Varied impacts on outpatient services among departments and divisions in the early phase of the COVID-19 pandemic: Implications for personnel mobilization and preparatory training.

BACKGROUND: Coronavirus disease 2019 (COVID-19) spread all over the world in 2020. In the face of the sudden pandemic, workforce mobilization has been of critical concern to medical institutions. During the pandemic, the public's behaviors of seeking medical assistance have also changed. Using the real-world data of a large medical center in Taiwan, this study aimed to analyze the fluctuations of outpatient visits among various departments and divisions in the early phase of the COVID-19 pandemic and to provide suggestions for staff allocation in similar future events. METHODS: Data of outpatient visits at Taipei Veterans General Hospital were obtained for analysis. The weekly fluctuations of outpatient visits among 36 departments or divisions were computed for 8 weeks from February 3 to March 29, 2020, the early phase of the pandemic. The monthly data of outpatient visits by department and division in March 2020 were also extracted for comparison with those in March 2019. A simple regression equation was used to calculate the weekly trends. RESULTS: Average outpatient visits decreased by 26% in 2 months following the outbreak. Among the 36 departments or divisions, ophthalmology, orthopedics, and cardiology underwent marked declines after the outbreak; the slopes of the simple regression equation were -110.8, -100.7, and -99.2, respectively. By contrast, transfusion medicine, toxicology, transplantation surgery, pediatric surgery, chest surgery, technical aid, and oncology were divisions less influenced. In the year-over-year comparison, infection was the only department or division with positive growth (20.5%), whereas all others exhibited negative growth. CONCLUSION: In the future, we can fulfil the additional personnel needs during a pandemic by redeploying physicians from departments experiencing a reduced workload. Hospitals should also establish preparatory employee training programs to ensure that the reassigned personnel are adequately equipped to serve in their new positions.

Experiences With Internet Triaging of 9498 Outpatients Daily at the Largest Public Hospital in Taiwan During the COVID-19 Pandemic: Observational Study.

BACKGROUND: During pandemics, acquiring outpatients' travel, occupation, contact, and cluster histories is one of the most important measures in assessing the disease risk among incoming patients. Previous means of acquiring this information in the examination room have been insufficient in preventing disease spread. OBJECTIVE: This study aimed to demonstrate the deployment of an automatic system to triage outpatients over the internet. METHODS: An automatic system was incorporated in the existing web-based appointment system of the hospital and deployed along with its on-site counterpart. Automatic queries to the virtual private network travel and contact history database with each patient's national ID number were made for each attempt to acquire the patient's travel and contact histories. Patients with relevant histories were denied registration or entry. Text messages were sent to patients without a relevant history for an expedited route of entry if applicable. RESULTS: A total of 127,857 visits were recorded. Among all visits, 91,195 were registered on the internet. In total, 71,816 of them generated text messages for an expedited route of entry. Furthermore, 65 patients had relevant histories, as revealed by the virtual private network database, and were denied registration or entry. CONCLUSIONS: An automatic triage system to acquire outpatients' relevant travel and contact histories was deployed rapidly in one of the largest academic medical centers in Taiwan. The updated system successfully denied patients with relevant travel or contact histories entry to the hospital, thus preventing long lines outside the hospital. Further efforts could be made to integrate the system with the electronic medical record system.

Where to buy face masks? Survey of applications using Taiwan's open data in the time of coronavirus disease 2019.

BACKGROUND: The coronavirus disease 2019 (COVID-19) had spread rapidly since late December 2019. Personal protective equipment was essential to prevent transmission. Owing to shortage of face masks, Taiwan government began to implement quasi rationing on February 6, 2020, by allowing each resident to purchase two masks in seven days. Taiwan National Health Insurance Administration offered online data with real-time updates on face mask availability in all contracted pharmacies and selected local health centers. Based on the open data, numerous software applications quickly emerged to assist the public in finding sales locations efficiently. METHODS: Up until March 15, 2020, the Public Digital Innovation Space of Taiwan government had recorded 134 software applications of face mask availability, and 24 software applications were excluded due to defect, duplicate, and unavailability. These applications were analyzed according to platform, developer type, and display mode. RESULTS: Of the 110 valid software applications, 67 (60.9%) applications were deployed on websites, followed by 21 (19.1%) on social networking sites, 19 (17.3%) as mobile applications, and 3 (2.7%) in other modes. Nearly two thirds (n = 70) of applications were developed by individuals, one third (n = 37) by commercial companies, only two applications by central and local governments, and one by a nongovernmental organization. With respect to the display mode, 47 (42.7%) applications adopted map-view only, 41 (37.3%) adopted table-view only, and 19 (17.3%) adopted both modes. Of the remaining three applications, two offered voice user interfaces and one used augmented reality. CONCLUSION: Taiwan's open data strategy facilitated rapid development of software applications for information dissemination to the public during the COVID-19 crisis. The transparency of real-time data could help alleviate the panic of the public. The collaborative contributions from the grassroots in disasters were priceless treasures.

Deployment of a computerized ward visitor registration system in coronavirus disease 2019 epidemic: Experiences of a large academic medical center in Taiwan.

BACKGROUND: Visitors to hospitalized patients during an epidemic might themselves be carriers and are therefore likely to spread the disease in wards. Although measures were taken to restrict hospital visits, traditional paper-based registration is insufficient to screen and monitor the numbers of visitors to a large hospital. METHODS: Throughout March 2020, during the coronavirus disease 2019 crisis, a computer system was deployed in the 2800-bed Taipei Veterans General Hospital (Taipei, Taiwan) to register, screen, and monitor inpatient visitors. This system comprised three parts: online registration form, entrance check-in interface, and registration database. The early utilization of this newly deployed system was then analyzed. RESULTS: A total of 22,336 visits were recorded between March 11, 2020, and March 31, 2020, with 1064 a day on average. Out of these visits, 18.1% (n = 4049) had made online reservations within 48 hours. On the other hand, of all 4941 online reservations, 18.1% (n = 892) were no-shows. In the last 12 days of the study period, eight prospective visitors were identified as ineligible by the computer system, and so their visits were denied. CONCLUSION: Using a computer system, the hospital was able to enforce restrictions on hospital visits. Although the online registration system had not been fully used yet in the early phase of adoption, its superiority from the standpoint of disease control should enable hospital managers to consider abolishing on-site visitor registration.