Introduction We assessed the utility of an emergency department (ED) protocol using clinical parameters to rapidly distinguish likelihood of novel coronavirus 2019 (COVID-19) infection; the applicability aimed to stratify infectious-risk pre-polymerase chain reaction (PCR) test results and accurately guide early patient cohorting decisions. Methods We performed this prospective study over a two-month period during the initial surge of the 2020 COVID-19 pandemic in a busy urban ED of patients presenting with respiratory symptoms who were admitted for in-patient care. Per protocol, each patient received assessment consisting of five clinical parameters: presence of fever; hypoxia; cough; shortness of breath/dyspnea; and performance of a chest radiograph to assess for bilateral pulmonary infiltrates. All patients received nasopharyngeal COVID-19 PCR testing. Results Of 283 patients studied, 221 (78%) were PCR+ and 62 (22%) PCR-. Chest radiograph revealed bilateral pulmonary infiltrates in 85%, which was significantly more common in PCR+ (94%) vs PCR- (52%) patients (P < 0.0001). The rate of manifesting all five positive clinical parameters was significantly greater in PCR+ (63%) vs PCR- (6.5%) patients (P < 0.0001). For PCR+ outcome, the presence of all five positive clinical parameters had a specificity of 94%, positive predictive value of 98%, and positive likelihood ratio of 10. Conclusions Using an ED protocol to rapidly assess five clinical parameters accurately distinguishes likelihood of COVID-19 infection prior to PCR test results, and can be used to augment early patient cohorting decisions.
Study Objective Patients with sickle cell disease (SCD) have many emergency department visits because of painful vaso‐occlusive episodes (VOE). Guidelines recommend treatment within 30 minutes of triage, but this is rarely achieved in clinical practice. Our goal was to develop an order set that is being implemented in the ED to facilitate and standardize emergency care for SCD patients in acute pain from VOEs presenting to the emergency department (ED) in New York City (NYC). Methods Using a RAND/University of California, Los Angeles modified Delphi panel, we convened a multidisciplinary panel and reviewed evidence on how to best manage SCD pain in the ED. Panelists collaboratively developed then rated 202 items that could be included in an ED order set. Results A consensus order set, a practical how‐to guide for managing SCD pain in the ED, was developed based on items that received high median ratings. Conclusions The management of acute pain experienced during VOEs is critical to patients with SCD; ED order sets, such as this one, can help standardize pain management, including at triage, evaluation, discharge, and follow‐up care. After implementation in NYC EDs, studies to examine changes in quality care metrics (eg, wait times, readmissions) are planned.
Study Objective: The COVID-19 pandemic put an immense strain on emergency departments (ED) throughout the country. Many patients required hospitalization, while others required symptomatic care and testing. We established a novel triage and treatment process, using a combination of telemedicine and a tent site adjacent to the ED, that provided safer and more efficient patient care.Methods: We conducted a retrospective study of patients with suspected COVID-19 evaluated at a suburban, academic medical center in Long Island, New York. Patients who presented to the ED with symptoms of COVID-19 during a 30-day timeframe between the hours of 11 am to 7 pm were triaged by vital signs and a questionnaire at the main ED entrance. If appropriate, patients were then directed to our tent site. Our primary outcome was 30-day return visits for acute medical concerns related to COVID-19.Results: We assessed 693 patients. 505 patients (73%) tested positive for COVID-19. The mean age was 41.6 years old. In regards to 30-day revisits, a total of 74 patients (10.1%) returned to the ED, and 38 (5.5%) of these were related to COVID-19. Of this group, 11 patients (1.6%) were admitted to the hospital, including one ICU admission. There was one death in the 30-day revisit group (COVID-related complications).Conclusion: Our novel triage and evaluation model provided a safe environment for testing and treating patients during the first wave of the COVID-19 pandemic. This information can help emergency departments provide alternative treatment models to care for patients during future surge scenarios. Outcome Variable Patients Per Day (mean, range) 21.7 (0 -42) Tent Length of Stay (mean minutes, range) 43 (13 -349)
Background and Objectives: COVID-19 is highly infectious and the pandemic requires many adaptations to how we deliver medical care. Early in the pandemic, much of this focus was on hospital and emergency department care delivery models to ensure the safety of non–COVID-19 patients and health care workers. However, providing much needed outpatient assessments for COVID-19 patients during a pandemic is also fraught with challenges. From our review of the literature, best practices for a dedicated pandemic ambulatory outpatient clinic have not previously been described. We present a model for creating a dedicated ambulatory pandemic clinic at our institution for the acute care needs of COVID-19 patients. Methods: To address the current pandemic, the Mayo Acute Symptoms of COVID-19 Clinic was implemented on April 13, 2020, with the aims of providing a stand-alone location for COVID-19 patients to have acute outpatient evaluations as well as diagnostics. Results: Recognized challenges addressed included consideration of airflow recirculation patterns in standard medical office buildings, optimization of protocols to conserve personal protective equipment (PPE), limiting total exposure time during patient flow, and reducing surfaces and spaces that patients would physically contact. To this end, unique methods of patient scheduling, patient flow process, staff training, and PPE protocols were developed and are explained in detail in this article. Conclusion: In the COVID-19 pandemic, as well as inevitably in future pandemics, outpatient medical facilities need to be prepared to care for nonhospitalized and nonemergent pandemic patients. We offer a practical approach that has been successful at our institution, with opportunity for local adaptation based on need and resources.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.