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Age and Ageing ; 51(SUPPL 1):i10, 2022.
Article in English | EMBASE | ID: covidwho-1815968


Introduction: Evaluation of Wythenshawe Hospital's Acute Frailty Service in January- June 2019 demonstrated slow referrals times and poor identification of frail patients due to inaccurate Clinical Frailty Scoring (CFS) at emergency department triage. This project presents the Results: of ongoing quality assessment of our service between June 2019- January 2021, following two quality improvement (QI) interventions. Aims: To evaluate our service's ability to deliver early identification and intervention for complex frail patients via Complex Geriatric Assessment (CGA), as set out in National and Regional Frailty standards.(1,2). -To improve and maintain better outcomes for patients accessing our frailty service. Method: Intervention1 (July'19): Specialist frailty nurses relocated to ED. Dedicated frailty clinical fellows and Consultant geriatrician input 0900-1700 weekdays. Intervention2 (Sep'20): Short-stay frailty unit opened. Junior clinical fellow cover increased (0900-1900 weekdays and 0900-1700 weekends). 299 patients seen at intervals between Jun'19-Jan'21 analysed using electronic records and completed CGA proformas. Results: Pre-intervention Intervention1 Intervention2 June'19(n = 22) July'19(n = 198) Nov'19(n = 25) Sep'20(n = 26) Jan'21(n = 28) Time from triage-to-CGA (mins) (CI 95%)∗ 372.0±178.2 56.0 83.4±31.0 72.9±35.7 48.4±20.0 Discharge(%): Same day 22.7 39.4 21.7 36.0 25.0<72 hr(cumulative) 72.7 63.6 47.8 68.0 57.1 Ave. length of stay(days)(CI95%) 10.4±5.9 20.6 20.0±8.7 7.1±3.4 5.4±2.1 Readmission <30 days(%) 30.0 9.0 17.4 12.5 25.0 CGA Quality(%) CFS completion 100 96.0100 89.3 ReSPECT discussion 29.3 64.0 61.5 67.9 Full medication review 46.5 96.0 80.8 89.3 Therapy assessment 85.5 92.0 92.3 89.3 ∗patients triaged between 0800-1700. Conclusion: Since Intervention1,Wythenshawe frailty service has sustained a reduction in triage-to-CGA time, maintained high percentages of same-day and<72 hr discharges, and sustained high rates of CFS completion and therapy assessments. Following intervention2, average length of stay reduced. Increased readmission rates in Jan'21 were impacted by COVID-19. Additional interventions targeted at reducing readmission rates and increasing ReSPECT discussions should be implemented. 1. GreaterManchester Frailty Collaborative and Network, 2019. 2. Same-day acute frailty service, NHS improvement, 2019.

PubMed; 2020.
Preprint in English | PubMed | ID: ppcovidwho-333523


IMPORTANCE: Case series without control groups suggest that Covid-19 may cause ischemic stroke, but whether Covid-19 is associated with a higher risk of ischemic stroke than would be expected from a viral respiratory infection is uncertain. OBJECTIVE: To compare the rate of ischemic stroke between patients with Covid-19 and patients with influenza, a respiratory viral illness previously linked to stroke. DESIGN: A retrospective cohort study. SETTING: Two academic hospitals in New York City. PARTICIPANTS: We included adult patients with emergency department visits or hospitalizations with Covid-19 from March 4, 2020 through May 2, 2020. Our comparison cohort included adult patients with emergency department visits or hospitalizations with influenza A or B from January 1, 2016 through May 31, 2018 (calendar years spanning moderate and severe influenza seasons). Exposures: Covid-19 infection confirmed by evidence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the nasopharynx by polymerase chain reaction, and laboratory-confirmed influenza A or B. Main Outcomes and Measures: A panel of neurologists adjudicated the primary outcome of acute ischemic stroke and its clinical characteristics, etiological mechanisms, and outcomes. We used logistic regression to compare the proportion of Covid-19 patients with ischemic stroke versus the proportion among patients with influenza. RESULTS: Among 2,132 patients with emergency department visits or hospitalizations with Covid-19, 31 patients (1.5%;95% confidence interval [CI], 1.0%-2.1%) had an acute ischemic stroke. The median age of patients with stroke was 69 years (interquartile range, 66-78) and 58% were men. Stroke was the reason for hospital presentation in 8 (26%) cases. For our comparison cohort, we identified 1,516 patients with influenza, of whom 0.2% (95% CI, 0.0-0.6%) had an acute ischemic stroke. After adjustment for age, sex, and race, the likelihood of stroke was significantly higher with Covid-19 than with influenza infection (odds ratio, 7.5;95% CI, 2.3-24.9). CONCLUSIONS AND RELEVANCE: Approximately 1.5% of patients with emergency department visits or hospitalizations with Covid-19 experienced ischemic stroke, a rate 7.5-fold higher than in patients with influenza. Future studies should investigate the thrombotic mechanisms in Covid-19 in order to determine optimal strategies to prevent disabling complications like ischemic stroke.