Implementation of a centralized discharge planning office during the COVID-19 pandemic: translating the experience from the emergency to routine clinical practice.

Background and aim During the COVID-19 emergency, the lombardy region (northern Italy) implemented a regional Centralized Discharge Planning Office (CDPO) to promptly manage the discharge requests, rapidly match the needs of discharge hospitals with the availability of admission facilities and ensure the management of the entire discharge process. To improve the discharge process in routine clinical practice, maintaining the role of the CDPO could be of great interest. This paper describes the experience of the CDPO during the COVID-19 pandemic and discusses the possibility to translate this operational model to routine clinical practice. METHODS: The PRIAMO web portal was developed to manage discharge requests with centralized and standardized procedures. The activity on PRIAMO consisted of three stages: discharge request, sorting process, and discharge follow-up phase. To evaluate the activity of the CDPO, these indicators were considered: average time (hours) between patient discharge and transfer acceptance; average time (hours) between patient discharge and effective admission to the new facility; percentage of transfers whose destination was found directly by the CDPO; percentage of reallocations beyond 24 hours; mean distance between discharge and admission facilities. RESULTS: Process indicator evaluation showed a great reduction in the time between the discharge and the admission to post-acute care facilities. Transfers whose destination was found directly by the CDPO progressively increased. Reallocations beyond 24 hours by the CDPO decreased, suggesting an improvement in the quality of the operations. CONCLUSIONS: Centralized discharge planning has enabled timely and efficient management of discharge requests even in the moment of a surge, saving time and costs for acute care hospitals.

Mixed Body/Hand Reference Frame for Reaching in 3D Space in Macaque Parietal Area PEc.

The neural correlates of coordinate transformations from vision to action are expressed in the activity of posterior parietal cortex (PPC). It has been demonstrated that among the medial-most areas of the PPC, reaching targets are represented mainly in hand-centered coordinates in area PE, and in eye-centered, body-centered, and mixed body/hand-centered coordinates in area V6A. Here, we assessed whether neurons of area PEc, located between V6A and PE in the medial PPC, encode targets in body-centered, hand-centered, or mixed frame of reference during planning and execution of reaching. We studied 104 PEc cells in 3 Macaca fascicularis. The animals performed a reaching task toward foveated targets located at different depths and directions in darkness, starting with the hand from 2 positions located at different depths, one next to the trunk and the other far from it. We show that most PEc neurons encoded targets in a mixed body/hand-centered frame of reference. Although the effect of hand position was often rather strong, it was not as strong as reported previously in area PE. Our results suggest that area PEc represents an intermediate node in the gradual transformation from vision to action that takes place in the reaching network of the dorsomedial PPC.

Temporal stability of reference frames in monkey area V6A during a reaching task in 3D space.

Neurons in the posterior parietal cortex of macaques show spatial tuning during several phases of an instructed delay reaching task, but their reference frames have been studied mostly during fixed periods without addressing how they evolve across task phases. In parietal area V6A, we reported recently that during the late delay and hand movement periods, most neurons represent target location either in body-centered frame of reference, or in mixed body/hand-centered coordinates, with no evidence of hand-centered representations. Here, we characterized the spatial representations of V6A neurons in earlier task epochs, i.e., immediately after target fixation and in the subsequent main part of the delay and examined whether the reference frames of individual neurons are stable across the task. We report no evidence of hand-centered coding also in the earlier phases of the task. Shortly, after target fixation and throughout the main part of the delay period, V6A neurons used either body-centered or mixed body/hand-centered reference frames. Most of the cells showed consistent reference frames across epochs. Interestingly, a population trend of shifting from mixed body/hand-centered frames to 'pure' body-centered coordinates was found as the task progressed. These findings suggest that, similar to other parietal areas, in V6A, the reference frames show a limited degree of temporal evolution. The stronger presence of mixed coding at the early task stages could reflect the early involvement of V6A in eye-hand coordination, whereas the increase in spatiotopic representations towards movement execution could be related to its role in online movement control.