ABSTRACT
Introduction: The aim of the audit was to assess the frequency of Emergency Department (ED) attendances before and after Intensive care and correlate this with functional decline and worsening comorbidities. Though the Covid 19 pandemic has highlighted this more starkly1 the implications of prolonged ICU care and increased long term care needs is well established.2 Objectives: A well-structured, comprehensive, multidisciplinary rehabilitation program during and after discharge from the hospital could improve outcomes and prevent further hospital/ED visits. Method: Data was collected using the ITU admission data base for all > 72 hour ITU patient stays over a two year period of 2017-2018 and 2018-2019 in a district general hospital in the UK. Each individual patient's number of same hospital ED attendances for twelve months before and after their ITU admission were reviewed and the causes for them assessed, in addition survival data over a two year period was also reviewed. Results: During 2017-2018 and 2018-2019 a total of 414 and 425 patients were admitted respectively to ITU for more than 72 hours (median= 133.5 hours). Of the total 839 ITU admissions 700 (83.4%) survived ICU stay. 165 (23.6%) of the 700 patients died in subsequent 2 years of ITU discharge. The two year survival rate was 65%. The most common ITU admissions reason was postoperative monitoring (20%) followed by Type 1 respiratory failure (18%) and Type 2 respiratory failure (15%). The median ED attendance was 0 (Range 0 to 29, mean 0.985, S.D 3.985) in the 17-18 and 0 (Range 0 to 24, mean 1.153, SD 2.154) in the 18-19 cohort in the 12 months prior to ITU admission while the median ED attendance was 0 (Range 0 to 15, mean 0.980, S.D 4.4) in the 17-18 and 0 (Range 0 to 15, mean 1.19, SD 2.0) in the 18-19 cohort in the 12 months following the ITU admission. 98% for 17-18 and 72% for 18-19 of ED reattendances following prolonged ITU stay were due to reasons similar to ITU care. Of the 445 patients with no prior ED attendance in 1 year, 168 or 38% (range 1 to 14) had at least one ED attendance in the 12 months following ITU discharge. The remaining 394 patients with at least one ED attendance prior to ICU, 185 or 47% (1 to 15 Range) had ED attendance 12 months following their ITU discharge. Conclusion: The results show that ITU admitted patients consume significant health resources before and after their ITU stay. Patients with no prior ED attendances before ITU admission also reattended in substantial numbers. Most of these attendances were related to their initial reason for ITU admission. A comprehensive rehabilitation program both in hospital and following discharge could improve patients' outcomes, reduce stress on emergency services and improve patient experience. A rehab service was implemented. The need for rehab program for Covid 19 patients during the pandemic has grown immense because of evolving evidence of Long Covid.3.
ABSTRACT
Introduction/Aim: We are seeing the rapid emergence of a significant new threat to CF survival;chronic nontuberculous mycobacterial (NTM) infection. This study aims to understand the aetiology and epidemiology of NTM in Australians with CF. Methods: Nationally, nine adult and nine paediatric CF services prospectively collected respiratory samples from people with CF (pwCF) for acid fast bacilli (AFB) culture at regular clinic appointments (Baseline, 6 months, 1 year, then annual to 4 years);associated clinical data, geographic and social data was also collected. Sites commenced recruitment between December 2016 and August 2018. Retrospective clinical and culture data were also collected to offset the shift to a telehealth model of care during the global coronavirus pandemic. Results: 15.1% of 1322 study participants cultured NTM (NTM+) from at least one AFB culture during the study, 5.1% of study participants were M. abscessus (MABS) positive. Adolescents and young adults (11-25 years) had the highest rates of NTM infection (19%, p = 0.0004). MABS was more commonly isolated in participants <25 years (6.7%) compared to participants 25 years and older (2.5%, p < 0.001). Of NTM+ study participants, 49% were incident cases. The species of NTM recovered from participants varied depending on the Australian state of residence, with South Australia, Western Australia and Tasmania having greater diversity of isolated species. Conclusion: In Australia, during this sampling period pwCF <25 years of age were more likely to be infected with MABS than older pwCF. We hypothesize that this may be due to increasing attempts at eradication of Pa in early life and/or increased exposure from environmental sources at a vulnerable age.