EVALUATION OF A TRANSITIONS CLINIC TO BRIDGE EMERGENCY DEPARTMENT AND PRIMARY CARE

BACKGROUND: Suboptimal transitions from emergency department (ED) to ambulatory settings contribute to poor clinical outcomes and unnecessary non-urgent ED utilization. Primary care-staffed care transition clinics (CTCs) are a potential solution to reduce ED crowding by providing ED follow-up care and facilitating the bridge to longer-term primary care. This study is a preliminary evaluation of the initiation of an ED transitions clinic on 30-day ED and hospital readmissions. METHODS: This retrospective cross-sectional study included adults discharged from the ED at UC hicago Medicine referred to the transitions clinic between November 2020 and May 2021. Appointment attendance, frequency of care type provided, and percent contacted with patient advocate were computed to assess clinic utilization. 30-day ED and hospital readmissions were compared between patients who completed their CTC appointment and patients who missed their CTC appointment using a chi-square test. RESULTS: In the first 6 months of program initiation, 116 patients were referred to the CTC from the ED and around half (47%) completed their follow-up appointment. The majority of patients were of black race (90%) and on public insurance (81%). Almost a quarter of referred patients (22%) were contacted by a patient advocate for referral to longer-term care. The most common reasons for referral were wound check (top 3: cellulitis, abscess, suture removal) and clinical problem management (top 3: SOB, chest pain, covid). Wound checks were 20% more likely to be completed compared to clinical appointments (58% show rate vs 38%). Patients who completed their CTC appointment had a lower rate of ED revisits (15% vs 20%) but the effect was not statistically significant (p>0.05). No statistically significant effects were seen for CTC appointment completion on hospital readmission. CONCLUSIONS: Transition clinics may have the potential to help reduce excess ED use for ambulatory care needs, particularly if they can help facilitate patients being connected to more permanent ambulatory care sites and clinicians. In addition to ongoing analysis of this program evaluation regarding ED and hospital utilization, additional research is needed to investigate the factors influencing follow-up completion and identifying effective interventions for increasing appointment attendance.

The relative impact of in-class closed-book versus take-home open-book examination type on academic performance, student knowledge retention and wellbeing

This study investigates the relationship between take-home (open-book) examinations (THE) and in-class (closed-book) examinations (ICE) on academic performance and student wellbeing. Two social science courses (one bachelor and one master) were included in the study. In the first cohort (2019), students from both courses performed an ICE, whereas students in the second cohort (2020) performed a THE. Four to six months following course completion, students were approached to fill out a survey pertaining to their academic performance and wellbeing during the course, and to complete a test measuring knowledge retention on the course materials. No significant differences were found between the ICE and THE cohorts in academic performance and knowledge retention for either the bachelor or the master students. Bachelor students who completed a THE in 2020 reported significantly lower wellbeing in comparison to their peers completing the ICE a year earlier. The implications of the results in the context of the Covid-19 pandemic are discussed.

Planning Intensive Care Resources: A Forecast and Simulation Approach Due COVID-19 Pandemic in Rio de Janeiro City

The COVID-19 pandemic recently challenges worldwide health system. Many countries have been establishing several rules in order to fight against the expected exponentially growth of affected people. After some weeks hospital bed occupancy started to grow because of infected people and this demand can potentially overlap hospital bed capacity. In this scenario, doctors would have to decide who should be treated and patients without adequate treatment can increase number of deaths. Thus, in order to avoid that patient demand overlap hospital bed capacity, this research propose a forecast and simulation approach in order to provide the number of intensive care beds and health care professionals that could be available in a short-term of 21 days ahead taking into account 3 patient demand scenarios. This research is applied to Rio de Janeiro city (Brazil) and all records were retrieved from Rio de Janeiro public database. Hospital length of stay (LOS) records were obtained with Rio de Janeiro City Health Department (RJHD). We concluded that to open the number of new intensive care unit (UCI) beds proposed by the government is lower than expected admission on the worst scenario. © 2021, The Author(s), under exclusive license to Springer Nature Switzerland AG.