Characterization and clinical course of 1000 patients with COVID-19 in New York: retrospective case series
Michael ArgenzianoSamuel L. BruceCody SlaterJonathan R. TiaoMatthew R. BaldwinR. Graham BarrBernard ChangKatherine H. ChauJustin J. ChoiNicholas GavinParag GoyalAngela M. MillsAshmi A PatelMarie-Laure S RomneyMonika M. SaffordNeil W. SchlugerSoumitra SenGuptaMagdalena E. SobieszczykJason ZuckerPaul A. AsadourianFletcher BellRebekah BoydMatthew CohenMacAlistair I ColquhounLucy A ColvilleJoseph H de JongeLyle DershowitzShirin DeyKatherine A. EisemanZachary GirvinDaniella T GoniAmro A. HarbNicholas HerzikSarah HouseholderLara E KaraaslanHeather LeeEvan LiebermanAndrew LingRee LuArthur Y ShouAlexander C. SistiZachary E SnowColin P. SperringYuqing XiongHenry W. ZhouKarthik NatarajanGeorge HripcsakRuijun Chen
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Abstract Objective To characterize patients with coronavirus disease 2019 (COVID-19) in a large New York City (NYC) medical center and describe their clinical course across the emergency department (ED), inpatient wards, and intensive care units (ICUs). Design Retrospective manual medical record review. Setting NewYork-Presbyterian/Columbia University Irving Medical Center (NYP/CUIMC), a quaternary care academic medical center in NYC. Participants The first 1000 consecutive patients with laboratory-confirmed COVID-19. Methods We identified the first 1000 consecutive patients with a positive RT-SARS-CoV-2 PCR test who first presented to the ED or were hospitalized at NYP/CUIMC between March 1 and April 5, 2020. Patient data was manually abstracted from the electronic medical record. Main outcome measures We describe patient characteristics including demographics, presenting symptoms, comorbidities on presentation, hospital course, time to intubation, complications, mortality, and disposition. Results Among the first 1000 patients, 150 were ED patients, 614 were admitted without requiring ICU-level care, and 236 were admitted or transferred to the ICU. The most common presenting symptoms were cough (73.2%), fever (72.8%), and dyspnea (63.1%). Hospitalized patients, and ICU patients in particular, most commonly had baseline comorbidities including of hypertension, diabetes, and obesity. ICU patients were older, predominantly male (66.9%), and long lengths of stay (median 23 days; IQR 12 to 32 days); 78.0% developed AKI and 35.2% required dialysis. Notably, for patients who required mechanical ventilation, only 4.4% were first intubated more than 14 days after symptom onset. Time to intubation from symptom onset had a bimodal distribution, with modes at 3-4 and 9 days. As of April 30, 90 patients remained hospitalized and 211 had died in the hospital. Conclusions Hospitalized patients with COVID-19 illness at this medical center faced significant morbidity and mortality, with high rates of AKI, dialysis, and a bimodal distribution in time to intubation from symptom onset.Keywords:
Medical record
Moral hazard
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Abstract Objective EDs are necessary for urgent health concerns; however, many physical ED visits could be better treated in alternate settings. The present study aimed to describe the feasibility, acceptability and effectiveness of a Virtual ED to reduce unnecessary physical ED presentations at a large tertiary health service in Australia. Methods This observational study using the RE‐AIM framework (Reach, Efficacy, Adoption, Implementation and Maintenance) evaluated the feasibility of a Virtual ED using routinely collected health service data and process‐evaluation to assess intervention fidelity and adherence between April 2020 and 31 March 2022. The primary outcome for the present study was the feasibility of the Virtual ED model of care. Results The Virtual ED received 2080 direct calls for patients with a mean age of 50.3 years, with 70.4% managed in the Virtual ED alone and 29.6% referred for physical ED presentation. Of the 2080 direct referrals, 95.8% were potentially avoidable ED presentations. Of those referred, 28.3% required an admission. Of calls managed entirely by Virtual ED, 18 (1.2%) unexpectedly required a hospital admission within 48 h. General practitioner respondents rated the Virtual ED service as helpful to very helpful. The service had an average of 212 referrals per month, with a 65.2% average growth rate. The Virtual ED service was considered helpful and clinically appropriate, with a high level of ED avoidance. Conclusion The Virtual ED prevented 70% of community triaged patients from presenting to the physical ED, with good uptake from all referrers, supporting the use of virtual care pathways in emergency care management.
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Objectives:To describe the rate of complaints from the parents of the children in outpatient department and emergency department,complaint categories,departments involved,outcomes of complaints.Methods:Retro- spective study was conducted to analyze the complaints made by parents of the children in outpatient department and emergency department in Shanghai Children's Medical Center from Jan.2005 to Nov.2007.The main indexes were complaints rate,department involved,complaints and outcomes.Results:The average rate of complaints was 0.133/1000 patients.Complaints relating to treatment,communication,patient' s right and access to healthcare accounted for 37.4%,29.8%,11.6% and 9.9% respectively.Apologies or explanations and educating the health- care staff resolved 73% of complaints.Conclusion:To take complaint data as quality improvement activities is rec- ommended.Interventions to decrease the number of complaints will be educating the healthcare staffs in the areas of communication,establishing reasonable procedure in outpatient department and emergency department.
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Polyembolokoilamania in the Emergency Department Polyembolokoilamania is a rare but serious medical condition that involves the presence of multiple foreign bodies in the patient's body [1]. This condition can be challenging to diagnose and manage in the emergency department. In this chapter, we will discuss the presentation, diagnosis, and management of polyembolokoilamania in the emergency department.
Presentation (obstetrics)
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Introduction: Emergency department (ED) crowding has been shown to negatively impact patient outcomes. Few studies have addressed the effect of ED crowding on patient satisfaction. Our objective was to evaluate the impact of ED crowding on patient satisfaction in patients discharged from the ED.Methods: We measured patient satisfaction using Press-Ganey surveys returned by patients that visited our ED between August 1, 2007 and March 31, 2008. We recorded all mean satisfaction scores and obtained mean ED occupancy rate, mean EDWIN score and hospital diversion status over each 8-hour shift from data archived in our electronic tracking board. Univariate and multivariate logistic regression analysis was calculated to determine the effect of ED crowding and hospital diversion status on the odds of achieving a mean satisfaction score ≥85, which was the patient satisfaction goal set forth by our ED administration.Results: A total of 1591 surveys were returned over the study period. Mean satisfaction score was 77.6 (SD±16) and mean occupancy rate was 1.23 (SD±0.31). The likelihood of failure to meet patient satisfaction goals was associated with an increase in average ED occupancy rate (OR 0.32, 95% CI 0.17 to 0.59, P<0.001) and an increase in EDWIN score (OR 0.05, 95% CI 0.004 to 0.55, P=0.015). Hospital diversion resulted in lower mean satisfaction scores, but this was not statistically significant (OR 0.62, 95% CI 0.36 to 1.05). In multivariable analysis controlling for hospital diversion status and time of shift, ED occupancy rate remained a significant predictor of failure to meet patient satisfaction goals (OR 0.34, 95% CI 0.18 to 0.66, P=0.001).Conclusions: Increased crowding, as measured by ED occupancy rate and EDWIN score, was significantly associated with reduced patient satisfaction. Although causative attribution was limited, our study suggested yet another negative impact resulting from ED crowding. [West J Emerg Med.2013;14(1):11-15.]
Crowding
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