SARS-CoV-2 testing and patient waiting times in the emergency department

Aim Emergency Departments (EDs) were impacted early in the coronavirus disease 2019 (COVID-19) pandemic, with high attendance numbers. EDs relied upon SARS-CoV-2 reverse-transcriptase polymerase chain reaction (RT-PCR) tests to triage patients and facilitate admission to appropriate wards, meaning positive patients were isolated as early as possible. In October 2020, we introduced a 24-hour SARS-CoV-2 testing service. We examined the impact of this on patient experience times (PETs) in the ED, and on healthcare-associated (HA) COVID-19 infections. Methods Data on PETs before and after the introduction of 24-hour testing were available from the ED. HA COVID-19 infections were reported weekly to the Health Services Executive as a key performance indicator. Results Mean PET prior to the pandemic was 20 hours and dropped to 10 and 13 hours respectively in the first and second wave. A surge in case numbers and ED attendances during the third wave was not reflected in a rise in PETs, with a mean PET of 11 hours, significantly below pre-pandemic levels. HA-COVID-19 infections remained stable between wave one and three (83 v 92). Conclusion The introduction of 24-hour SARS-CoV-2 testing in our ED contributed to a reduction in PETs, facilitated appropriate patient placement at ward level, and kept HA-COVID-19 infections at acceptably low levels.

SARS-CoV-2 Testing and Patient Waiting Times in the Emergency Department.

Aim Emergency Departments (EDs) were impacted early in the coronavirus disease 2019 (COVID-19) pandemic, with high attendance numbers. EDs relied upon SARS-CoV-2 reverse-transcriptase polymerase chain reaction (RT-PCR) tests to triage patients and facilitate admission to appropriate wards, meaning positive patients were isolated as early as possible. In October 2020, we introduced a 24-hour SARS-CoV-2 testing service. We examined the impact of this on patient experience times (PETs) in the ED, and on healthcare-associated (HA) COVID-19 infections. Methods Data on PETs before and after the introduction of 24-hour testing were available from the ED. HA COVID-19 infections were reported weekly to the Health Services Executive as a key performance indicator. Results Mean PET prior to the pandemic was 20 hours and dropped to 10 and 13 hours respectively in the first and second wave. A surge in case numbers and ED attendances during the third wave was not reflected in a rise in PETs, with a mean PET of 11 hours, significantly below pre-pandemic levels. HA-COVID-19 infections remained stable between wave one and three (83 v 92). Conclusion The introduction of 24-hour SARS-CoV-2 testing in our ED contributed to a reduction in PETs, facilitated appropriate patient placement at ward level, and kept HA-COVID-19 infections at acceptably low levels.

REMOTE SIM: RECONFIGURING EDUCATION TO MEDICAL OFFICERS WITH TELE-ENABLED SIMULATION

Background: Public health restrictions during the COVID-19 pandemic create a need to restructure education delivery to health professionals. Simulation is a fundamental education mode for teams and individuals.1 An Australian scoping review published by Heffernan and colleagues in 2021 suggests the remote delivery of simulation may be both feasible and effective for participants and facilitators.2 The education unit of a tertiary hospital in Perth, Western Australia, sought to develop a method to deliver remote tele-simulation using existing local resources. There are similarly equipped units across Australasia with dedicated simulation suites that could benefit from the REMOTE Sim framework. Aim: The aim of the project was to develop a tele-simulation method that preserved the benefits of simulation education for medical staff when inperson delivery was not possible. A secondary objective was to leverage existing simulation suite infrastructure to enhance the tele-simulation format. Method: Authors reviewed an existing, locally evaluated, in-person simulation program designed to improve multidisciplinary collaboration in recognising and responding to ward-based acute clinical deterioration. By applying principles from established simulation frameworks, authors adapted in-person delivery to a tele-simulation format. Key frameworks included advocacy-inquiry, tag-team, and stop-and-go simulation.3-5 Results: The existing in-person simulation programme divided participants into two groups. One group participated as responders to a simulated scenario, while the other observed via a live audio-visual feed. Observers viewed live audio and video of the simulation, as well the simulated patient's clinical monitoring. In REMOTE Sim, this existing audio-visual feed is shared via video conferencing software. This enables remote participants to observe the simulated patient room and clinical monitoring in real time. Faculty members are located in the simulation suite and participants connect via video conferencing individually in their own environment. Faculty comprises of four or more members allocated to the roles of simulation director, manikin operator, confederate first responder, confederate second responder and so on. Participants are divided into two groups, and undertake a pre-brief that includes an overview of the format and video-conferencing etiquette. During scenarios participants are asked to direct confederate faculty to perform tasks at intervals guided by the simulation director. For example, when the first responder enters the room, group one would be asked by the simulation director to provide direction. Participants might identify the patient is speaking but in respiratory distress, and direct the relevant faculty member to apply 15L of oxygen via a non-rebreather mask. At the next interval, group two would be asked to provide direction to confederate faculty. This maintains the engagement of both groups of participants, using principles of stop-and-go and tag-team simulation.3,4 During these intervals learning points can also be discussed. Following each scenario a simulation debrief is performed with all participants via video-conference. Conclusion: The adapted tele-simulation format described aims to maintain the beneficial use of simulation suite infrastructure when in-person delivery is not possible. Validation of the format is developing, with particular focus on the impact of technology on participant engagement, critical thinking, psychological safety, and learning and reflection during the simulation and debrief.

Asynchronous online mathematics learning support: An exploration of interaction data to inform future provision

Over the past 30 years, higher education institutions (HEIs) worldwide have been grappling with the difficulties experienced by many students entering higher education due to their poor pre-entry core mathematical skills. In the Republic of Ireland and the UK, the provision of mathematics learning support (MLS) is the approach most commonly adopted by HEIs to deal with this problem, providing free one-to-one mathematical support and/or workshops for students. However, despite the availability of such supports and research that suggests that engagement with these supports can have a positive impact on student retention and progression, ensuring high levels of student engagement with these supports remains a significant challenge. In more recent years, some institutions have started to provide online MLS which takes many different forms but mainly provide links to websites, revision notes, past exam papers, etc. In light of the COVID-19 pandemic and the need for many to resort to remote teaching, it would appear the successful provision of online mathematics support is set to become increasingly important over the coming years. This paper will examine student interaction data with one such online MLS provision, hosted within a virtual learning environment. The interaction data will be analysed in order to gain a better understanding of the level of student engagement with this resource and the content most frequently accessed. This analysis will be used to inform the future development and enhancement of the resource so as to encourage student engagement. © 2020 The Author(s) 2021. Published by Oxford University Press on behalf of The Institute of Mathematics and its Applications. All rights reserved

Do established infection prevention and control measures prevent spread of SARS-CoV-2 to the hospital environment beyond the patient room?

The role of the hospital environment in the transmission of infection is well described. With an emerging infection whose mode of transmission is under investigation, strict infection prevention and control measures, including patient isolation, hand hygiene, personal protective equipment that is doffed on exiting the patient room, and environmental cleaning should be implemented to prevent spread. Environmental testing demonstrated that COVID-19 patients contaminated the patient area (11/26, 42.3% of tests) but contamination of general ward areas was minimal (1/30, 3%) and the virus was detected after cleaning on one item only (1/25, 4%) which was noted to be in disrepair.