Management practices of emergency departments in general hospitals based on blockage of chain of infection during a COVID-19 epidemic

Infectious Risk in Pediatric Emergency Departments in Italy: A Survey by the Italian Society for Pediatric Emergency and Urgent Medicine (SIMEUP) on Available Preventive and Diagnostic Tools

Background/Objectives: The COVID-19 pandemic has emphasized the importance of preparedness in preventing the spread of infectious diseases, especially in Emergency Departments (EDs), where initial patient assessments and triage occur. This study aims to evaluate the current practices and available tools for infection control in Pediatric EDs across Italy, focusing on the differences between various hospital types and regional settings. Methods: A cross-sectional national survey was conducted in February 2022, targeting healthcare workers in Pediatric EDs across Italy. The survey, distributed via the Italian Society for Pediatric Emergency and Urgent Medicine (SIMEUP) mailing list, collected data on infection control measures, including the availability of hand hygiene stations, personal protective equipment, disinfection protocols, and the use of rapid diagnostic tests. Results: A total of 80 questionnaires were completed from 119 (67.2%) different ERs. The majority of respondents were from Northern Italy (47.5%) and worked in hospitals with 24 h pediatric assistance (48.8%). Less than half of non-pediatric hospitals had separate access for children, potentially exposing them to adult pathogens. Across all settings, basic infection control measures, such as providing masks and hand gel, were widely implemented. However, significant differences were observed in the availability of social distancing, informational materials, and dedicated pediatric pathways, with I level assistance hospitals less likely to have these resources. Rapid diagnostic tests were available in most settings, but the focus was predominantly on SARS-CoV-2, despite other respiratory pathogens' relevance in pediatric care. Conclusions: Strengthening preparations for future pandemics will be crucial in enhancing the resilience of healthcare systems and ensuring the safety of both patients and healthcare workers in the face of emerging infectious threats.

COVID-19 retreats and world recovers: A silver lining in the dark cloud

The coronavirus disease (COVID-19), which the World Health Organization classified as the Sixth Public Health Emergency Of International Concern (PHEIC) on January 30, 2020, is no longer a PHEIC. Millions were affected due to unawareness. The increase in fatalities and shortage of medicine was the first outrage of COVID-19. As per the Johns Hopkins COVID-19 resource center database, it was observed that the disease has spread dynamically across 200+ nations worldwide affecting more than 600 million people from 2019 to 2023, and over thousands of people were victimized regularly at a 2% mortality rate (approx.). In the midway, the mutant variants of concern like omicron, and delta have also created havoc and caused significant impact on public health, global economy, and lifestyle. Since 2019, 3 years now passed and the dynamic disease statistics seem decelerated; moreover, the prevalence of COVID-19 is also fading. The Johns Hopkins resource center has also stopped recording the data of the global pandemic recently from March 10, 2023. Hence, based on the facts, we are presenting a concise report on the pandemic from 2019 to 2023, which includes a brief discussion of the global pandemic. We have highlighted global epidemiology, emphasizing the Indian COVID scenario, vaccination across the globe, and the psychosocial and geopolitical consequences of COVID-19 with a brief background to pathology, clinical management, and the worldwide response against triage. A lot has changed and still needs to change after three tough years of COVID-19. Even though science has progressed and advanced research in medicine is pointing toward future generations, there is no standard care supplied for COVID-19-like calamities. COVID-19 cases might have declined but its influence on the society is still stagnant. This COVID experience has taught us that, despite our bleak beginnings, there is always hope for the future and that we must act with foresight to improve things for future generations.

Construction of a 5G-based, three-dimensional, and efficiently connected emergency medical management system

Background

Shenzhen is unique in its need for ad hoc responses to emergencies. The need for emergency medicine also demonstrates a trend of sustained growth.

Objective

A three-dimensional and efficiently connected emergency medical management model using fifth generation mobile communication technology (5G) was established to improve the efficiency and level of management in emergency medicine.

Method

A mixed-frequency band private network collaborative emergency treatment mode was built under daily emergency scenarios using 5G. The efficiency of a three-dimensional telemedicine treatment mode was tested using prehospital emergency medicine. Also, the feasibility of quickly establishing a temporary network information system using unmanned aerial vehicle (UAV) and/or high-throughput communication satellites under disaster-caused power outages and network interruptions was examined. A monitoring system was constructed for suspected cases using 5G amid public health emergencies, which raised the Emergency Department's efficiency and security in responding to the pandemic.

Results

The three-dimensional rescue system supported by 5G showed that the radius of the emergency medical rescue services expanded from 5 to 60 km, and the cross-district emergency reaction time reduced from 1 h to <20 min. Thus, it was feasible to construct a communication network expeditiously with devices carried by UAV under disastrous scenarios. The system developed based on 5G could be used in managing suspected cases of public emergencies. Among the 134 suspected cases in the early stage of the pandemic, no nosocomial infection was detected.

Conclusion

A three-dimensional, efficiently connected emergency medical management system based on 5G was constructed, following which the emergency rescue radius quickly expanded and the emergency response time reduced. Thus, with the aid of new technology, an emergency information network system was built expeditiously under specific scenarios, such as a natural disaster, and the level of management under public health emergencies advances. The confidentiality of patient information is a critical issue regarding the application of new technology.

Facing the Impact of the COVID-19 Pandemic: How Can We Allocate Outpatient Doctor Resources More Effectively?

The COVID-19 pandemic caused significant damage to global healthcare systems. Previous studies regarding COVID-19’s impact on outpatient numbers focused only on a specific department, lacking research data for multiple departments in general hospitals. We assessed differences in COVID-19’s impact on outpatient numbers for different departments to help hospital managers allocate outpatient doctor resources more effectively during the pandemic. We compared the outpatient numbers of 24 departments in a general hospital in Beijing in 2019 and 2020. We also examined an indicator not mentioned in previous studies, monthly departmental patient reservation rates. The results show that, compared with 2019, 2020 outpatient numbers decreased overall by 33.36%. Ten departments’ outpatient numbers decreased >33.36%; however, outpatient numbers increased in two departments. In 2020, the overall patient reservation rate in 24 departments was 82.22% of the 2019 reservation rate; the rates in 14 departments were <82.22%. Moreover, patient reservation rates varied across different months. Our research shows that COVID-19’s impact on different departments also varied. Additionally, our research suggests that well-known departments will be less affected by COVID-19, as will departments related to tumor treatment, where there may also be an increase in patient numbers. Patient reservation rates are an indicator worthy of attention. We suggest that hospital managers classify departments according to changes in outpatient numbers and patient reservation rates and adopt accurate, dynamic, and humanized management strategies to allocate outpatient doctor resources.

Assessment of COVID-19 prevention and protection measures in hospitals

This paper aims to develop an assessment framework for the Covid-19 prevention and protection measures in hospitals. The conceptual model is developed by using fifty-four attributes, fifteen criteria, and three enablers. The multi-grade fuzzy approach is used to develop the assessment framework, and Importance Performance Analysis (IPA) identifies the weaker attributes in the case organization. The case hospital's preventive and safety measures assessment level is 8.05, which is 'very highly focused on protection measures,' and fourteen weaker attributes were identified. The case hospital management should focus on the guidelines of Covid-19 preventive and protection measures, strict protocols, regular audits, education and training of the staff, and active surveillance. Case hospital managers should also focus on staffing and timings, the formulation of policies, and abiding by those policies without any fail. This proposed assessment model is a new initiative in-hospital assessment in preventive and safety measures in the healthcare sector during the Covid-19 era. This framework will enable hospital managers as a continuous assessment tool to improve their Covid-19 prevention operations.

Factors affecting doctor’s recommendation for mobile health services

Objective

As a new medical service mode, the value of mobile health (mHealth） services has received increasing attention and recognition. However, compared with the owners of mobile devices, the user scale of mHealth services is still small. It is well known that doctors’ recommendations have an important impact on what kind of medical service patients choose. To explore the key factors affecting doctors’ recommendation of mHealth services to patients, and to provide countermeasures for mHealth service providers and hospital managers, so as to promote doctors to recommend mHealth services to more patients.

Methods

Through literature review, expert consultation and pre-test, a questionnaire including 22 questions was designed, and 114 valid questionnaires were collected by online research. Net Promoter Score (NPS) was used to evaluate doctors’ recommendation willingness, and multivariate logistics analysis was used to evaluate the key factors affecting doctors’ recommendation willingness.

Results

The NPS of doctors was 6.06%, among which the recommenders, neutrals and critics accounted for 29.56%, 46.96% and 23.48%, respectively. The attitude towards mHealth services and whether they pay attention to and/or are willing to try new technologies are the key factors affecting the doctors’ recommendation, and the usefulness for patients most often emphasized by mHealth service providers to doctors does not affect doctors’ recommendation willingness. In addition, whether mHealth services can help doctors establish personal brands may be a potential factor to enhance doctors’ recommendation willingness.

Conclusion

In order to improve the recommendation willingness of doctors, mHealth service providers and hospital managers should focus on doctors who have a positive attitude towards mHealth services and are highly innovative (which often means younger and lower professional levels). At the same time, they should think about how to use mHealth services to help doctors establish personal brands in the future.