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Intro: The Out-Patient Parenteral Antimicrobial Therapy (OPAT) is a form of Antimicrobial Stewardship that is now widely-practise throughout the world. However, in Malaysia, this has just only begun to take root and the OPAT in Universiti Malaya (UM) has only just begin operating on 2 August, 2018. The OPAT in Universiti Malaya has been operating for 4 years and is a collaboration between the General Medical Unit and the Infectious Control Unit. Method(s): This was a longitudinal study of all the patients that has been admitted to the OPAT since the start of the service. For each patient the starting and ending date in OPAT, anitbiotic used, the diagnosis, the referring unit, and any problems were recorded. Finding(s): The total patient-days of antibiotics served in the OPAT was 4978, with a mean duration of 66.37 days per patient and a median of 31 days. The majority of cases was referred from the medical department with 41 cases (54.67%) followed by Surgery with 22 cases (29.33%). Ertapenem was the most common antimicrobial served with 39 patients on it (52%) and ceftriaxone was second with 8 patients served (10.67%). All antibiotics have been agreed upon by the Infectious Disease Unit. In our study, 2 patients in OPAT has died but the rest none of them were admitted for hospital associated infection. Discussion(s): We found that OPAT on average save at least ten beds per day in the hospital. The patients are happy because they do not need to be warded in hospital to receive their antimicrobials. However, we faced limitations in recruitment of patients to the OPAT during the COVID-19 pandemic, staff shortages, the lack of infusion pumps for serving multidose antimicrobials, and bureacratic red-tape. Conclusion(s): OPAT was useful in reducing bed occupancy rate and hospital associated infection. Patients also are happy with the service.Copyright © 2023
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Background A paradigm shift appears to be occurring with overwhelming evidence of trans-radial access (TRA) being a safe and feasible approach for peripheral interventions compared to trans-femoral access (TFA). Our study explores the additional, multifactorial benefits of TRA regarding perioperative times, radiation, contrast administration, and cost-savings for patients and hospitals during Covid era. Methods A retrospective review of all peripheral interventions were performed over two years to outline the advantages and limitations of TRA compared to TFA approach. Patient demographics, procedural time, contrast usage, and radiation dose were recorded and analyzed. Hospital discharges and bed utilization were also studied. Results Total of 170 procedures performed via radial access were evaluated and compared to a control population of n=20 femoral access procedures. Procedural success rate for all interventions was 100% with 10% of cases presenting with acute limb ischemia and 90% presenting with chronic limb ischemia. A two-fold decrease in procedural time for TRA was evident in our analysis compared to the procedures conducted via TFA (81 +/- 43 mins vs. 164 +/- 36 mins, respectively). Furthermore, contrast usage and radiation absorption in TRA procedures decreased dramatically, adding to the potential cost-saving and safety measures for the patient and hospital system. Conclusion While current TRA limitations include operator experience, length of devices, and sheath sizes, the overall benefits of TRA over traditional TFA management cannot be ignored. TRA approach is undoubtedly a safe, feasible, efficient, and cost-saving route for peripheral interventions. It is here to stay as the present and future of diagnosing and treating peripheral arterial disease.Copyright © 2023 American College of Cardiology Foundation
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INTRODUCTION: The current CDC guidelines recommend COVID-19 vaccine boosters for all eligible individuals to enhance protection. Resources have been allocated to research done regarding the COVID-19 vaccine, and we speculate that there is a correlation between COVID booster rates and number of COVID patients in the ICU. We hypothesize that the states with a higher percentage of the population that received the booster shot will have decreased COVID ICU bed utilization and vice versa. METHOD(S): The percentage of people who received the COVID-19 booster vaccine and the number of ICU beds occupied by patients with COVID-19 per 10,000 population, both stratified by states, were reviewed to determine the pattern of correlation. The data for both the variables was sourced from Becker's Healthcare as it used information from the CDC's data tracker to rank states by their booster rates. The rankings were last updated based on data from July 20th, 2022. The state of Idaho was excluded because the data was not available. Limitations of the study included reporting lags between the states and CDC, the emergence of numerous variants of the virus, and a lack of a standardized timeline across the states. RESULT(S): Pearson Correlation Coefficient was used to determine the pattern of correlation between COVID booster rates and the number of COVID patients in the ICU for all US states. Booster rates was set as x and ICU patients was set as y. The data was analyzed while using the formula r = SIGMA((X - My)(Y - Mx)) / ((SSx)(SSy)). X Values were calculated with SIGMA = 2407.7, Mean = 48.154 and SIGMA(X - Mx)2 = SSx = 2308.544. Y Values were calculated with SIGMA = 5112, Mean = 102.24 and SIGMA(Y - My)2 = SSy = 835103.12. The coefficient of determination, R2, was 0.0611. Our obtained R was -0.25 which means no strong correlation was found. The data was analyzed independently by two statisticians and the same results were obtained. The results failed to confirm our hypothesis and suggested that there was no correlation between COVID booster rates and the number of COVID patients in the ICU. CONCLUSION(S): Based on our results, no correlation was found between the states' COVID booster rates and ICU bed occupancy. Further studies are needed to quantify this association if any as highly virulent COVID strains pose a threat to humanity.
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INTRODUCTION: ICU admission occurs for active treatment (ventilation, vasopressors) and to monitor patients at risk. The Acute Physiology and Chronic Health Evaluation (APACHE) IVb defines Low Risk Monitor (LRM) as not actively treated on ICU day 1 and < 10% prospective risk of ever needing active treatment. LRM patients potentially fill ICU beds required by acutely ill patients. We investigated if unprecedented ICU demand during the COVID-19 pandemic decreased LRM admissions during COVID surges. METHOD(S): Retrospective analysis of hospitals tracking COVID-19 status and consistently contributing to the APACHE database March 23, 2020 to December 31, 2021. Baseline pre-pandemic data was also assessed. Patients with primary surgical and trauma diagnoses were removed to eliminate incidental COVID diagnoses. Pearson's correlation coefficient (r) assessed the weekly relationship between %COVID and LRM patients. RESULT(S): 117,004 patients were admitted to ICU at 43 hospitals. Baseline LRM averaged 28.6% pre-COVID. During successive COVID peaks in April, July and December 2020 and April, August and December 2021, there was high inverse correlation (r=-0.90) between COVID census and LRM percentage. For example, in September 2020 COVID% was 7.81 and LRM was 28.2%. In December 2020, COVID surged to 31.1% and LRM dropped to 21.3%. These percentages returned to COVID 9.5% and LRM 28.2% during the March 2021 trough. Hospital mortality was 10.9% pre-pandemic, and 14.69% actual/13.66 predicted (SMR=1.08) from April 2020 through December 2021. Mean ventilator days were 4.08 pre- and 5.58 pandemic. ICU LOS increased from 3.52 to 4.16 days (ratio 1.11). CONCLUSION(S): LRM admissions decreased dramatically during successive COVID-19 surges, demonstrating considerable elasticity in ICU triage decisions. Mortality, ventilator days and ICU LOS all increased during the pandemic compared to baseline. Consistent measurement of % LRM may be helpful in recognizing opportunities to reduce inappropriate ICU bed utilization and as a marker of strained capacity.
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Background: Emergency departments (EDs) have experienced increases in patient boarding, which has resulted in significant challenges to providing quality care. The COVID pandemic has exacerbated ED crowding despite reduced ED volumes nationally, which is in part due to national ED nursing shortages. Nursing-specific operational inefficiencies can have detrimental financial consequences for the ED and hospitals. Study Objectives: There were two primary objectives: 1) To quantify the amount of ED beds unavailable due to nurse-staffing challenges 2) To estimate the financial impact of this reduced capacity on the ED. Method(s): A retrospective, cohort review of all ED encounters from January 1, 2021 - December 31, 2021, was identified at our large, academic, safety-net trauma center. Performance metrics were retrieved from a novel, interactive, digital data dashboard at the Zuckerberg San Francisco General Hospital (ZSFGH). Average daily staffed nursing beds were obtained during two key time points daily: 11am and 7pm from Q4- 2021 (October 1, 2021 - December 31, 2021) and extrapolated for the calendar year. Total unavailable ED bed minutes were determined based on nursing staffing as were total potential missed encounters due to unavailable ED beds. These were estimated using the average LOS for ED encounters. Average institutional ED charges and realized payments were then used to determine a financial estimate of the impact of the nursing shortage during Q4-2021 and annualized for 2021. We assume, based on pre-pandemic census data, that there is sufficient ED demand and volume to occupy all available ED beds. Result(s): The ZSFGH is a 59-bed ED that when maximally staffed has a weighted average of 56.25 beds daily, accounting for nighttime closures. During the review period, the average daily nursing-staffed beds during Q4-2021 were 47.7 (84.7%). From January 1, 2021 - December 31, 2021, there were 57,888 encounters of which 53,012 (91.6%) were included and 4,876 (8.4%) were excluded due to alternative dispositions such as Absent Without Leave (AWOL), Left Without Being Seen (LWBS), Left Without Being Triaged (LWBT) and Nursing Referrals (RN Referrals). The total unstaffed ED bed minutes was an estimated 4,511,400. The average LOS excluding AWOL, LWBS, LWBT, RN Referrals, and Against Medical Advice (AMA) during this time period was 411 minutes resulting in an estimated 10,977 potential missed encounters, an estimated $8.56M in lost potential charges, and $1.97M in potential lost revenue [Figure 1]. During the pre-pandemic period with available data (August 1, 2019 - February 29, 2020) when boarding and nursing staffing weren't as limited, the daily census was 184.1 patients, excluding LWBS, LWBT, and RN Referrals with an average LOS of 407 minutes for a total daily bedtime of 74,929 minutes for a utilization of 92.5%. During this period, the total daily census with LWBS, LWBT, and RN Referrals was 210.1 patients. These additional patients would account for another 10,582 bed minutes for a total bed utilization of 85,511 mins (105.6%). Conclusion(s): The COVID pandemic has resulted in increasing challenges for already strained EDs. Increasing national nursing shortages reduce operational performance and result in a significant financial loss to EDs. Greater attention to the financial consequences of nursing shortages on EDs may allow for improved resource allocation, capacity recovery, and financial performance. [Formula presented] Yes, authors have interests to disclose Disclosure: FujiFilm-SonoSite Consultant/Advisor FujiFilm-SonoSite Disclosure: Inflammatix Consultant/Advisor Inflammatix Copyright © 2022
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Introduction: As of March 2020, COVID-19 pneumonia was declared a global pandemic by the World Health Organisation (WHO).1 COVID19 pneumonia typically presents with systematic and/or respiratory manifestations, with a large percentage requiring advanced respiratory support.2 In severe cases COVID-19 pneumonia can induce acute respiratory distress syndrome leading to refractory hypoxaemia and the use of extra-corporeal life support (ECLS) may be appropriate as a rescue therapy.3 The functional outcomes of patients receiving extra-corporeal membrane oxygenation (ECMO) for COVID are unknown and this observational study will present data from the first and second wave of the pandemic. Objectives: To describe the demographics, functional outcomes and discharge needs of patients receiving ECMO for COVID-19. Methods: Adults admitted to ICU for ECMO with a confirmed diagnosis of COVID19 were included. Functional outcomes were measured using the Chelsea Physical Assessment Scale (CPAx)4 and ICU mobility score.5 Measurements were taken once patients were deemed appropriate for rehabilitation up to discharge from the hospital. Data collection and analysis was performed by two independent unblinded reviewers. Results: A total number of n34 patients were included in the review, n21 survived to hospital discharge and were included in the analysis. 71% of patients were male with an average age of 46 (±9.9) The predominant method of ECMO was veno-venous (90%). Mean duration of ECMO was 25.1 days (±19.6) The average time to mobilise post decannulation from ECMO was 10.86 days (±6.61), with an average CPAx score of 30.10 (±8.94) and ICU mobility score of 6.14 (±2.33) on ICU discharge. Functional milestones included on average achieving independent sitting balance at ∼4 weeks and mobilising +/-an aid at ∼6 weeks. There were no significant differences between patients who were mobilised within 7 days of decannulation of ECMO (P= 0.9) Patients who did not require a tracheostomy had reduced ICU length of stay (P= 0.006). There was nil significant difference between patients who received steroids for ICU length of stay (P = 0.143), CPAx (P= 0.357) or ICU mobility scores (P= 0.414) on discharge from ICU. On discharge from hospital 95% of patients required ongoing support which included the following-discharge home with community therapy, in-hospital transfer and referral to a rehabilitation centre. Conclusions: This data is the first of its kind to present the functional outcomes of patients receiving ECMO during the COVID19 pandemic. Patients receiving ECMO for COVID19 present with high acuity of illness with prolonged mechanical ventilation and ongoing rehabilitation needs at discharge from hospital. Despite a surge in ECMO bed occupancy and redeployment of staff, the therapy team were able to provide high level rehabilitation to patients and a follow up clinic was established to support ongoing needs post hospital care.
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Introduction: Mental, physical, and cognitive impairments are common after an intensive care unit (ICU) stay. It remains unknown to what extent the extraordinary increase in bed occupancy during the pandemic could be linked to the severity and frequency of patient's impairments. Objective: To determine the frequency, severity, and risk factors for mental, physical, and cognitive impairments at ICU discharge during high and low bed occupancy periods. Methods: Prospective cohort study in seven Chilean ICUs (ClinicalTrials.gov Identifier: NCT04979897). We included adults, mechanically ventilated >48 hours in the ICU who could walk independently prior to admission. Trained physiotherapists assessed the Medical Research Council Sum-Score (MRC-SS), Montreal Cognitive Assessment (MOCA-blind), Hospital Anxiety and Depression Scale (HADS), Impact of Event Scale-Revised (IES-R), and the World Health Organization Disability Assessment Schedule (WHODAS 2.0) at ICU discharge. Pre-admission employment status, educational level, and Clinical Frailty Scale (CFS) were also collected. We compared periods of low and high bed-occupancy, defined as less or more than 90% of staffed ICU beds occupied. We used t-test for normally distributed, Mann-Whitney for those not normally distributed, and chi-square for categorical variables. We explored risk factors for mental, physical, and cognitive impairments using logistic regression adjusted for age, sex, educational level, and bed occupancy. Analyses were performed in Stata/SE 16.0. Results: We included 192 patients with COVID-19 of which 126 [66%] were admitted during a high bedoccupancy period (January to April 2021). Majority were male (137 [71%]) and worked full-time (127 [66%]). Median [P25-P75] age was 57 [47-67], length of ICU stay was 15[ 11-27] days, and duration of mechanical ventilation (MV) was 9 [6-16.5] days. Seven (4%) patients were clinically frail, 65 (34%) had ICUacquired weakness (ICU-AW), 134(70%) had cognitive impairment, 122 (64%) had post-traumatic stress symptoms (PTSS), 53 (28%) had depressive symptoms, 106 (55%) had anxiety symptoms, and 148 (77%) had severe disability. Table 1 shows the combined prevalence of physical and mental health problems. Patients admitted during the high-occupancy period were younger (mean 54, 95% confidence interval [47, 61] vs 61 [58, 64]), more likely to have a higher education qualification(HEQ) (OR 1.67 [0.9, 3.06]), and had a shorter duration of MV (8 [6-13] vs 13 [8-34];p<0.001) and ICU stay (13 [10-19] vs 21.5 [13-42];p<0.001). Mental, physical, and cognitive impairments were similar in low and high occupancy periods. Patients with a HEQ were less likely to have ICU-AW (OR 0.23 [0.11, 0.46]), cognitive impairments (OR 0.26 [0.11, 0.6]), symptoms of depression (OR 0.45 [0.22, 0.9]) or anxiety (OR 0.26 [0.13, 0.5]), and severe disability (OR 0.4 [0.18, 0.94]). Females were more likely to have ICU-AW (OR 2.4 [1.13, 4.93]). Older patients were less likely to suffer PTSS (OR 0.97 [0.94, 0.99] per year old). Conclusions: Majority of patients had at least one mental, physical or cognitive impairment being similar by bed occupancy. Having a higher education qualification was the main protective factor for impairments at ICU discharge. Preventative treatments programmes should target patients with <12 years of education.
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Background: The Covid-19 pandemic has had a significant impact on population mental health and the demand for mental health services while also disrupting and halting some critical mental health services. Mental health providers have been under pressure to respond to the pandemic in a variety of ways. Many have seen sharp changes in activity levels, for example, at the outset, there was a rush to clear hospital beds and rapidly discharge patients. Wards were reconfigured to accommodate patients with Covid which reduced capacity. Many services saw reductions in inpatient admissions. But patterns changed over time with bed occupancy levels apparently returning back to pre-pandemic levels and urgent referrals going up. The complex interplay of factors may have affected providers differently during the different pandemic waves. Mental health providers have called for greater understanding of capacity requirements, to facilitate service recovery and navigate future phases of the pandemic. There is therefore a pressing need for a robust examination of the impact of the pandemic on the delivery of mental health services. Aims of the Study: We examine (i) whether during Covid-19, relative to pre-Covid, there were changes in activity levels for mental health providers in England in terms of numbers of inpatient admissions, length of stay, bed days and discharges, (ii)) whether changes in levels differed with respect to certain groups e.g. mental health diagnosis, ethnicity, or socio-economic status, and (iii) whether mental health patients discharged from mental health providers at the start of the pandemic, present in other parts of the healthcare system e.g. outpatient services. Methods: We conducted an interrupted time-series analysis (where March 2020 was the point of interruption) on monthly (and daily) mental health activity data from a sample of mental health providers for the period 1 January 2015 to 31 August 2021. We used monthly release data from the Hospital Episodes Statistics (HES) Admitted Patient Care data in England. We examined changes in activity for admissions, bed days and discharges for all mental health providers, and changes in length of stay at provider/month level, using a rich set of explanatory variables. We stratified analyses by mental health condition (using ICD-10 diagnostic codes), deprivation quintile and ethnicity. We examined measures of excess admissions and their duration to quantify how many patients were not treated as a result of the pandemic. Finally, we undertook a descriptive analysis of the discharge destinations (e.g. usual place of residence, transfer elsewhere) of mental health patients immediately prior to and during the pandemic and tracked whether they reappear in other parts of the healthcare system such as outpatients. Results: Preliminary results show a sharp and significant reduction in certain activity levels e.g. around 117 fewer admissions per month. Discussion and Limitations: We are only able to include data from a subset of mental health providers that submit data to HES. Implications for Health Care Provision and Use: Mental health providers need to be able to respond swiftly to the sharp changes in demand for different services. Implications for Health Policies: Our analysis can help policymakers and services with future pandemic preparedness. Implications for Further Research: Future research should examine the response of mental health providers with other types of activity such as community care.
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Background: Describe the impact of one-year COVID-19 pandemic on subacute rehabilitation of brain injured patients. In this study we propose an analysis of critical points and possible solutions to carry out intensive rehabilitation while preventing the infection spreading. Methods: We delivered an individualized rehabilitation plan that relies on a multidisciplinary and inter-professional teamwork to develop neuromotor, cognitive, occupational and recreational activities. Our facility is based on a 40-beds ward that admits patients from acute care units. During the COVID- 19 outbreak, a deep reorganization of rehabilitative activities was done to prevent the risk of infection. Infection spreading prevention: education of health-care professionals, patients and care givers to the correct use of personal protective equipment;symptomatic surveillance and periodic screening;rearrangement of care pathways and spaces. Redefinition of rehabilitation activities: reduction of the patients' number in the therapeutic setting;redistribution of the treatments throughout the day;introduction of activities in small groups and specific protocols for robotics. In the early phase, music-therapy, pet-therapy, sports activities, in-hospital school, return-to-work projects were temporary interrupted but later restored. Technology-assisted communications: participation of care givers through video-calls to stimulate interaction and reduce isolation;online periodic team meetings for clinical and rehabilitative updating;virtual home visits to prepare discharge. We maintained caregiver direct participation for patients with disorders of consciousness, severe cognitive-behavioral disorders, pediatric patients;we maintained caregivers' training before discharge. Results: From March 2020 to March 2021, we admitted 166 patients (59 females, 107 males;mean age 58,11 years), 104 of which with severe brain injury. Bed occupancy rate was 93,80%;mean length of stay was 63,73 days. Etiology was hemorrhagic in 53, anoxic in 7, traumatic in 38, neoplastic in 11, ischemic in 45, infectious in 8, neuropathic in 4 cases. Delta-FIM (Functional Independence Measure) was 1,42;delta-BI (Barthel Index) was 33,68;delta-DRS (DisabilityRating Scale) was -2,13;delta-RCS -E (Rehabilitation Complexity Scale-Extended) was 6,56. Only five patients and eight health-care professionals resulted COVID-19 positive during this period. Conclusions: Despite COVID-19 pandemic we provided intensive rehabilitation treatment, without reducing the beds and maintaining a COVID-19 free ward. Bed occupancy rate was similar to that of 2019 (92,13%). We had only 13 positive cases over a year. The complexity and intensity of the treatment was maintained. All activities have been guaranteed although with some adjustments. We developed adaptability and a proactive attitude in the continuous search for new solutions. Despite the efforts, COVID-19 pandemic inevitably impacted on the continuum of care and rehabilitation of brain injuries, especially on complex and fragile cases. Future goals could be further personalization of the treatment and implementation of caregiver participation through technology-assisted communication.
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Introduction: Glan Clwyd Hospital (GCH) has offered a 24/7 Percutaneous Coronary Intervention (PCI) service in North Wales (population approx. 690,000) since 2017 and has been designated one of three Welsh Cardiac Arrest Centres. The aim of the study was to evaluate the impact of this development upon resource requirements and outcomes. Methods: Retrospective review of the ICU Ward Watcher database to identify patients undergoing CPR in the 24 h prior to admission April 2013-April 2021. Patients likely to have sustained Out-of-Hospital Cardiac Arrest (OOHCA) of primary cardiac aetiology (OOHCAC) were identified from primary/secondary diagnoses and free text entry. Data were subsequently analysed using Excel and SPSS. The project was registered as a service evaluation. Results: There were 367 ICU admissions following cardiac arrest;245 were OOHCA, of which 189 were considered OOHCA-C. Annual OOHCA admissions increased through the study period from 12 (2013-2014) to 50 (2019-2020) before decreasing to 29 during COVID-19 pandemic (2020-2021). OOHCA bed days increased from 38 in 2013-2014 to 215 in 2019-2020, falling to 169 in 2020-2021. Proportions of OOHCA-C patients undergoing pre-ICU PCI increased with time (33% in 2013-2014 to 47% in 2020-2021). Hospital mortality following OOHCA was 61.2% and OOHCA-C was 59.7%;temporal trends did not reach statistical significance. Main factors from first 24 h of ICU admission associated with hospital mortality are presented below. On logistic regression, only lactate, central temperature and lack of pre-ICU PCI significantly predicted hospital mortality (p < 0.001) (Table 1). Conclusions: Centralising cardiac arrest care has led to an appreciable rise in ICU bed occupancy. Although overall hospital mortality for OOHCA-C remains high and appreciating potential selection bias, a significant association between PCI and survival to hospital discharge appears to support clinical pathways enabling PCI access following OOHA-C [1]. (Table Presented).
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Objective: It has raised drastic changes in the routine flow-through of daily life since the beginning of the coronavirus disease-2019 pandemic. One of these is also the education and training of life from the cradle to the grave. We aimed to investigate the pandemic's impact on the dermatology residents' knowledge, skill, and experience levels in this study. Material and Methods: This descriptive research was conducted on dermatology residents from Turkey. The demographic characteristics, the residency duration, teledermatology use, number of outpatients, bedside visits, diagnostic diversity among inpatients, and bed occupancy rates were recorded. Before and after the pandemic in various dermatology-related issues, self-assessment levels of competence were also questioned with the visual analogue scale. Results: A total of 88 residents, 57 (64.8%) women, were included in the study. Sixty nine (78.4%) residents have worked in a pandemic hospital, 81 (92.0%) of the participants thought the pandemic had a negative effect on residency training. Issues such as the decrease in occupancy rates of dermatology service and diagnostic diversity of the inpatients, interrupted physicians' bedside visits, markedly reduced training time, and the inability to conduct theoretical exams reinforced this negative perception (p=0.005, p=0.023, p=0.003, p=0.011, p<0.001;respectively). There was a significant decrease compared to the expected level in the issues such as biological agent therapy, phototherapy, and dermato-surgery and dermatoscopy, although it varied according to the residency duration (p<0.05). Conclusion: Our study revealed that the pandemic affects the dermatology residents more negatively in terms of practical skills and experiences rather than theoretical knowledge level.
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The consequences of Covid-19 disease were examined, and specifically the ways in which it has affected health indicators and health services in six European countries, Belgium, France, Germany, Greece, Italy, and Spain. A search was made in the national databases, Εurostat, EuroMOMO, ECDC and Our World in Data, and some of the most important health indicators were extracted, including morbidity, mortality and fatality, and also the intensive care unit (ICU) capacity and occupancy. Study of these health indicators showed that Greece, in contrast to the other five countries was not significantly negatively affected during the first wave of the pandemic, probably due to the early introduction of lockdown and other preventive measures. Concerning the availability of ICU beds, Greece and Germany faced no problems during the first wave, while the health systems of Italy, Spain, Belgium and France could not cope with the increased needs for ICU beds. All six countries, however, have been dramatically affected, and their ICU capacity has been stretched during the second wave of the pandemic. In conclusion, the health services of all countries need to be strengthened and adequately prepared to face, not only new possible waves of this pandemic, but also other future threats. © 2021, BETA Medical Publishers Ltd. All rights reserved.
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Introduction The standard of care for patients with multiple myeloma (MM) involves autologous hematopoietic stem cell transplantation (ASCT). Pre-ASCT mobilization chemotherapy for MM, vinorelbine and high dose cyclophosphamide (VC), has been historically given in the inpatient (IP) setting. Due to rising bed occupancy rates and patients' preferences for treatment in the ambulatory setting, our team has offered eligible patients an option to receive VC outpatient (OP) since 2018. Our study aims to audit the feasibility and safety of this initiative, and review potential healthcare-related cost savings. Methods Eligibility criteria for OP chemotherapy were developed by a multidisciplinary team based on patients' age, functional status, medical comorbidities and social factors (Figure 1). The chemotherapy regimen was modified for an OP setting (Figure 2), of which the main alteration involved changing the route of administration of intravenous (IV) mesna to a combination of IV and oral. A retrospective review was conducted for 35 MM patients (18 IP and 17 OP) who received VC for mobilisation at our center from 2018 to 2019. The patient characteristics were similar between the two groups (Table 1). Patient data were analyzed from the day of admission for VC (IP) or day 1 of VC (OP), to the day before admission for stem cell harvesting. Clinical charts were reviewed for unexpected complications and unplanned admissions. Costs incurred were calculated using the value-driven-outcome (VDO) informatics analysis of the hospital. Results There were no unexpected clinical complications or unplanned admissions in both groups. The median length of hospital stay for the IP cohort was 3 days, amounting to a saving of 51 hospital days over 2 years in the OP cohort. Median costs were 73% lower in the OP cohort (Figure 3). The difference was mainly due to certain costs not incurred in the OP setting. These included room charges and daily treatment fees (which accounted for an average of 46% and 19% of IP charges respectively). Investigation costs were also 55% lower in the OP cohort, which could be attributed to more investigations being performed in the IP setting such as screening for methicillin-resistant Staphylococcus aureus and nonurgent radiographs ordered after hours by the on-call physician upon admission. Conclusions Our findings show that OP mobilization chemotherapy for MM is safe, feasible and associated with improved bed utilization and cost savings. Other components of the stem cell transplantation process are also increasingly being transitioned from the IP to OP setting in our center as part of an ongoing paradigm shift in right-siting treatment services, which has been accelerated by the COVID-19 pandemic's strain on inpatient capacity. These results provide an affirmation of our efforts to optimize the utilization of healthcare resources. [Formula presented] Disclosures: Chng: Takeda: Consultancy;GlaxoSmithKline: Consultancy;Johnson & Johnson: Consultancy, Research Funding;Aslan: Research Funding;Antengene: Consultancy;Abbvie: Consultancy;Pfizer: Consultancy;Novartis: Research Funding;Sanofi: Consultancy;Amgen: Consultancy;BMS/Celgene: Consultancy, Research Funding.
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Introduction: The COVID pandemic has exerted unprecedented pressure on hospital resources. Resulting in cancellation of elective operative services, increased patient waiting lists, limited surgical training opportunities along with reduced availability of staff, theatre, and inpatient bed capacity. A novel approach for day case forefoot surgery under ankle block, to mitigate the pandemic service limitations without compromising care, was developed. Method: This is a 3-month, multi-centre, prospective cohort study evaluating the novel ankle block day case forefoot surgery pathway. Patients had a minimum of three months clinical follow up with outcome scores. They were matched to a cohort undergoing similar surgery prior to the COVID pandemic. Results: The utilisation of an ankle block pathway resulted in an average reduction of inpatient stay by 2 days per patient. Over the study period conservative savings of £26,659 were calculated. Anecdotally we observed a reduction in morbidity (wound complications, SSI's) although not statistically significant. Conclusions: Our novel surgical pathway has enabled continued elective operating for procedures that previously required hospital admission during a period of severe restrictions within the NHS. We observed significant reductions in cost, surgical inpatient bed utilisation and total operative time with staff, resource, and time savings. We hypothesise that prehabilitation with physiotherapy, ankle instead of thigh tourniquets and early mobilisation may have contributed to improved morbidity scores. The findings of this project have implications for training, upper limb services and are transferrable as a template to improve service efficiency while maintaining high quality care.
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Aim: We assessed patient perceptions of hand trauma management through a plastic surgery trauma clinic. We also assessed effects of educating patients about outcomes of their condition on their desire to have prompt surgery. Method: A prospective survey review was conducted at our plastic surgery trauma clinic. Patients included were those referred due to simple hand trauma. Any patients needing urgent admissions were excluded. An anonymous survey assessing patient perceptions before and after education about delay in surgery was distributed. Results: Of 100 patients, there were mixed expectations regarding trauma clinic;38% (n=38) expect an operation, 32% (n=32) expect no operation and 30% (n=30) expect either option. 90% (n=90) expect surgery within a week (50% n=50) or within a day (40% n=40);10% expect it (n=10) within a few weeks. After educating patients about no negative effects on their condition from surgical delay, 43% (n=17) fewer patients desired surgery within a day, and 8% (n=3) fewer patients desired surgery within a week. 190% (n=19) more patients were willing to have surgery within a few weeks. 79% (n=79) would rather come back at a guaranteed surgical slot than stay in hospital until a slot is available. 72% (n=72) considered knowledge about long-term outcomes associated with surgical delay to influence their decision more than anaesthetic type (12% n=12) and personal circumstances (16% n=16). Conclusions: If appropriate patients are assured that their condition will not be affected by surgical delay, fewer patients may stay in hospital with financial benefits of reduced bed occupancy and reduced covid risks.