Comparison of outcomes in emergency department revisiting patients before and after coronavirus disease 2019 epidemic.

BACKGROUND AND IMPORTANCE: The outbreak of COVID-19 challenged the global health system and specifically impacted the emergency departments (EDs). Studying the quality indicators of ED care under COVID-19 has been a necessary task, and ED revisits have been used as an indicator to monitor ED performance. OBJECTIVES: The study investigated whether discrepancies existed among ED revisiting cases before and after COVID-19 and whether the COVID-19 epidemic was a predictor of poor outcomes of ED revisits. DESIGN: Retrospective study. SETTINGS AND PARTICIPANTS: We used electronic health records data from a tertiary medical center. Data of patients with 72-h ED revisit after the COVID-19 epidemic were collected from February 2020 to June 2020 and compared with those of patients before COVID-19, from February 2019 to June 2019. OUTCOME MEASURES AND ANALYSIS: The investigated outcomes included hospital admission, ICU admission, out-of-hospital cardiac arrest, and subsequent inhospital mortality. Univariate and multivariate logistic regression models were used to identify independent predictors of 72-h ED revisit outcomes. MAIN RESULTS: In total, 1786 patients were enrolled in our study - 765 in the COVID group and 1021 in the non-COVID group. Compared with the non-COVID group, patients in the COVID group were younger (53.9 vs. 56.1 years old; P = 0.002) and more often female (66.1% vs. 47.3%; P < 0.001) and had less escalation of triage level (11.6% vs. 15.0%; P = 0.041). The hospital admission and inhospital mortality rates in the COVID and non-COVID groups were 33.9% vs. 32.0% and 2.7% vs. 1.5%, respectively. In the logistic regression model, the COVID-19 period was significantly associated with inhospital mortality (adjusted odds ratio, 2.289; 95% confidence interval, 1.059-4.948; P = 0.035). CONCLUSION: Patients with 72-h ED revisits showed distinct demographic and clinical patterns before and after the COVID-19 epidemic; the COVID-19 period was an independent predictor of increased inhospital mortality.

Experience of resources management on coronavirus disease 2019 epidemic at a tertiary medical center in Northern Taiwan.

BACKGROUND: Coronavirus disease 2019 (COVID-19) is a respiratory infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that causes infectious symptoms including fever, cough, respiratory and gastrointestinal symptoms, and even loss of smell/taste and to date had caused 489 000 people to be infected with 32 000 deaths. This article aims to develop some strategies in dealing with the COVID-19 epidemic to prevent nosocomial infection and ensure the safety of healthcare workforce and employees. METHODS: This is a prospectively registered and retrospective descriptive study investigating the clinical characteristics, results of diagnostic tests, and patients' disposition from February 1, 2020, to April 30, 2020, at a tertiary medical center in Northern Taiwan. RESULTS: There is no nosocomial spreading of SARS-CoV-2 in our facility. The following strategies were followed: information transparency; epidemic prevention resources planning by authorities; multidisciplinary cooperation; informative technologies; immigration quarantine policies; travel restrictions; management of diversion/subdivision; self-health monitoring; social distancing; screening of travel, occupation, contact, and cluster (TOCC) history; traffic control bundling (TCB); training of using personal protective equipment; real-name visiting management; and employee care. The patients' basic characteristics and diagnostic results were gathered. Of the 3832 cases, about 25.9% had travel history. Most of them were traveling to Asia (419 people/time, 10.9%) and from China (256 people/time, 6.7%). Meanwhile, healthcare personnel accounted for 316 people/time (8.3%) and cleaning personnel, 6 people/time (0.16%). The 36 cases who care or have contact with confirmed cases have negative results from the COVID-19 test. The most frequent symptoms were fever and upper respiratory infection followed by gastrointestinal symptoms. CONCLUSION: The above strategies were followed. Patients were stratified based on the risk of TOCC history assessment to ensure the safety of healthcare personnel and patients' appropriate and timely medical services.

Emergency department response to coronavirus disease 2019 outbreak with a fever screening station and "graded approach" for isolation and testing.

BACKGROUND: Ever since coronavirus disease 2019 (COVID-19) emerged in Wuhan, China, in December 2019, it has had a devastating effect on the world through exponential case growth and death tolls in at least 146 countries. Rapid response and timely modifications in the emergency department (ED) for infection control are paramount to maintaining basic medical services and preventing the spread of COVID-19. This study presents the unique measure of combining a fever screening station (FSS) and graded approach to isolation and testing in a Taiwanese medical center. METHODS: An FSS was immediately set up outside the ED on January 27, 2019. A graded approach was adopted to stratify patients into "high risk," "intermediate risk," and "undetermined risk" for both isolation and testing. RESULTS: A total of 3755 patients were screened at the FSS, with 80.3% visiting the ED from home, 70.9% having no travel history, 21.4% having traveled to Asia, and 10.0% of TVGH staff. Further, 54.9% had fever, 35.5% had respiratory symptoms, 3.2% had gastrointestinal symptoms, 0.6% experienced loss of smell, and 3.1% had no symptoms; 81.3% were discharged, 18.6% admitted, and 0.1% died. About 1.9% were admitted to the intensive care unit, 10.3% to the general ward, and 6.4% were isolated. Two patients tested positive for COVID-19 (0.1%) and 127 (3.4%) tested positive for atypical infection; 1471 patients were tested for COVID-19; 583 were stratified as high-risk, 781 as intermediate-risk, and 107 as undetermined-risk patients. CONCLUSION: Rapid response for infection control is a paramount in the ED to confront the COVID-19 outbreak. The FFS helped divide the flow of high- and intermediate-risk patients; it also decreased the ED workload during a surge of febrile patients. A graded approach to testing uses risk stratification to prevent nosocomial infection of asymptomatic patients. A graded approach to isolation enables efficient allocation of scarce medical resources according to risk stratification.