Evolving swabbing practices for COVID-19 in a New Zealand emergency department during the early stages of an emerging pandemic.

OBJECTIVE: To review if tests for suspected COVID-19 were performed according to the Ministry of Health (MoH) case definitions, identify patterns associated with testing outside of the case definition, and discuss the potential impacts on hospital services. METHODS: This was a retrospective audit of patients presenting to the Wellington Hospital ED between 24 March 2020 and 27 April 2020 who were swabbed for COVID-19 in ED. Swabs were audited against the March 15th and April 8th MoH COVID-19 case definitions. RESULTS: Five hundred and thirty-six COVID-19 swabs for 518 patients were taken during the study period. There was poor alignment of testing with the March 15th case definition, with only 11.6% of the 164 swabs taken during this period meeting the case definition. Of the 145 swabs that did not meet the case definition, the majority (n = 119, 82.1%) met symptom criteria only. Alignment of testing with the wider April 8th case definition was much higher with 88.2% meeting criteria. Factors associated with being swabbed despite not meeting the case definitions included fever >38°, a diagnosis of cancer, subsequent hospital admission, and for the March case definition only 'contact with a traveller'. CONCLUSION: There were associations found between testing outside of criteria and specific variables potentially perceived as high-risk. Poor alignment of testing with case definitions can impact hospital services through the (mis)use of limited laboratory testing capacity and implications for resource management. Improved communication and feedback between clinicians and policymakers may improve case definition implementation in a clinical setting.

Cruise ship patient presentation, admission, and intervention rates to the emergency department

AIMS: Patients presenting to emergency departments (EDs) from cruise ships are a unique cohort of patients with several management challenges. Little evidence details the effect this has on EDs in terms of resource use. Therefore, we aimed to review the frequency, characteristics, admission, and intervention rates of cruise ship patient presentations to ED. METHODS: This retrospective study reviewed patient presentations to Wellington ED from cruise ships between 2016 and 2019. Data regarding presenting features, intervention and disposition were extracted via chart review. RESULTS: There were 214 patient presentations included with a median age of 68 (IQR 43.0-76.0);97/214(45.3%) were female. Regarding referral, cruise ship doctors referred 79/214 (36.9%) patients;16/79 (24.1%) to in-patient specialties and 63/79 (79.7%) to emergency medicine (EM);and 135/214 (63%) self-referred to ED. Common presenting complaints were chest pain, abdominal pain and trauma. Advanced imaging was requested for 21.5% of patients and 9.9% required urgent intervention. Regarding disposition, 38% were admitted (22% to in-patient wards, 16% to ED observation unit [OU]) and 61% were discharged (30% by ED and 31% after specialty consultation). CONCLUSION: Overall, the number of cruise ship patients presenting to the ED was low and unlikely to be a significant resource burden. Referrals by cruise ship doctors were appropriate. Education for cruise ship patients and port services regarding non-emergent care options would be valuable to reduce self-referral rates.