Emergency centre reorganization in preparation to the COVID-19 pandemic: A district hospital's dynamic adaptation response

The COVID-19 global pandemic forced healthcare facilities to put special isolation measures in place to limit nosocomial transmission. Cohorting is such a measure and refers to placing infected patients (or under investigation) together in a designated area. This report describes the physical reorganisation of the emergency centre at Khayelitsha Hospital, a district level hospital in Cape Town, South Africa in preparation to the COVID-19 pandemic. The preparation included the identification of a person under investigation (PUI) room, converting short stay wards into COVID-19 isolation areas, and relocating the paediatric section to an area outside the emergency centre. Finally, we had to divide the emergency centre into a respiratory and non-respiratory side by utilising part of the hospital's main reception. We are positive that the preparation and reorganization of the emergency centre will limit nosocomial transmission during the expected COVID-19 surge. Our experience in adapting to COVID-19 may have useful implications for ECs throughout South Africa and in low-and-middle income countries that are preparing for this pandemic

Perfil da demanda de um serviço de oftalmologia em uma unidade de emergência / Demanding profile of an ophthalmological service in an emergency unit

Foram estudados 301 pacientes atendidos no Serviço de Oftalmologia da Unidade de Emergência do Hospital das Clínicas da Faculdade de Medicina de Ribeiräo Preto da Universidade de Sao Paulo. Destes, 176 (58,5%) foram considerados como casos de emergência. A faixa etária mais acometida foi a de 15 a 45 anos, sendo os homens mais atingidos que as mulheres. O perfil de morbidade se caracterizou por causas traumáticas, predominantemente, muitas vezes com características profissionais

[ORL emergencies at a hospital. Descriptive study. Degree of adequacy of the demand in relation to hospital ORL care]. / Urgencias ORL en una ciudad sanitaria. Estudio descriptivo. Grado de adecuación de la demanda respecto a la asistencia ORL hospitalaria.

We present a descriptive study of 6,522 ENT emergencies in our universitary hospital in 1987. They are analysed under different parameters, which include the reason for emergency, seriousness, surgery, hospitalization and interexaminations. We expose the correlation among the different parameters and the evaluation of the adequacy between hospitalary emergency services and the demand.

[The demand for emergency services at pediatric hospitals: a study of 4,858 cases treated at the emergency department of a pediatric hospital]. / Demanda urgente de asistencia pediátrica hospitalaria: estudio de 4.858 casos atendidos en el servicio de urgencias de un hospital infantil.

Given the rise in hospital emergencies, a detailed study of the demand for emergency pediatric care is a must. We compiled 4,858 medical records elected at random and gathered data about global activity in the emergency department of pediatric hospital. The demand for emergency pediatric care grows faster than the corresponding population. The higher and lower patient influxes were on Sunday and Wednesday respectively. The peak rate of influx was attained at 8 pm, whereas the low happened at 6 am. Pediatric emergencies diminish with age and are less frequent in girls than in boys. Only 15.86% of the patients had been referred by a physician. Fever and accidents were the most frequent reason for consultation. Ear, nose and throat diseases are at the top and double in frequency the bronchopulmonary sickness. Analyses were done in 12% of the cases, radiographs were taken in 23% of the patients and 68.58% of the casualties were taken were care of without any of these means. The visit was finished in a mean of 1.99 hours, a swift performance. Of all the cases studied, 93.4% were discharged and 5.3% were admitted to the same hospital. Our data confirm and complete the one published fragmentarily in the Spanish literature. We emphasize that a primary pediatrician could have spared the emergency department a lot of work. We conclude that accessible continuous care must be offered in order to transcend patchwork in following growth and development through pediatric emergency rooms.

The role of specialized clinical services in competition among hospitals.

Because duplication of services among hospitals can be costly, it is important to understand the circumstances under which duplication occurs among hospitals within a region. In this sample of 3,584 community hospitals surveyed in 1972, we analyzed the impact of competition on the availability of specialized clinical services, with special focus on mammography, emergency services, cobalt therapy, heart surgery, and cardiac catheterization. We found that the presence of nearby institutions and services increases the availability of most of these services in neighboring hospitals. This supports the hypothesis that competition among hospitals within an open-ended reimbursement environment takes the form of nonprice competition for community-based physicians through the acquisition of expensive clinical facilities.