Subject(s)
Hospitalization , Hospitals , Medical Errors , Patient Safety , Quality Improvement , Risk Management , Hospitalization/statistics & numerical data , Hospitals/standards , Hospitals/statistics & numerical data , Medical Errors/prevention & control , Medical Errors/statistics & numerical data , Patient Safety/standards , Patient Safety/statistics & numerical data , Quality Improvement/standards , Quality Improvement/statistics & numerical data , Risk Management/standards , Risk Management/statistics & numerical dataABSTRACT
A recent analysis highlights waste and missed opportunities to improve outcomes.
Subject(s)
Health Expenditures/statistics & numerical data , Health Facilities/economics , Health Facilities/statistics & numerical data , Population Health/statistics & numerical data , Quality Improvement/economics , Quality Improvement/statistics & numerical data , Humans , United StatesSubject(s)
COVID-19/prevention & control , Delivery of Health Care/organization & administration , Hospitals, Rural/organization & administration , Pandemics/prevention & control , Population Health/statistics & numerical data , Public Health Administration , Quality Improvement/organization & administration , Adult , Aged , Aged, 80 and over , COVID-19/epidemiology , Cities/epidemiology , Cities/statistics & numerical data , Delivery of Health Care/statistics & numerical data , Female , Hospitals, Rural/statistics & numerical data , Humans , Incidence , Male , Middle Aged , North Carolina/epidemiology , Pandemics/statistics & numerical data , Quality Improvement/statistics & numerical data , Rural Population/statistics & numerical data , SARS-CoV-2 , Urban Population/statistics & numerical dataABSTRACT
OBJECTIVE: The aim of the present study was to describe the epidemiology and clinical features of patients presenting to the ED with suspected and confirmed COVID-19. METHODS: The COVID-19 ED (COVED) Project is an ongoing prospective cohort study in Australian EDs. This analysis presents data from eight sites across Victoria and Tasmania for July 2020 (during Australia's 'second wave'). All adult patients who met criteria for 'suspected COVID-19' and underwent testing for SARS-CoV-2 in the ED were eligible for inclusion. Study outcomes included a positive SARS-CoV-2 test result and mechanical ventilation. RESULTS: In the period 1 July to 31 July 2020, there were 30 378 presentations to the participating EDs and 2917 (9.6%; 95% confidence interval 9.3-9.9) underwent testing for SARS-CoV-2. Of these, 50 (2%) patients returned a positive result. Among positive cases, two (4%) received mechanical ventilation during their hospital admission compared to 45 (2%) of the SARS-CoV-2 negative patients (odds ratio 1.7, 95% confidence interval 0.4-7.3; P = 0.47). Two (4%) SARS-CoV-2 positive patients died in hospital compared to 46 (2%) of the SARS-CoV-2 negative patients (odds ratio 1.7, 95% confidence interval 0.4-7.1; P = 0.49). Strong clinical predictors of a positive SARS-CoV-2 result included self-reported fever, non-smoking status, bilateral infiltrates on chest X-ray and absence of a leucocytosis on first ED blood tests (P < 0.05). CONCLUSION: In this prospective multi-site study from July 2020, a substantial proportion of ED patients required SARS-CoV-2 testing, isolation and enhanced infection prevention and control precautions. Presence of SARS-CoV-2 on nasopharyngeal swab was not associated with death or mechanical ventilation.
Subject(s)
COVID-19/epidemiology , Emergency Service, Hospital/statistics & numerical data , Quality Improvement/statistics & numerical data , COVID-19/diagnosis , COVID-19/prevention & control , COVID-19/therapy , COVID-19 Testing/methods , COVID-19 Testing/statistics & numerical data , Cross Infection/prevention & control , Emergency Service, Hospital/organization & administration , Female , Humans , Male , Middle Aged , Quality Improvement/organization & administration , SARS-CoV-2 , Tasmania/epidemiology , Victoria/epidemiologyABSTRACT
The rapid growth of the coronavirus disease 2019 (COVID-19) pandemic, limited availability of personal protective equipment, and uncertainties regarding transmission modes of severe acute respiratory syndrome coronavirus-2 have heightened concerns for the safety of healthcare workers (HCWs). Systematic studies of occupational risks for COVID-19 in the context of community risks are difficult and have only recently started to be reported. Ongoing quality improvement studies in various locales and within many affected healthcare institutions are needed. A template design for small-scale quality improvement surveys is proposed. Such surveys have the potential for rapid implementation and completion, are cost-effective, impose little administrative or workforce burden, can reveal occupational risks while taking community risks into account, and can be repeated easily with short time intervals between repetitions. This article describes a template design and proposes a survey instrument that is easily modifiable to fit the particular needs of various healthcare institutions in the hope of beginning a collaborative effort to refine the design and instrument. These methods, along with data management and analytic techniques, can be widely useful and shared globally. The authors' goal is to facilitate quality improvement surveys aimed at reducing the risk of occupational infection of HCWs during the COVID-19 pandemic.