The effect of COVID-19 on the characteristics of adult emergency department visits: A retrospective cohort tertiary hospital experience in Riyadh.

BACKGROUND: On March 2, 2020, Saudi Arabia identified the first positive COVID-19 case. Since then, several aspects of the COVID-19 impact on Emergency Departments (EDs) use have been reported. The objective of this study is to describe the pattern and characteristics of Emergency Department visits during the COVID-19 pandemic period, compared with the same period in the previous year, including the patients' demographic information, acuity level, length of stay, and admission rate. METHODS: Data were collected from King Abdulaziz Medical City in Riyadh, Saudi Arabia. The health records of all the patients who presented at the Emergency Department from January 2019 to September 2020 were retrospectively reviewed. The variations in the patient and the visit characteristics were described for the periods before and during COVID-19. RESULTS: The records of 209,954 patients who presented at the Emergency Department were retrieved. In contrast to 2019, the number of visits during the pandemic period reduced by 23%. A dramatic decrease was observed after the announcement of the first COVID-19 diagnosed case in Saudi Arabia, and subsequently the numbers gradually increased. The patients who presented at the Emergency Department during the pandemic period were slightly older (mean age, 43.1 versus 44.0 years), more likely to be older, more urgent and had a higher admission rate compared to the pre-pandemic period. There was a slight increase in visits during the daytime curfew hours and a decrease during the nighttime. CONCLUSION: We report a considerable decrease in the number of Emergency Department visits. The reduction was higher in non-urgent and less urgent cases. Patients presenting at the Emergency Department during the curfew times were more likely to stay longer in the Emergency Department and more likely to be admitted, compared with the pre-pandemic period.

A comparative study on emergency triage efficiency between emergency rapid triage system and emergency severity classification of 4 level / 中国实用护理杂志

Objective To probe into the emergency triage efficiency between emergency rapid triage system (ERTS) and emergency severity classification of 4 level. Methods A total of 46965 emergency patients from January to December in 2015 were selected as the research object and utilized a data of patients from the electronic triage system, and triaged the emergency patients by means of ERTS retrospectively. A comparison was performed in patient visits, outcome and hospital rates between ERTS and emergency severity classification of 4 level. Results In both of these triage systems, almost 80％of patients are assigned to the lowest acuity (levelⅢandⅣ). The visits of patients with gradeⅢand grade IV diseases were 71.5％(33580/46965), 50.5％(23717/46965) in ERTS and 12.1％(5683/46965), 35.1％(16485/46965) in emergency severity classification of 4 level respectively. The outcomes of patient under the ERTS were better than emergency severity classification of 4 level at levelⅠandⅡ(χ2=11.79, 1100.62, P<0.05). At levelⅠandⅡ, ERTS in the patient's disease hospital admission rates were 70.5％(311/441), 72.6％(5274/7264), which higher than emergency severity classification of 4 level, 62.5％(371/594), 45.2％(2785/6161), the difference was statistically significant (χ2=7.32, 1043.13, P<0.05). At level Ⅲ and Ⅳ, ERTS in the patient's disease hospital admission rates were 9.6％(3676/38288), 7.9％(77/972) , which lower than emergency severity classification of 4 level, 19.3％(4578/23719) , 9.9％(1632/16491), the difference was statistically significant (χ2=1153.10, 4.05, P<0.05). Conclusions ERTS significantly improves the sensitivity and accuracy of emergency triage compared to emergency severity classification of 4 level. ERTS has obvious significance in the emergency patient distribution, and also has a certain advantage in the patient outcomes and hospitalization rates. It can be used as a auxiliary tool.

Does the Norwegian emergency medical dispatch classification as non-urgent predict no need for pre-hospital medical treatment? An observational study.

BACKGROUND: The number of ambulance call-outs in Norway is increasing owing to societal changes and increased demand from the public. Together with improved but more expensive education of ambulance staff, this leads to increased costs and staffing shortages. We wanted to study whether the current dispatch triage tools could reliably identify patients who only required transport, and not pre-hospital medical care. This could allow selection of such patients for designated transport units, freeing up highly trained ambulance staff to attend patients in greater need. METHODS: A cross-sectional observational study was used, drawing on all electronic and paper records in our ambulance service from four random days in 2012. The patients were classified into acuity groups, based on Emergency Medical Dispatch codes, and pre-hospital interventions were extracted from the Patient Report Forms. RESULTS: Of the 1489 ambulance call-outs included in this study, 82 PRFs (5 %) were missing. A highly significant association was found between acuity group and recorded pre-hospital intervention (p ≤ 0.001). We found no correlation between gender, distance to hospital, age and pre-hospital interventions. Ambulances staffed by paramedics performed more interventions (234/917, 26 %) than those with emergency medical technicians (42/282, 15 %). The strongest predictor for needing pre-hospital interventions was found to be the emergency medical dispatch acuity descriptor. DISCUSSION: This study has demonstrated that the Norwegian dispatch system is able to correctly identify patients who do not need pre-hospital interventions. Patients with a low acuity code had a very low level of pre-hospital interventions. Evaluation of adherence to protocol in the Emergency Medical Dispatch is not possible due to the inherent need for medical experience in the triage process. CONCLUSIONS: This study validates the Norwegian dispatch tool (Norwegian index) as a predictor of patients who do not need pre-hospital interventions.

Evaluating the Effectiveness of a Nurse Practitioner-Led Outreach Program for Long-Term-Care Homes.

An observational prospective cohort study was conducted on 1,353 observations from a convenience sample of 311 long-term-care (LTC) residents to evaluate the effectiveness of a nurse practitioner-led outreach program on the health outcomes, emergency department (ED) transfers, and hospital admissions of LTC residents. The results show that ED transfers by the NPs were 27% less likely to be non-urgent than transfers made by MDs (OR = .73; 95% CI .54-.97) and that ED transfers by the NPs were 3.23 times more likely to be admitted to hospital than transfers by MDs (OR = 3.23; 95% CI 1.17-8.90). These findings highlight the potential benefits of the NP-led outreach program for LTC residents and for the health-care system.

Dans le cadre d'une étude de cohorte prospective observationnelle, 1 353 observations provenant d'un échantillon de commodité composé de 311 bénéficiaires de soins de longue durée ont été soumises à un examen visant à évaluer l'efficacité d'un programme d'extension des services dirigé par des infirmières praticiennes en ce qui a trait aux résultats sur la santé, aux transferts vers le service des urgences et à l'hospitalisation des bénéficiaires de soins de longue durée. Les résultats indiquent que les patients transférés au service des urgences par des infirmières praticiennes étaient dans une proportion de 27 % moins susceptibles d'être non urgents que ceux transférés par des médecins (rapport de cotes = 0,73; intervalle de confiance à 95 % de 0,54 à 0,97), et 3,23 fois plus susceptibles d'être admis à l'hôpital que ceux transférés par des médecins (rapport de cotes = 3,23; intervalle de confiance à 95 % de 1,17 à 8,90). Ces constatations ont permis de mettre en évidence les avantages possibles d'un programme d'extension des services dirigé par des infirmières praticiennes pour les bénéficiaires de soins de longue durée et le système de soins de santé.