The benefit of introducing a virtual trauma assessment clinic during a global pandemic.

Sars-CoV2/COVID-19 pandemic created a national emergency in Ireland. Our institution implemented a virtual trauma assessment clinic to reduce attendance to our district hospital which was stimulated by the development of 'safe-distanced' care. The audit aimed to evaluate the impact of our trauma assessment clinic on care provision and presentation to hospital. All patients were managed according to the newly implemented virtual trauma assessment clinic protocol. Data was prospectively collected over a 6.5 week period from 23rd March 2020 to 7th May 2020. These referrals were reviewed twice weekly by a Consultant-led multidisciplinary team. 142 patients were referred to the virtual trauma assessment clinic. Mean age of referrals was 33.04 years. 43% (n=61) were male patients. Overall 32.4% (n=46) of new referrals were discharged directly to their family doctor. 30.3% (n=43) were discharged for physiotherapy follow up. 36.6% (n=52) required presentation to the hospital for further clinical review and 0.7% (n=1) was admitted for surgical intervention. Overall, this represents a reduction of 63% of patients attending the hospital. A simple virtual trauma assessment clinic model resulted in significant reduction in unnecessary attendance at face-to-face fracture clinics enhancing patient and staff safety during a global pandemic. This virtual trauma assessment clinic model has allowed the mobilisation of staff to assist with other essential duties in other areas of our hospital without compromising care.

Correlates of Delayed Initial Contact to Emergency Services among Patients with Suspected ST-Elevation Myocardial Infarction.

BACKGROUND: Early diagnosis and treatment of a patient displaying symptoms of myocardial ischemia is paramount in preventing detrimental tissue damage, arrhythmias, and death. Patient-related hospital delay is the greatest considerable cause of total delay in treatment for acute myocardial infarction. OBJECTIVE: To identify patient characteristics contributing to prehospital delay and ultimately developing health interventions to prevent future delay and improve health outcomes. METHODS: A retrospective chart review of 287 patients diagnosed with ST-elevation myocardial infarction (STEMI) was evaluated to examine correlates of patient-related delays to care. RESULTS: Stepwise logistic regression modeling with forward selection (likelihood ratio) was performed to identify predictors of first medical contact (FMC) within 120 minutes of symptom onset and door-to-balloon (DTB) time within 90 minutes. Distance from the hospital, being unmarried, self-medicating, disability, and hemodynamic stability emerged as variables that were found to be predictive of FMC within the first 120 minutes after symptom onset. Similarly, patient characteristics of gender and disability and having an initial nondiagnostic electrocardiogram emerged as significant predictors of DTB within 90 minutes. CONCLUSIONS: Individual attention to high-risk patients and public education campaigns using printed materials, public lectures, and entertainment mediums are likely needed to disseminate information to improve prevention strategies. Future research should focus on identifying the strengths of prehospital predictors and finding other variables that can be established as forecasters of delay. Interventions to enhance survival in acute STEMI should continue as to provide substantial advances in overall health outcomes.