COVID-19 has had a significant effect on healthcare resources worldwide, with our knowledge of the natural progression of the disease evolving for the individual patient. To allow for early detection of worsening clinical status, protect hospital capacity and provide extended access for vulnerable patients, our emergency department developed a remote patient monitoring programme for discharged patients with COVID-19. The programme uses a daily emailed secure link to a survey in which patients submit biometric and symptoms data for monitoring. Patients’ meeting criteria are escalated to a physician for a phone or video visit. Here, we describe the development, implementation and preliminary analysis of utilisation of the programme.
Objectives: Competency assessment is a key component of point-of-care ultrasound (POCUS) training. The purpose of this study was to design a smartphone-based standardized direct observation tool (SDOT) and to compare a faculty-observed competency assessment at the bedside with a blinded reference standard assessment in the quality assurance (QA) review of ultrasound images. Methods: In this prospective, observational study, an SDOT was created using SurveyMonkey containing specific scoring and evaluation items based on the Council of Emergency Medicine Residency-Academy of Emergency Ultrasound: Consensus Document for the Emergency Ultrasound Milestone Project. Ultrasound faculty used the mobile phone-based data collection tool as an SDOT at the bedside when students, residents, and fellows were performing one of eight core POCUS examinations. Data recorded included demographic data, examination-specific data, and overall quality measures (on a scale of 1-5, with 3 and above being defined as adequate for clinical decision making), as well as interpretation and clinical knowledge. The POCUS examination itself was recorded and uploaded to QPath, a HIPAA-compliant ultrasound archive. Each examination was later reviewed by another faculty blinded to the result of the bedside evaluation. The agreement of examinations scored adequate (3 and above) in the two evaluation methods was the primary outcome.
BackgroundChest pain is a common complaint in EDs. In this study, we describe demographic, care and cost trends in US ED visits for chest pain over 11 years.MethodsThis is a retrospective descriptive study of trends in utilisation and care of ED chest pain visits from 2006 to 2016) using data from the Healthcare Cost and Utilization Project database, a national sample of US ED visits and hospitalisations.ResultsFrom 2006 to 2016, there were 42.48 million chest pain visits. Visits per 100 000 persons increased from 1140.4 in 2006 to 1611.7 in 2016 (p<0.001). The chest pain inpatient admission rate declined from 19% in 2006 to 3.9% in 2016 (p<0.001); associated inpatient hospitalisation costs declined from $10.4 billion (2006–2008) to $6.2 billion (2012–2014).ConclusionFrom 2006 to 2016, ED visits in the USA for chest pain increased with a significant decline in admission rates and inpatient hospitalisation costs.
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