Pediatric otolaryngology trends in patient care volume during covid-19: A survey study.

PURPOSE: To assess changes in outpatient clinic, inpatient consult, and operative volumes among pediatric otolaryngologists in response to the COVID-19 pandemic. MATERIALS AND METHODS: An online questionnaire was distributed to 535 active members of the American Society of Pediatric Otolaryngology from April 21, 2020, to May 4, 2020. The questionnaire assessed operative and clinical volumes during a two-week period between April 6, 2020, to April 20, 2020, while restrictions on elective surgery were in place, as compared to an average two-week period before the start of the COVID-19 pandemic. RESULTS: Both outpatient clinic and inpatient consult visit volume decreased significantly during the Covid-19 period. Academic practitioners typically reported seeing fewer outpatient visits than their private practice counterparts. Operative case volume decreased significantly across all procedures and surgeries common to pediatric otolaryngology. One-third of surveyed surgeons reported no operative cases during the assessed period. CONCLUSIONS: Pediatric otolaryngologists reported a severe reduction in operative volume, in-office visits, and inpatient consults during a time period at the peak of the 2020 Covid-19 outbreak. Many respondents saw no patients, nor operated in any capacity. This time period could have lasting effects on practitioner finances and trainee education.

Impact of COVID-19 pandemic waves on pediatric emergency department patients presenting with asthma attacks in Taiwan

The number of pediatric emergency department (PED) visits fell significantly during the coronavirus disease 2019 (COVID-19) pandemic. However, the impact of the ongoing pandemic on PED patients suffering from asthma attacks in Taiwan has not been studied. We thus analyzed patients with asthma attacks visiting a PED during the early stage of the COVID-19 pandemic and the following (resurgent) waves. We retrospectively studied pediatric patients with asthma attacks who visited the PED from 01 January 2019 to 30 September 2021. We retrieved patient numbers, demographic characteristics, triage acuities, medications, and PED dispositions during the various waves of the COVID-19 pandemic. A total of 1842 patients with asthmatic attacks presented to the PED during the study period. PED visits caused by asthmatic attacks declined by 55% after the first COVID-19 outbreak in early 2020 (p = 0.009) and fell even more remarkably (by 85%) in mid-2021 (p = 0.038), during the time when the numbers of confirmed COVID-19 cases skyrocketed (the second wave). However, neither the high-triage acuity rate nor the rate of admission differed between the two periods (p = 0.08 and 0.406, respectively). However, the proportion of systemic corticosteroid (SCS) prescriptions increased during the pandemic (81.90 vs. 77.77%, p = 0.029). The COVID-19 pandemic notably impacted the number of asthmatic PED visits not only during the first peak period but also during the following waves, but asthma severity did not vary over time. Physicians tended to prescribe more SCSs during the pandemic to control respiratory symptoms. We suggest that SCSs should be used cautiously even during the pandemic to minimize their adverse effects. Copyright © 2022 The Author(s). Published by MRE Press.

IMPLEMENTATION OF A SIMPLE CLINICAL PATHWAY INCREASES RELEVANCE OF INPATIENT CONSULTS FOR URINARY RETENTION

INTRODUCTION AND OBJECTIVE: Inpatient consultations are sometimes initiated in order to establish care without any acute need for specialist services. This creates additional expense for the health system while potentially delaying patient care and/or discharge. Urinary retention is often straightforward, requiring only bladder rest and medical optimization prior to trial of void in the outpatient setting for resolution. We sought to evaluate whether or not a simple decision tree could assist medical hospitalists in appropriately selecting patients requiring inpatient urologic management from those who can be safely directed to outpatient care. METHODS: Consults for urinary retention were identified based on billing data from July 2019 through June 2021. Male and female retention guideline policies were implemented to assist primary teams in determining if a patient's retention could be managed via simple algorithm, or were deemed complex and requiring of inpatient urologic evaluation. Consults were considered complex if associated with gross hematuria with clots, recent pelvic trauma, neurologic deficits/injury, new or worsening hydronephrosis, or acute kidney injury. Patients were grouped into a pre-intervention 8-month period of July 2019 through February 2020, which was compared to a post intervention 10-month period of September 2020 through June 2021. March to August 2020 were excluded due to COVID-19 hospital volume changes. Chi square analysis was performed. RESULTS: A total of 163 retention consults were placed over the 18 study months. In the pre-intervention period, urology consultation was only truly required in 27/80 (33.8%). After implementation of the pathway, this significantly increased to 47/83 (56.6%, p=0.003). Furthermore while the percentage of monthly consults requiring inpatient consultation increased in the post-intervention period, the overall total number of consults decreased from 10.0/month to 8.3/ month. CONCLUSIONS: Implementation of this urinary retention pathway increased the number of relevant inpatient consults while decreasing the number of simple retention consults. The net effect was a decrease in overall consults. This simple pathway may have identified more complex patients while reducing overutilization of specialist care.

COVID-19 has not decreased the volume of transcatheter aortic valve replacements performed in The United States

Introduction: Transcatheter aortic valve replacement (TAVR) is the predominant technique for aortic valve replacements. The COVID19 pandemic caused significant disruptions to hospital procedural and surgical volume and revenue, which could affect patients with aortic stenosis. Hypothesis: The COVID-19 pandemic may have decreased the volume of TAVRs in the United States. Methods: The National Readmission Database (NRD) was reviewed for all adults from 2012 to 2017 who underwent a TAVR procedure based on ICD 9 and 10 coding. A linear regression based on year and quarter was used to project the trend of volume and cost through the end of 2020. Institutional TAVR volume was compared from 2020 to 2019 to generate an estimate of COVID's effect on volume. This trend effect was utilized for the 2020 projections to create national estimates of changes in volume and hospital costs. The NRD weights were used to generate national estimates, charge-cost ratios were used to convert hospital charges to hospital costs, and all monetary values were adjusted to 2020 dollars via the GDP. Results: A total of 172,546 TAVR procedures were performed. TAVR volume has been increasing since 2012 with an estimated 21,516 cases in the last quarter of 2020 (Figure 1A). The linear regression was well fit with a R of 0.995. Similarly, hospital costs of TAVR have been increasing since 2012 with a projected 4.18 billion dollars in 2020 (Figure 1B). The linear regression was also well fit with a R of 0.968. There were two quarters in which hospital volume outperformed predicted values and two in which it underperformed (Figure 1C). Throughout the pandemic, there was a net increase of 1,918 TAVR procedures and an associated increase of 114 million dollars in hospital costs. Conclusions: TAVR volumes have been steadily increasing, with commensurate escalation in hospital hosts. The COVID-19 pandemic has caused minimal derailment to this trend, with an actual increase in volume and hospital costs during this time.