ABSTRACT
Purpose : To examine how the quantity and characteristics of ophthalmology consults at a New York City hospital system changed during the COVID-19 pandemic peak. Methods : In an IRB approved, HIPAA compliant retrospective, comparative chart review study, ophthalmology (initial, follow-up, and electronic) consult notes from February to May 2019 were compared to those in February to May 2020. Statistical comparisons between 2019 and 2020 were made using T-tests and Fisher's exact tests. Results : Of 2,215 notes analyzed, 1,374 (62%) were from 2019 and 841 (38%) were from 2020 (p=0.0002). Baseline characteristics between groups, including chronic medical conditions, did not differ significantly. In 2019, 41% of patients had a primary hospital diagnosis related to ophthalmology, whereas in 2020 this decreased to 32% (p=0.002). In 2019, 7.5% of patients were on ventilators;this increased in 2020 to 10.8% (p=0.035). Top reasons for consult requests were stable between years: eye pain/pressure (16.4%, 14.1%, p=0.79), trauma (13.1%, 13.7%, p=1), and blurry vision (12.9%, 11.2%, p=0.85) (Figure 1). After evaluation, the most common diagnoses in 2019 were trauma (14.0%) and glaucoma (10.9%). In 2020, they were trauma (15.2%) and retinopathy of prematurity (11.2%). In 2020, 1.8% of consults were in a newly available format, the e-consult (telephone visit). Within 2020, the number of consults decreased at the end of February (-47.5 %) and in mid-March (-44.1%) (Figure 2). In 2020, 22.5% of all consults were COVID tested and 2.4% of all consults were positive within 2 weeks of in-person evaluation. Conclusions : These results reflect changes in the activity of the ophthalmology consult service during the peak of the COVID-19 crisis. Consult quantities decreased dramatically in late February and mid-March, which correlate with the timing of the first COVID-19 case in New York State (reported February 29) and the New York State on Pause Program that required all non-essential workers to stay home (ordered March 22). The lower number of ophthalmology consult requests in 2020 may reflect that patients with non-acute eye problems did not seek medical attention and/or primary teams deferred requests.
ABSTRACT
IntroductionWhen New York City became an epicenter of the COVID-19 pandemic, healthcare workers from an array of specialties were deployed to work on general medicine units with limited time for clinical retraining.ObjectivesThis study assesses the subjective experience and perceived preparedness of a cohort of non-internal medicine clinicians who were deployed to assist with inpatient management of patients with COVID-19 in the Spring of 2020.MethodsAn online survey was distributed to clinicians (residents, fellows, attendings, nurse practitioners, and physician assistants) who cared for patients in roles outside their usual specialties during the pandemic at the Montefiore Health System in the Bronx, NY.Results85/169 (50.3%) clinicians responded. 16.5% reported strong feelings of preparedness prior to deployment (≥7/10 Likert scale). ‘Access to appropriate and efficient review materials prior to deployment’ was ranked as 6/10, overall level of stress as 8/10 and concern for contracting COVID-19 while deployed as 8/10. Responses regarding ‘general feelings of preparedness’ had a weak negative association with ‘feelings of frustration about one’s circumstance’ (r= -0.39, p<0.001). Weak negative associations were found between feelings of ‘access to adequate review materials’ and ‘overall stress levels’ (r= -0.31, p<0.001). A moderate positive association was found between ‘feelings of access to adequate review materials’ and ‘feeling on top of one’s work responsibilities’ (r= 0.40, p< 0.001).ConclusionsThe majority of respondents did not feel adequately prepared to care for patients with COVID-19 prior to deployment and had both high stress levels and fear of contracting COVID-19 in the first wave of the pandemic.DisclosureNo significant relationships.