 nursing staff working in the emergency isolation wards of Sichuan Provincial People's Hospital that participated in this study. The questionnaires were conducted with Likert scale. The operation assessment teachers have received standardized training. The self-rating anxiety scale (SAS) and self-rating depression Scale (SDS) were applied to assess the mental state of nurses. RESULTS: After short-term training, these nurses can handle the emergency tasks in a timely manner. The pass rate of nurse theory and operation assessment is 100%. The 111 suspected patients admitted to the emergency isolation ward have been scientifically diagnosed and treated, the three confirmed patients have received appropriate treatment. No nurses have been infected. CONCLUSIONS: In this study, the personalized emergency training mode was feasible in the emergency isolation ward during the COVID-19 epidemic, which rapidly improved the rescue ability of nurses and effectively avoid the occurrence of cross-infection. This mode can provide a valuable reference for the emergency training of nurses in the future.


Asunto(s)
/enfermería , Servicio de Urgencia en Hospital/organización & administración , Hospitales de Aislamiento/organización & administración , Personal de Enfermería en Hospital/educación , Adulto , China , Femenino , Humanos , Control de Infecciones/organización & administración , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Personal de Enfermería en Hospital/psicología , Estrés Laboral/prevención & control , Pandemias , Encuestas y Cuestionarios
14.
BMC Public Health ; 20(1): 1919, 2020 Dec 17.
Artículo en Inglés | MEDLINE | ID: mdl-33334334

RESUMEN

BACKGROUND: Emergency risk communication is a critical component in emergency planning and response. It has been recognised as significant for planning for and responding to public health emergencies. While there is a growing body of guidelines and frameworks on emergency risk communication, it remains a relatively new field. There has also been limited attention on how emergency risk communication is being performed in public health organisations, such as acute hospitals, and what the associated challenges are. This article seeks to examine the perception of crisis and emergency risk communication in an acute hospital in response to COVID-19 pandemic in Singapore and to identify its associated enablers and barriers. METHODS: A 13-item Crisis and Emergency Risk Communication (CERC) Survey, based on the US Centers for Disease and Control (CDC) CERC framework, was developed and administered to hospital staff during February 24-28, 2020. The survey also included an open-ended question to solicit feedback on areas of CERC in need of improvement. Chi-square test was used for analysis of survey data. Thematic analysis was performed on qualitative feedback. RESULTS: Of the 1154 participants who responded to the survey, most (94.1%) reported that regular hospital updates on COVID-19 were understandable and actionable. Many (92.5%) stated that accurate, concise and timely information helped to keep them safe. A majority (92.3%) of them were clear about the hospital's response to the COVID-19 situation, and 79.4% of the respondents reported that the hospital had been able to understand their challenges and address their concerns. Sociodemographic characteristics, such as occupation, age, marital status, work experience, gender, and staff's primary work location influenced the responses to hospital CERC. Local leaders within the hospital would need support to better communicate and translate hospital updates in response to COVID-19 to actionable plans for their staff. Better communication in executing resource utilization plans, expressing more empathy and care for their staff, and enhancing communication channels, such as through the use of secure text messaging rather than emails would be important. CONCLUSION: CERC is relevant and important in the hospital setting to managing COVID-19 and should be considered concurrently with hospital emergency response domains.


Asunto(s)
/terapia , Control de Enfermedades Transmisibles/normas , Sistemas de Comunicación entre Servicios de Urgencia/normas , Servicio de Urgencia en Hospital/organización & administración , Tratamiento de Urgencia/normas , Centers for Disease Control and Prevention, U.S. , Humanos , Difusión de la Información/métodos , Pandemias/prevención & control , Singapur , Estados Unidos
15.
Scand J Trauma Resusc Emerg Med ; 28(1): 118, 2020 Dec 17.
Artículo en Inglés | MEDLINE | ID: mdl-33334364

RESUMEN

BACKGROUND: The current COVID-19 pandemic is highlighting gaps around the world in the design and workflow of Emergency Departments (ED). These gaps have an impact on both patient care and staff safety and represent a risk to public health. There is a need for a conceptual framework to guide ED design and workflow to address these challenges. Such a framework is important as the ED environment will always remain vulnerable to infectious diseases outbreaks in the future. AIMS: This paper aims to address issues and principles around ED design and workflow amidst the COVID-19 pandemic. We propose a conceptual framework and checklist for EDs to be prepared for future outbreaks as well. METHODS: A scoping literature review was conducted, of the experiences of EDs in managing outbreaks such as SARS, H1N1 and COVID-19. The combined experiences of the authors and the experiences from the literature were grouped under common themes to develop the conceptual framework. RESULTS: Four key principles were derived- (1) situational awareness, surveillance and perimeter defence, (2) ED staff protection, (3) surge capacity management and (4) ED recovery. The findings were integrated in a proposed conceptual framework to guide ED design in response to an infectious disease outbreak. There are various elements which need to be considered at ED input, throughput and output. These elements can be categorised into (1) system (workflow, protocols and communication), (2) staff (human resources), (3) space (infrastructure), and (4) supply (logistics) and are placed in a checklist for pragmatic use. CONCLUSION: The ED needs to be in a constant state of preparedness. A framework can be useful to guide ED design and workflow to achieve this. As all ED systems are different with varying capabilities, our framework may help EDs across the world prepare for infectious disease outbreaks.


Asunto(s)
/epidemiología , Servicio de Urgencia en Hospital/organización & administración , Pandemias/prevención & control , Humanos , Salud Pública
16.
S Afr Med J ; 0(0): 13182, 2020 12 14.
Artículo en Inglés | MEDLINE | ID: mdl-33334391

RESUMEN

BACKGROUND: The COVID-19 pandemic has led to the implementation of restrictive policies on theatre procedures, with profound impacts on service delivery and theatre output. OBJECTIVES: To quantify these effects at a tertiary hospital in KwaZulu-Natal Province, South Africa. METHODS: A retrospective review of morbidity and mortality data was conducted. The effects on emergency and elective caseload, intensive care unit (ICU) admissions from theatre, theatre cancellations and regional techniques were noted. RESULTS: Theatre caseload decreased by 30% from January to April 2020 (p=0.02), ICU admissions remained constant, and theatre cancellations were proportionally reduced, as were the absolute number of regional techniques. CONCLUSIONS: The resulting theatre case deficit was 1 260 cases. It will take 315 days to clear this deficit if four additional surgeries are performed per day.


Asunto(s)
Procedimientos Quirúrgicos Electivos/estadística & datos numéricos , Control de Infecciones , Servicio de Cirugía en Hospital , Atención Terciaria de Salud , Adulto , /prevención & control , Servicio de Urgencia en Hospital/organización & administración , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Política de Salud , Humanos , Control de Infecciones/métodos , Control de Infecciones/organización & administración , Masculino , Mortalidad , Evaluación de Necesidades , Innovación Organizacional , Administración de la Seguridad/tendencias , Sudáfrica/epidemiología , Servicio de Cirugía en Hospital/organización & administración , Servicio de Cirugía en Hospital/estadística & datos numéricos , Atención Terciaria de Salud/organización & administración , Atención Terciaria de Salud/tendencias
17.
Rev Paul Pediatr ; 40: e2020302, 2020.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-33331510

RESUMEN

OBJECTIVE: To analyze literature data about unnecessary exposure of pediatric emergency patients to ionizing agents from imaging examinations, nowadays and during times of COVID-19. DATA SOURCES: Between April and July 2020, articles were selected using the databases: Virtual Health Library, PubMed and Scientific Electronic Library Online. The following descriptors were used: [(pediatrics) AND (emergencies) AND (diagnostic imaging) AND (medical overuse)] and [(Coronavirus infections) OR (COVID-19) AND (pediatrics) AND (emergencies) AND (diagnostic imaging)]. Inclusion criteria were articles available in full, in Portuguese or English, published from 2016 to 2020 or from 2019 to 2020, and articles that covered the theme. Articles without adherence to the theme and duplicate texts in the databases were excluded. DATA SYNTHESIS: 61 publications were identified, of which 17 were comprised in this review. Some imaging tests used in pediatric emergency departments increase the possibility of developing future malignancies in patients, since they emit ionizing radiation. There are clinical decision instruments that allow reducing unnecessary exam requests, avoiding over-medicalization, and hospital expenses. Moreover, with the COVID-19 pandemic, there was a growing concern about the overuse of imaging exams in the pediatric population, which highlights the problems pointed out by this review. CONCLUSIONS: It is necessary to improve hospital staff training, use clinical decision instruments and develop guidelines to reduce the number of exams required, allowing hospital cost savings; and reducing children's exposure to ionizing agents.


Asunto(s)
/diagnóstico por imagen , Pediatría/métodos , Niño , Servicio de Urgencia en Hospital/organización & administración , Humanos , Pulmón/diagnóstico por imagen , Pandemias , Tomografía Computarizada por Rayos X/efectos adversos , Ultrasonografía/efectos adversos , Procedimientos Innecesarios
20.
Acute Med ; 19(4): 183-191, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33215171

RESUMEN

INTRODUCTION: COVID-19 pneumonia presented a unique problem for healthcare systems with the potential to overwhelm hospitals and lead to unnecessary morbidity and mortality. Safe triage and follow up systems are required to manage this unprecedented demand. METHODS: We designed a pathway for the triage and assessment of patients based on their resting oxygen saturations and response to a 30 metre rapid walking test. We admitted patients to a 'Virtual Ward' for remote oximetry monitoring from the Emergency Department, step down from inpatient wards and from the local Primary Care 'Hot Hub'. This allowed the safe and managed readmission of those patients who deteriorated at home. RESULTS: During the first wave of COVID-19 we entered 273 onto the pathway for Virtual Ward follow up. Of these, 31 patients were readmitted to hospital, two were admitted to Intensive Care and one patient died. Median oxygen saturation at presentation was 97 % (IQR 96-98%) and following a 30 metre walk test 96% (IQR 94-97%). Median NEWS-2 score was 2 (IQR 1-3). On feedback 99.5% of patients were likely or extremely likely to recommend the service to their family and friends. There was a cost avoidance of £107,600 per month. CONCLUSION: It is safe, feasible and cost effective to set up a triage system with remote oximetry monitoring for patients with COVID-19 and overwhelmingly patients find it a positive experience.


Asunto(s)
Infecciones por Coronavirus/diagnóstico , Servicio de Urgencia en Hospital/organización & administración , Oximetría , Neumonía Viral/diagnóstico , Consulta Remota , Triaje , Betacoronavirus , Humanos , Pandemias , Readmisión del Paciente
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