Trends in STI testing and diagnosis rates during the COVID-19 pandemic at a large urban tertiary care center, and the role of the emergency department in STI care.

Introduction: The COVID-19 pandemic has had profound effects on access to care, including outpatient sexually transmitted infection (STI) testing and treatment. Many vulnerable populations already relied on the emergency department (ED) for much of their care prior to the pandemic. This study examines trends in STI testing and positivity before and during the pandemic at a large urban medical center and evaluates the role of the ED in providing STI care. Methods: This is a retrospective review of all gonorrhea, chlamydia, and trichomonas tests from November 1, 2018, through July 31, 2021. Demographic information and location and results of STI testing were extracted from the electronic medical record. Trends in STI testing and positivity were examined for 16 month periods before and after the COVID-19 pandemic started (March 15, 2020), with the latter divided into the early pandemic period (EPP: March 15 -July 31, 2020) and late pandemic period (LPP: August 1, 2020 - July 31, 2021). Results: Tests per month decreased by 42.4% during the EPP, but rebounded by July 2020. During the EPP, the proportion of all STI testing originating in the ED increased from 21.4% pre-pandemic to 29.3%, and among pregnant women from 45.2% to 51.5%. Overall STI positivity rate increased from 4.4% pre-pandemic to 6.2% in the EPP. Parallel trends were observed for gonorrhea and chlamydia individually. The ED represented 50.5% of overall positive tests, and as much as 63.1% of positive testing during the EPP. The ED was the source of 73.4% of positive tests among pregnant women, which increased to 82.1% during the EPP. Conclusions: STI trends from this large urban medical center paralleled national trends, with an early decrease in positive cases followed by a rebound by the end of May 2020. The ED represented an important source of testing for all patients, and especially for pregnant patients, throughout the study period, but even more so early in the pandemic. This suggests that more resources should be directed towards STI testing, education, and prevention in the ED, as well as to support linkage to outpatient primary and obstetric care during the ED visit.

ENT Referral From Emergency Department During COVID-19: A Single-Center Experience.

PURPOSE: COVID-19 pandemic transformed the health system response worldwide. The aim of this study is to report changes about numbers and reason for ENT consultations in emergency department (ED) during COVID-19 pandemic comparing with those occurred the previous year (2019). METHODS: Data about patients admitted to adult and pediatric ED were collected from March 1 to May 31, 2019 and 2020. Patients referred for urgency from general practitioners were excluded from the study. RESULTS: Global ED admission (except for dyspnea or COVID-19-related symptoms) dramatically decreased during pandemic (-50.9% among adults and -71.4% among pediatrics). At the same time, ENT consultancy significantly reduced too, by 71.5% (P < .01) among adults and 45.1% (P < .01) for pediatrics. Among adults, it was reported a statistically significant decrease in consultation for ear problems (-88.5%, P = .0146). Reduction in ENT referral for bone fracture (-40%, P = .059), vertigo (-77.8%, P = .637), and tonsillitis (-87.5%, P = .688) was consistent, but not significant. Among pediatric patients, it was observed an increase by 25% about foreign bodies (12 vs 15, P < .01). A reduction in numbers of consults for ear problem (-90.8%; P = .045), epistaxis (-80%; P = .196), and nasal fracture (-70%; P = .36) was also observed. CONCLUSION: Fear of infection and the forced lock down caused a significant decrease in the number of ED accesses and in ENT consultancy. These data may suggest that some ED referral usually could be deferred, but on the other hand, pandemic will cause a great diagnostic delay.

Emergency department treatment process planning: a field research, case analysis, and simulation approach.

Background: The coronavirus disease 2019 (COVID-19) has forced accelerated optimization of Emergency Department (ED) process, and simulation tools offer an alternative approach to strategic assessment and selection. Methods: Field research and case analysis methods were used to obtain the treatment process and medical records information from the ED of a general hospital. Minitab was used for analysis of the measurement system, and Arena was applied for simulation modelling. We established a framework for the triage protocol of ordinary and quarantined patients, analysed bottlenecks in the treatment time of the hospital's ED, and proposed an optimised management strategy. Results: The computed tomography (CT) pre-scheduling strategy simulation results demonstrated that longer CT room preparation times for quarantined people before their arrival (Tp) resulted in reduced CT scan and waiting times for quarantined patients, but these times were longer for ordinary patients. The nucleic acid priority strategy simulation results demonstrated that when the average daily number of ordinary patients (λc) was relatively stable, the hospital could guide ordinary patients to perform nucleic acid testing first followed by CT testing. However, when λc fluctuated greatly, the hospital could appropriately reduce the proportion of preferential nucleic acid testing. Furthermore, when λc was overloaded, the nucleic acid priority strategy showed no advantages. The joint analysis results demonstrated that the optimal strategy selection was significantly affected by the severity of the epidemic. The nucleic acid detection sample size optimisation strategy demonstrated that optimizing the sample size of each batch according to the number of patients could effectively reduce the waiting times for nucleic acid testing (Tn). Conclusions: Simulation tools are an alternative method for strategic evaluation and selection that do not require external factors.

Prediction of Length of Stay in the Emergency Department for COVID-19 Patients: A Machine Learning Approach

The coronavirus disease (COVID-19) outbreak has become a global public health threat. The influx of COVID-19 patients has prolonged the length of stay (LOS) in the emergency department (ED) in the United States. Our objective is to develop a reliable prediction model for COVID-19 patient ED LOS and identify clinical factors, such as age and comorbidities, associated with LOS within a “4-hour target.”Data were collected from an urban, demographically diverse hospital in Detroit for all COVID-19 patients’ED presentations from March 16 to December 29, 2020. We trained four machine learning models, namely logistic regression (LR), gradient boosting (GB), decision tree (DT), and random forest (RF), across different data processing stages to predict COVID-19 patients with an ED LOS of less than or greater than 4 hours. The analysis is inclusive of 3,301 COVID-19 patients with known ED LOS, and 17 significant clinical factors were incorporated. The GB model outperformed the baseline classifier (LR) and tree-based classifiers (DT and RF) with an accuracy of 85% and F1-score of 0.88 for predicting ED LOS in the testing data. No significant accuracy gains were achieved through further splitting. This study identified key independent factors from a combination of patient demographics, comorbidities, and ED operational data that predicted ED stay in patients with prolonged COVID-19. The prediction framework can serve as a decision-support tool to improve ED and hospital resource planning and inform patients about better ED LOS estimations. Author

Integration and Validation of a Natural Language Processing Machine Learning Suicide Risk Prediction Model Based on Open-Ended Interview Language in the Emergency Department.

BACKGROUND: Emergency departments (ED) are an important intercept point for identifying suicide risk and connecting patients to care, however, more innovative, person-centered screening tools are needed. Natural language processing (NLP) -based machine learning (ML) techniques have shown promise to assess suicide risk, although whether NLP models perform well in differing geographic regions, at different time periods, or after large-scale events such as the COVID-19 pandemic is unknown. OBJECTIVE: To evaluate the performance of an NLP/ML suicide risk prediction model on newly collected language from the Southeastern United States using models previously tested on language collected in the Midwestern US. METHOD: 37 Suicidal and 33 non-suicidal patients from two EDs were interviewed to test a previously developed suicide risk prediction NLP/ML model. Model performance was evaluated with the area under the receiver operating characteristic curve (AUC) and Brier scores. RESULTS: NLP/ML models performed with an AUC of 0.81 (95% CI: 0.71-0.91) and Brier score of 0.23. CONCLUSION: The language-based suicide risk model performed with good discrimination when identifying the language of suicidal patients from a different part of the US and at a later time period than when the model was originally developed and trained.

Analgesic Treatment and the Patients' Opinion on the Hospital Emergency Department.

AIM: The aim of the study was to analyze whether a patient's opinion is related to the effect of analgesic treatment. METHODS: The study was conducted using a survey questionnaire among adult patients admitted to the hospital emergency department in March 2021. The Numerical Rating Scale (NRS) was used to assess pain. Patients were asked to rate the intensity of pain during their stay in the emergency department in three situations: (1) at admission; (2) during the stay; and (3) upon discharge. The relationships between qualitative variables were assessed by the chi-squared test. Significance was set at p < 0.05. RESULTS: There was no statistical dependence between the patient's opinion about the medical institution and results of the effectiveness of analgesic treatments (p = 0.056). The highest percentage of patients satisfied with the received treatment were those who did not feel pain during ED discharge (94.12%), and the lowest were those who complained of severe pain during ED discharge (63.91%). The average mark for the functioning and organization of the emergency department was 7.44 (±2.04). Only 54 patients (29.83%) had taken pain medication before deciding to visit ED. CONCLUSIONS: No statistical dependency between the effect of the analgesic treatment and the patient's opinion has been observed. The majority of patients with pain discomfort visit emergency departments without looking for consultation in other locations or without taking analgesics. In the considered institution, patients were satisfied with the analgesic treatment, staff performance, and with the organization of the department.

Occupational stress and its relationship with spiritual coping among emergency department nurses and emergency medical services staff.

INTRODUCTION: Emergency Department (ED) nurses and Emergency Medical Services (EMS) Staff are faced with several stressors daily, such as the COVID 19 pandemic situation, which affects the health and the quality of services to patients. Spiritual coping with stress is an attempt to overcome the stress on the basis of what is transcendent. The use of spiritual coping strategies helps a person to overcome tensions caused by the work environment. OBJECTIVE: The current study aimed to investigate occupational stress and its relationship with spiritual coping among ED nurses and EMS staff. MATERIALS AND METHODS: This study was descriptive-correlational research. Using convenience sampling methods, 516 ED nurses and EMS staff were enrolled in the study. The study instruments included demographic information, HSE Occupational Stress, and spiritual coping questionnaires. Data were analyzed using SPSSv.22 software and the descriptive statistics, Pearson correlation test, t-test, ANOVA, and multiple linear regression. RESULTS: The highest and lowest levels of occupational stress were the dimensions of "demand" (2.96 ± 0.65) and "role" (3.89 ± 0.81) respectively. Multiple linear regression analysis showed that positive spiritual coping, negative spiritual coping, workplace, service location, type of employment, and work position were important factors affecting the occupational stress of ED nurses and EMS staff, which accounted for 0.34% of the variance. CONCLUSION: The findings showed the need to improve the work environment for ED nurses and EMS staff, including changes in physical working conditions, salaries, and better employment conditions. Training programs are recommended to reduce stress through the use of positive spiritual coping strategies.

The effect of the COVID-19 pandemic on non-COVID respiratory ED visits in Israel.

BACKGROUND: The COVID 19 pandemic has had a crucial effect on the patterns of disease and treatment in the healthcare system. This study examines the effect of the COVID-19 pandemic on respiratory ED visits and admissions broken down by age group and respiratory diagnostic category. METHODS: Data on non-COVID related ED visits and hospitalizations from the ED were obtained in a retrospective analysis for 29 acute care hospitals, covering 98% of ED beds in Israel, and analyzed by 5 age groups: under one-year-old, 1-17, 18-44, 45-74 and 75 and over. Diagnoses were classified into three categories: Upper respiratory tract infections (URTI), pneumonia, and COPD or asthma. Data were collected for the whole of 2020, and compared for each month to the average number of cases in the three pre-COVID years (2017-2019). RESULTS: In 2020 compared to 2017-2019, there was a decrease of 34% in non-COVID ED visits due to URTI, 40% for pneumonia and a 35% decrease for COPD and asthma. Reductions occurred in most age groups, but were most marked among infants under a year, during and following lockdowns, with an 80% reduction. Patients over 75 years old displayed a marked drop in URTI visits. Pediatric asthma visits fell during lockdowns, but spiked when restrictions were lifted, accompanied by a higher proportion admitted. The percent of admissions from the ED visits remained mostly stable for pneumonia; the percent of young adults admitted with URTI decreased significantly from March to October. CONCLUSIONS: Changing patterns of ED use were probably due to a combination of a reduced rate of viral diseases, availability of additional virtual services, and avoidance of exposure to the ED environment. Improved hygiene measures during peaks of respiratory infections could be implemented in future to reduce respiratory morbidity; and continued provision of remote health services may reduce overuse of ED services for mild cases.

Characteristics of cancer patients with COVID-19 in a cancer hospital.

BACKGROUND: Cancer patients are vulnerable to the coronavirus disease (COVID-19) given their compromised immune system. The purpose of this study was to describe the presenting symptoms, inpatient stay trajectory, and survival outcomes, for cancer patients infected with COVID-19; who presented to the emergency department (ED) of a single center during the early months of the pandemic. METHODS: We reviewed the electronic medical records of all cancer patients diagnosed with COVID-19 at our institution for demographic information, clinical presentation, laboratory findings, treatment intervention and outcomes. All patients had at least 14 days of follow-up. We determined their survival outcomes as of August 5, 2020. RESULTS: Twenty-eight cancer patients were diagnosed with COVID-19, and 16 (57%) presented to the ED during the study period. The median age of patients who presented to the ED was 61 years, 69% were women, and the median length of hospitalization was 11 days. There was no difference between the groups (ED vs. no ED visit) for demographics, treatment status or solid tumor versus hematologic malignancies or treatments. Dyspnea was a significant symptom with 67% of ED patients experiencing it versus only 17% of those that did not come to the ED (P=0.009). Do not resuscitate orders were initiated in eight patients, as early as two days from ED presentation and two of these patients died, while 88% of patients were discharged alive. CONCLUSIONS: Most cancer patients with COVID-19 infection admitted though the ED experienced dyspnea and were discharged from the hospital. We did not notice a statistically significant difference between cancer types or type of therapy. A broad differential is of utmost importance when caring for cancer patients with COVID-19 due to the complexity of this population. Early goals of care discussion should be initiated in the ED.