Purpose: Coronavirus disease (COVID-19) has been associated with neurologic sequelae and neuroimaging abnormalities in several case series previously. In this study, the neuroimaging findings and clinical course of adult patients admitted with COVID-19 to a tertiary care hospital network in Canada were characterized. Methods: This is a retrospective observational study conducted at a tertiary hospital network in Ontario, Canada. All adult patients with PCR-confirmed COVID-19 admitted from February 1, 2020 to July 22, 2020 who received neuroimaging related to their COVID-19 admission were included. CT and MR images were reviewed and categorized by fellowship-trained neuroradiologists. Demographic and clinical data were collected and correlated with imaging findings. Results: We identified 422 patients admitted with COVID-19 during the study period. 103 (24.4%) met the inclusion criteria and were included: 30 ICU patients (29.1%) and 73 non-ICU patients (70.9%). A total of 198 neuroimaging studies were performed: 177 CTs and 21 MRIs. 17 out of 103 imaged patients (16.8%) had acute abnormalities on neuroimaging: 10 had macrohemorrhages (58.8%), 9 had acute ischemia (52.9%), 4 had SWI abnormalities (23.5%), and 1 had asymmetric sulcal effacement suggesting possible focal encephalitis (5.8%). ICU patients were more likely to have positive neuroimaging findings, more specifically acute ischemia and macrohemorrhages ( P < 0.05). Macrohemorrhages were associated with increased mortality ( P < 0.05). Conclusion: Macrohemorrhages, acute ischemia and SWI abnormalities were the main neuroimaging abnormalities in our cohort of hospitalized COVID-19 patients. Acute ischemia and hemorrhage were associated with worse clinical status.

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Introduction: Bed boarding of admitted patients in the Emergency Department (ED) is widely recognized as a major contributor to overcrowding, particularly in very high-volume hospitals. The issue of bed boarding is directly tied to hospital-wide capacity, flow and operations. Early morning discharge from inpatient units has been identified as a low-cost intervention to decrease bed boarding, as it allows earlier transfer of admitted patients from the ED. Several hospitals have instituted discharge before noon, or discharge before 10AM policies, practices and targets. Our objectives were 1) to assess the current status of flow within 3 high-volume community hospitals with respect to time of day of discharges from the in-patient units and time of day of transfers from the ED to in-patient units, and 2) to assess the association between time of transfer from the ED and total ED Length of Stay (EDLOS) of admitted patients. Methods: We conducted a retrospective multi-centre observational study during the period of January 1, 2015 to December 31, 2015 at three high-volume community hospitals within Ontario, Canada. All patients admitted to the Medicine service were identified. Time of discharge from the in-patient units and time of transfer from the ED were collected for all patients. EDLOS was calculated for all patients as a function of time of transfer from the ED. Results: Preliminary findings show that, for the three community hospitals, only 11.7% - 19.6% of admitted patients were discharged from the in-patient units during the period between 6AM and 12PM, with a peak discharge time of 2PM in all three hospitals. A concurrent lag was observed in the time of transfer of patients from the ED, with peak transfer times occurring the late afternoon between 3PM and 9PM, and coinciding with a peak in patient volume in the ED. Patients transferred out of the ED earlier in the day (between 12AM 11:59AM) had between 1.4 hours to 8.0 hours lower mean EDLOS when compared to those patients transferred later in the day (between 12PM 11:59PM). Conclusion: Hospital-wide flow and operational issues have a significant impact on ED bed boarding, and potential efficiencies seem at the current time to be underutilized. Interventions aimed at optimizing flow must be implemented alongside those aimed at increasing capacity in order to improve bed boarding. ** These findings are best communicated in graphic form to better represent the dynamics of the flow in and out of the ED over a 24-hour period, and will be presented in graphic format if selected for the conference.

Introduction: Bed boarding of admitted patients in the Emergency Department (ED) is one of the major contributors to ED overcrowding, and an indicator of hospital-wide deficiencies in capacity and flow. Most indicators of ED overcrowding have measured either counts or percentages of patient subgroups (e.g. number/percentage of patients waiting in triage or number/percentage of admitted patients as compared to full ED census), or specific process time intervals related to patient movement through the hospital (e.g. Physician to Initial Assessment (PIA) time or total ED Length of Stay (EDLOS)). We sought to 1) devise an alternative measure of ED overcrowding that captured the dynamic and disproportionate resource utilization of admitted versus non-admitted patients in the ED, and to 2) determine the association of this measure with selected ED quality metrics for non-admitted patients. Methods: We conducted a retrospective multi-centre observational study at three very high-volume community hospitals in the Greater Toronto Area. Data on all patients visiting the ED during the period between January 1, 2015 and December 31, 2016 were included in the study. We calculated the total daily cumulative boarding time - or time to bed (TTB) - for each day of the study duration. The daily cumulative TTB was calculated as the time from decision to admit to transfer from the ED for all admitted patients within a 24-hour period. We conducted linear regression analysis to determine the association between our measured daily cumulative TTB and daily median and 90th percentile PIA and EDLOS times for non-admitted patients. Results: Preliminary results for 2015 indicate a total cumulative TTB time ranging from 50,973 hours to 191,093 patient-hours for the year, with daily mean cumulative TTB ranging from 140 524 patient-hours/day among the three hospitals. In all three hospitals, there was a statistically significant (p<0.01) positive association between daily cumulative TTB and both median and 90th percentile PIA times for all patients, and median EDLOS times for non-admitted CTAS 1 -3 patients. There was a statistically significant (p<0.05) positive association between daily cumulative TTB and 90th percentile EDLOS for non-admitted CTAS 1-3 patients in two of the three hospitals, with the third hospital showing a positive but non-significant association. Conclusion: Bed boarding constitutes a significant resource cost for EDs, and has a negative impact on timeliness of ED care for the general ED population, particularly more complex (CTAS 1-3) non-admitted patients.