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1.
Sci Rep ; 12(1): 17466, 2022 Oct 19.
Article in English | MEDLINE | ID: covidwho-2077110

ABSTRACT

Emergency departments (EDs) are experiencing complex demands. An ED triage tool, the Score for Emergency Risk Prediction (SERP), was previously developed using an interpretable machine learning framework. It achieved a good performance in the Singapore population. We aimed to externally validate the SERP in a Korean cohort for all ED patients and compare its performance with Korean triage acuity scale (KTAS). This retrospective cohort study included all adult ED patients of Samsung Medical Center from 2016 to 2020. The outcomes were 30-day and in-hospital mortality after the patients' ED visit. We used the area under the receiver operating characteristic curve (AUROC) to assess the performance of the SERP and other conventional scores, including KTAS. The study population included 285,523 ED visits, of which 53,541 were after the COVID-19 outbreak (2020). The whole cohort, in-hospital, and 30 days mortality rates were 1.60%, and 3.80%. The SERP achieved an AUROC of 0.821 and 0.803, outperforming KTAS of 0.679 and 0.729 for in-hospital and 30-day mortality, respectively. SERP was superior to other scores for in-hospital and 30-day mortality prediction in an external validation cohort. SERP is a generic, intuitive, and effective triage tool to stratify general patients who present to the emergency department.


Subject(s)
COVID-19 , Triage , Adult , Humans , Retrospective Studies , Emergency Service, Hospital , COVID-19/diagnosis , COVID-19/epidemiology , Machine Learning
2.
JMIR Serious Games ; 10(3): e38433, 2022 Jul 22.
Article in English | MEDLINE | ID: covidwho-1963267

ABSTRACT

BACKGROUND: Recently, the demand for mechanical ventilation (MV) has increased with the COVID-19 pandemic; however, the conventional approaches to MV training are resource intensive and require on-site training. Consequently, the need for independent learning platforms with remote assistance in institutions without resources has surged. OBJECTIVE: This study aimed to determine the feasibility and effectiveness of an augmented reality (AR)-based self-learning platform for novices to set up a ventilator without on-site assistance. METHODS: This prospective randomized controlled pilot study was conducted at Samsung Medical Center, Korea, from January to February 2022. Nurses with no prior experience of MV or AR were enrolled. We randomized the participants into 2 groups: manual and AR groups. Participants in the manual group used a printed manual and made a phone call for assistance, whereas participants in the AR group were guided by AR-based instructions and requested assistance with the head-mounted display. We compared the overall score of the procedure, required level of assistance, and user experience between the groups. RESULTS: In total, 30 participants completed the entire procedure with or without remote assistance. Fewer participants requested assistance in the AR group compared to the manual group (7/15, 47.7% vs 14/15, 93.3%; P=.02). The number of steps that required assistance was also lower in the AR group compared to the manual group (n=13 vs n=33; P=.004). The AR group had a higher rating in predeveloped questions for confidence (median 3, IQR 2.50-4.00 vs median 2, IQR 2.00-3.00; P=.01), suitability of method (median 4, IQR 4.00-5.00 vs median 3, IQR 3.00-3.50; P=.01), and whether they intended to recommend AR systems to others (median 4, IQR 3.00-5.00 vs median 3, IQR 2.00-3.00; P=.002). CONCLUSIONS: AR-based instructions to set up a mechanical ventilator were feasible for novices who had no prior experience with MV or AR. Additionally, participants in the AR group required less assistance compared with those in the manual group, resulting in higher confidence after training. TRIAL REGISTRATION: ClinicalTrials.gov NCT05446896; https://beta.clinicaltrials.gov/study/NCT05446896.

3.
Clin Exp Emerg Med ; 9(1): 1-9, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-1771870

ABSTRACT

OBJECTIVE: Coronavirus disease 2019 (COVID-19) has notably altered the emergency department isolation protocol, imposing stricter requirements on probable infectious disease patients that enter the department. This has caused adverse effects, such as an increased rate of leave without being seen (LWBS). This study describes the effect of fever/respiratory symptoms as the main cause of isolation regarding LWBS after the COVID-19 pandemic. METHODS: We retrospectively analyzed emergency department visits before (March to July 2019) and after (March to July 2020) the COVID-19 pandemic. Patients were grouped based on existing fever or respiratory symptoms, with the LWBS rate as the primary outcome. Logistic regression analysis was used to identify the risk factors of LWBS. Logistic regression was performed using interaction terminology (fever/respiratory symptom patient [FRP] × post-COVID-19) to determine the interaction between patients with FRPs and the COVID-19 pandemic period. RESULTS: A total of 60,290 patients were included (34,492 in the pre-COVID-19, and 25,298 in the post-COVID-19 group). The proportion of FRPs decreased significantly after the pandemic (P < 0.001), while the LWBS rate in FRPs significantly increased from 2.8% to 19.2% (P < 0.001). Both FRPs (odds ratio, 1.76; 95% confidence interval, 1.59-1.84 (P < 0.001) and the COVID-19 period (odds ratio, 2.29; 95% confidence interval, 2.15-2.44; P < 0.001) were significantly associated with increased LWBS. Additionally, there was a significant interaction between the incidence of LWBS in FRPs and the COVID-19 pandemic period (P < 0.001). CONCLUSION: The LWBS rate has increased in FRPs after the COVID-19 pandemic; additionally, the effect observed was disproportionate compared with that of nonfever/respiratory symptom patients.

4.
Medicina (Kaunas) ; 58(2)2022 Feb 01.
Article in English | MEDLINE | ID: covidwho-1667240

ABSTRACT

Background and Objectives: Point-of-care ultrasound (POCUS) is a useful tool that helps clinicians properly treat patients in emergency department (ED). This study aimed to evaluate the impact of specific interventions on the use of POCUS in the ED. Materials and Methods: This retrospective study used an interrupted time series analysis to assess how interventions changed the use of POCUS in the emergency department of a tertiary medical institute in South Korea from October 2016 to February 2021. We chose two main interventions-expansion of benefit coverage of the National Health Insurance (NHI) for emergency ultrasound (EUS) and annual ultrasound educational workshops. The primary variable was the EUS rate, defined as the number of EUS scans per 1000 eligible patients per month. We compared the level and slope of EUS rates before and after interventions. Results: A total of 5188 scanned records were included. Before interventions, the EUS rate had increased gradually. After interventions, except for the first workshop, the EUS rate immediately increased significantly (p < 0.05). The difference in the EUS rate according to the expansion of the NHI was estimated to be the largest (p < 0.001). However, the change in slope significantly decreased after the third workshop during the coronavirus disease 2019 pandemic (p = 0.004). The EUS rate increased significantly in the presence of physicians participating in intensive POCUS training (p < 0.001). Conclusion: This study found that expansion of insurance coverage for EUS and ultrasound education led to a significant and immediate increase in the use of POCUS, suggesting that POCUS use can be increased by improving education and insurance benefits.


Subject(s)
COVID-19 , Point-of-Care Systems , Emergency Service, Hospital , Humans , Insurance Benefits , Interrupted Time Series Analysis , Retrospective Studies , SARS-CoV-2 , Ultrasonography
5.
J Korean Med Sci ; 36(28): e209, 2021 Jul 19.
Article in English | MEDLINE | ID: covidwho-1318379

ABSTRACT

BACKGROUND: Ear-loop-type Korean Filter 94 masks (KF94 masks, equivalent to the N95 and FFP2) are broadly used in health care settings in Korea for the coronavirus disease 2019 pandemic. METHODS: A prospective randomized open-label study was designed to identify differences in the fitting performance between mask wearing methods in three different types of KF94 mask with ear loops between January to March 2021. General-fitting involved wearing an ear-loop-type KF94 mask, and tight-fitting involved wearing a mask aided by a clip connecting the ear loops. Each of the 30 participants wore three types of masks according to a randomly assigned order in both methods and performed a total of six quantitative fit tests (QNFTs) according to the occupational safety and health administration protocol. RESULTS: All fit factors (FFs) measured by the QNFT were significantly higher for tight-fitting method with the clip in all KF94 masks (P < 0.001). However, the total FFs were very low, with a median (interquartile range) of 6 (3-23) and 29 (9-116) for general-fitting and tight-fitting, respectively. When wearing tightly, the horizontal 3-fold type mask with adjustable ear-loop length had the highest FF, with a median of 125, and the QNFT pass rate (FF ≥ 100) increased significantly from 4 (13%) to 18 (60%). CONCLUSION: Even with sufficient filter efficiency, ear-loop-type-KF94 masks do not provide adequate protection. However, in relatively low-risk environments, wearing a face-seal adjustable KF94 mask and tight wearing with a clip can improve respiratory protection for healthcare workers. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04794556.


Subject(s)
COVID-19/prevention & control , N95 Respirators , SARS-CoV-2 , Adult , Female , Health Personnel , Humans , Male , Prospective Studies
6.
J Clin Med ; 9(12)2020 Nov 26.
Article in English | MEDLINE | ID: covidwho-945861

ABSTRACT

(1) Background: During a pandemic, patients and processes in the emergency department (ED) change. These circumstances affect the length of stay (LOS) or degree of crowding in the ED. The processes for patients with acute critical illness, such as cerebrovascular disease (CVD), can be also delayed. Using the process mining (PM) method, this study aimed to evaluate LOS, ED processes for CVD, and delayed processes during the coronavirus disease 2019 (COVID-19) pandemic. (2) Methods: Data were collected from the Clinical Data Warehouse of a medical center. Phase 1 included patients who visited the ED before the COVID-19 outbreak. In Phase 2, post-COVID-19 ED patients were divided into the COVID-19 tested group (CTG) and COVID-19 not tested group (CNTG) according to whether polymerase chain reaction test was performed. We analyzed patients' ED processes before and after COVID-19 using the PM method. We analyzed patients with acute CVD separately to determine whether the process and LOS of patients with acute critical illness were changed or delayed. (3) Results: After the COVID-19 outbreak, the overall LOS was delayed and all processes in CTG patients were delayed. Registration to triage and triage were delayed in both CTG and CNTG patients. The brain imaging process for CTG patients with acute CVD was also delayed. (4) Conclusion: After a pandemic, some processes were changed, new processes were developed, and processes for patients with acute CVD who needed proper time management were not exempted.

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