The Scope and Impact of the COVID-19 Pandemic on Neuroemergent Patient Transfers, Clinical Care and Patient Outcomes

Woodward, Josha; Meza, Samuel; Richards, Dominick; Koro, Lacin; Keegan, Christopher; Joshi, Krishna C.; Munoz, Lorenzo F.; Byrne, Richard W.; John, Sayona

doi:10.3389/fsurg.2022.914798

Front. Surg.

2022

DOI: 10.3389/fsurg.2022.914798

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The Scope and Impact of the COVID-19 Pandemic on Neuroemergent Patient Transfers, Clinical Care and Patient Outcomes

Josha Woodward

Samuel Meza²,

Dominick Richards³

et al.

Abstract: IntroductionThe SARS-CoV-2 (COVID-19) pandemic continues to substantially alter previously established clinical practice patterns and has transformed patient care in American healthcare. However, studies to evaluate the impact of COVID-19 on neuroemergent patient care and associated clinical outcomes are limited. Herein, we describe the impact of COVID-19 on the Neuroemergency Transfer Program (NTP) - a novel, urban, high volume interhospital patient transfer program.ObjectiveTo evaluate and describe the clini… Show more

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2024

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Cited by 3 publications

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Interhospital transfer among US veterans admitted to community and veterans affairs hospitals for acute myocardial infarction and ischemic stroke before and during the COVID‐19 pandemic

Vaughan‐Sarrazin,

Miell,

Beck

et al. 2024

Journal of Hospital Medicine

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BackgroundVeterans Health Administration (VHA) enrollees may use community hospitals for inpatient care and sometimes require transfer to larger community or VHA hospitals. Little is known about interhospital transfer patterns among veterans using community and VHA hospitals or how coronavirus disease 2019 (COVID‐19) case surges affected transfer.MethodsRetrospective cohort study among veterans age 65+ admitted to community and VHA hospitals for acute myocardial infarction (AMI) or acute ischemic stroke (AIS) during 2018–2021. We examined associations between COVID‐19 case density in regional hospital referral networks and the likelihood of transfer.ResultsA total of 8373 (23.6%) veterans with AMI and 4630 (13.1%) with AIS were transferred in the prepandemic period. Transfer was especially common for rural veterans (36% with AMI, 20% with AIS). Most transfers (88%) were between community hospitals and 6% from community to VHA. Among AMI patients, transfer was less likely among patients age >90 (relative to age 65–69), those with non‐White race/ethnicity, and females. Transfer was more common among patients initially seen in rural hospitals (AMI, odds ratio [OR] = 2.73, 95% confidence interval [CI], 2.90–3.74; AIS, OR = 2.43; 95% CI, 2.24–2.65). During 2020–2021, transfer among AMI patients was less likely during COVID‐19 case density surges affecting the admitting hospital's referral network (OR = 0.86; 95% CI, 0.78–0.96 for highest compared with lowest quartile of COVID‐19 cases).ConclusionInterhospital transfer was common for veterans with AMI and AIS, especially among rural veterans. Few transfers were to VHA hospitals. COVID‐19 case surges were associated with decreased transfer for veterans with AMI, potentially limiting access to needed care.

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Interhospital transfer among US veterans admitted to community and veterans affairs hospitals for acute myocardial infarction and ischemic stroke before and during the COVID‐19 pandemic

Vaughan‐Sarrazin,

Miell,

Beck

et al. 2024

Journal of Hospital Medicine

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The Impact of the Pandemic of COVID-19 on the Head Injury Fast-Track System and Surgical Outcome

Norasethada,

Limpastan,

Vaniyapong

et al. 2024

Asian J Neurosurg

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Objective This study aims to evaluate the impact of the coronavirus disease 2019 (COVID-19) pandemic on the head injury fast-track system and surgical treatment outcomes. Materials and Methods A retrospective review was conducted on patients who underwent emergency neurological procedures according to the head injury fast-track system. Data from April 2018 to April 2020 (pre-COVID) were compared with data from May 2020 to May 2022 (during COVID). Results The analysis comprised 128 patients in the prepandemic group and 119 patients in the pandemic group, with 5 patients diagnosed with COVID infection during the pandemic. Acute subdural hematoma resulting from motorcycle accidents was the most common diagnosis in both groups (56.3 and 47.5%, respectively). The initial Glasgow coma scale (GCS) score was significantly lower during the pandemic compared to the prepandemic period (p = 0.025). Time metrics in the emergency department, including door to computed tomography (CT), emergency room (ER) exit, and incision times, were significantly longer in the pandemic group (p < 0.05). However, there were no statistically significant differences in in-hospital mortality rates (25.8 and 17.7%, respectively; p = 0.12) or the percentage of patients with a favorable functional outcome (Glasgow outcome scale ≥4). At 1 month, a favorable functional outcome was observed in 51.6% of prepandemic patients and 57.1% of pandemic patients (p = 0.69), while at 6 months, the percentages were 56.8 and 64.5%, respectively (p = 0.23). Conclusions Our study revealed significant delays in hospital processes for head injuries during the COVID-19 pandemic. However, we found no significant impact on mortality rates or functional outcomes of patients.

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Rise of long‐distance urology transfer during the COVID‐19 pandemic: Identifying factors to enhance transfers of care efficiency and clinical outcomes

Lin,

Vaserman,

Spencer

et al. 2024

Int J of Urology

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ObjectiveThe objective of this study is to identify variables associated with clinical outcomes after urologic transfers before and during the COVID pandemic.MethodsAfter IRB approval, a retrospective chart review was performed on adult patients transferred to our institution from 01/01/2018 to 12/31/2019 (“pre‐COVID”) and from 01/02/2020 to 12/31/2022 (“COVID”). We identified demographics, origin hospitals, ICD‐10 pre‐ and post‐transfer diagnoses, distance of transfer, and post‐transfer CPT codes.ResultsDuring the study period, our adult urology service accepted 160 transfers with a mean patient age of 71 years. A total of 49/160 (30%) of subjects made up the “pre‐COVID” cohort and 111/160 (70%) made up the “COVID” cohort. There were 11/111 (10%) transfers of >100 miles in the COVID period but 0/49 in the pre‐COVID period (p = 0.02). Patients from the COVID period waited on average 1.2 days longer for a procedure after transfer compared to pre‐COVID period (p = 0.03). The time until a patient's surgical procedure after transfer was a significant predictor of length of stay > 5 days (OR 1.91, CI 1.43 – 2.58, p < 0.01). Different diagnosis upon re‐evaluation after transfer was associated with a decreased rate of subsequent readmission (OR 0.30, CI 0.09–0.97, p = 0.05).ConclusionsLong‐distance transfer, even >100 miles (which we termed “mega‐transfers”), was a new pandemic‐related phenomenon at our institution. Delays in definitive care and changes in diagnoses after transfer were associated with readmission and length of stay. Our findings illustrate the importance of inter‐institutional communication, diagnostic accuracy, and post discharge planning when managing transfer patients.

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The Scope and Impact of the COVID-19 Pandemic on Neuroemergent Patient Transfers, Clinical Care and Patient Outcomes

Cited by 3 publications

References 31 publications

Interhospital transfer among US veterans admitted to community and veterans affairs hospitals for acute myocardial infarction and ischemic stroke before and during the COVID‐19 pandemic

Interhospital transfer among US veterans admitted to community and veterans affairs hospitals for acute myocardial infarction and ischemic stroke before and during the COVID‐19 pandemic

The Impact of the Pandemic of COVID-19 on the Head Injury Fast-Track System and Surgical Outcome

Rise of long‐distance urology transfer during the COVID‐19 pandemic: Identifying factors to enhance transfers of care efficiency and clinical outcomes

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