ABSTRACT
This study aimed to analyze early revisits (within 48 hours of discharge) in an Emergency Department. Among the 178,295 visits, 11,686 were revisits, resulting in a rate of 6.55% (95%CI 6.43-6.67). A total of 1,410 revisits required hospitalization, and 252 were due to preventable errors (17.87%). These errors were mainly related to an inadequate therapeutic plan at discharge (47.22%), an incomplete diagnostic process (29.37%), and misdiagnoses (13.10%). These findings represent a technology-enabled clinical audit tool. Electronic Healthcare Records have the potential to: provide quality metrics of hospital performance, help to keep revisit rates updated (assessment through a real-time dashboard), and improve clinical management (by transparency initiatives about errors, and a supportive learning environment regarding lessons learned).
Subject(s)
Hospitalization , Patient Discharge , Humans , Benchmarking , Emergency Service, Hospital , Health FacilitiesABSTRACT
The objective of this study was to reveal how the COVID-19 pandemic process affected the number of visits to an emergency department of a highly complex hospital located in the Ciudad Autónoma de Buenos Aires, to explore the characteristics and reasons for consultation. The monthly number of visits between January 2019 and December 2020 was analyzed. The data showed a strong decrease in the number of visits (176 370 in 2019 and 95 421 in 2020), with an abrupt drop after the lockdown disposal (In aprilshowed the maximum reduction: 77.1%), and the different stages are reflected in the evolution (a consequence of quarantine), yielding a global annual reduction of 45.9%. The number of patients admitted by ambulances increased (5.1% in 2019 to 10.4% in 2020; p < 0.05), and consequently, the number of patients in the more complex sector (area B 2019: 5.3%, 2020: 11.5%; p < 0.01), as well as unscheduled hospitalizations from 6.8% (95% CI 6.7-6.9) to 12.1% in 2020 (95%CI11.8-12.3), p < 0.01. The five most frequent reasons for consultation in 2020 were: fever (5.1%), odynophagia (4.7%), abdominal pain (2.6%), cough (1.8%) and headache (1.8%), probably all related to COVID-19. In conclusion, the number of emergency department visits decreased by half compared to the previous year.
El objetivo de este estudio fue revelar cómo el COVID-19 afectó el número de visitas a un servicio de urgencias de un hospital de alta complejidad ubicado en la Ciudad Autónoma de Buenos Aires, explorar las características y los motivos de consulta. Se analizó el número mensual entre enero 2019 y diciembre 2020. Los datos mostraron una fuerte disminución en el número de visitas (176 370 en 2019 y 95 421 en 2020), con una caída abrupta luego de disposición aislamiento social, preventivo y obligatorio (el mes de abril arrojó el máximo valor de reducción: 77.1%), y se reflejan las diferentes etapas evolutivas (consecuencia de la cuarentena), arrojando una reducción global anual del 45.9%. Sin embargo, aumentó el número de pacientes que ingresaron en ambulancias (5.1% en 2019 a 10.4% en 2020; p < 0.05), y, en consecuencia, los pacientes del sector de mayor complejidad (área B 2019: 5.3%, 2020: 11.5%; p < 0.01), y las hospitalizaciones no programadas de 6.8% (IC95% 6.7-6.9) a 12.1% en 2020 (IC95% 11.8-12.3), p < 0.01. Los cinco motivos de consulta más frecuentes durante 2020 resultaron: fiebre (5.1%), odinofagia (4.7%), dolor abdominal (2.6%), tos (1.8%) y cefalea (1.8%), probablemente todos relacionados a COVID-19. En conclusión, se redujo a la mitad el número de visitas a urgencias en comparación con el año previo.
Subject(s)
COVID-19 , Pandemics , Argentina/epidemiology , Communicable Disease Control , Emergency Service, Hospital , Humans , SARS-CoV-2ABSTRACT
OBJECTIVE: Determining the prevalence of squamous intraepithelial lesions (SIL), and their association with known cervical neoplasia risk factors in seropositive HIV female patients. MATERIALS AND METHODS: A transversal study including 50 seropositive HIV female patients was carried out. The patients were interrogated concerning known cervical neoplasia risk factors. Cervical cytology tests and colposcopic evaluations of the lower genital tract, with directed biopsies, were carried out. The presence of HPV-DNA was investigated using the polymerase chain reaction and CD4 and CD8 T lymphocyte titers were determined. Two comparison groups were formed, in accordance to the presence or absence of cervical lesions. RESULTS: Average age was 36 +/- 9.3 years, ranging from 20 to 61 years, 26% had never submitted to a cervical cytology test, and an average of 33 months (1-130 months) had elapsed after the last test of those who had. HIV transmission had been sexual in 72% of the cases, and the period of time elapsed since the infection was diagnosed and until the patients were evaluated for this study was of 40.6 +/- 33.5 months. HPV-DNA was detected in 64% (n = 32) of the patients, and co-infection with more than one HPV was detected in 42% of them, with the 16 and 31 types being the most frequent. A cervical lesion was diagnosed in 52% of the cases, 18% being of high degree and 34% of low degree. When risk factors for cervical neoplasia and lymphocyte titers were compared between group I (with SIL, n = 26), and group II (without SIL, n = 24), the only significant differences found were the presence of HPV-DNA and the co-infection with more than one type of HPV, which were more frequent in group I. Sexual transmission of HIV was also more frequent in group I. The presence of vaginal and vulvar synchronous lesions was determined in 20% and 12% of the cases, respectively. CONCLUSIONS: There is a high prevalence of positive DNA-HPV and SIL in seropositive HIV patients, which pose them in a higher risk of developing invasive cervical cancer. Thus, creating adequate strategies for the detection, diagnosis, management, and follow-up of these patients is of the utmost importance.
