Predicting COVID-19 Disease Severity in Adults

From ContagionLive:

Age and number of comorbidities, as well as hospital admission from nursing homes, can all be used to predict novel coronavirus (COVID-19) disease severity in adult patients, according to a paper published in the Annals of Internal Medicine.

Investigators from Johns Hopkins University School of Medicine observed 832 consecutive COVID-19 hospital admissions in order to determine the factors of hospital admission that could predict severe disease or death as a result of COVID-19. The study authors wrote that furthering the definition of factors present at hospital admissions that predict poor outcomes could eventually inform allocation plans for resources that may be scarce (such as ventilators or therapeutics) as well as guide discussions with patients and families.

Hospital Finances, Patient Volumes Took A Step Back in August

From Managed Healthcare Executive:

Hospital finances and volume took a step back in August after recovering some from the dire months of March and April, according to Kaufman Hall’s most recent hospital report.

The “National Hospital Flash Report,” which is based on a sample of 800 hospitals around the country shows, showed declines median operating margins, adjusted discharges and emergency department visits compared with August of last year. Kaufman Hall puts out a report for every month, and the reports have provided some measurements of how hospitals are faring financially during COVID pandemic.

“August was a challenging month for hospitals nationwide, as margins fell across the board. The declines follow three months of moderate gains after devastating losses in the early months of the COVID-19 pandemic,” says the report.

New data shows alarming surge in opioid-related overdoses during COVID-19

From News Medical Net:

In a paper published Friday by the Journal of the American Medical Association, Virginia Commonwealth University researchers released data showing an alarming surge in opioid-related overdoses during the COVID-19 pandemic.

Nonfatal opioid overdose visits to the VCU Medical Center emergency department in Richmond increased from 102 between March and June 2019 to 227 between March and June 2020. That’s an increase of 123%.

The overdose increase occurred during a time when the emergency room was experiencing a lower-than-average number of visits overall. March through June visits in 2020 were down 29% from the same time last year.

EDs should tailor clinical decision support to avoid antibiotic overprescribing, data suggests

From Helatcare Finance:

A unique set of factors of the emergency department makes standard Clinical Decision Support (CDS) systems not as effective in helping to reduce antibiotic overprescribing in that environment, according to findings from the University of Colorado College of Nursing at the Anschutz Medical Campus.

Antimicrobial resistance is a major public health concern, accounting for 2.8 million infections and 35,000 deaths annually. Hospitals have focused on antibiotic stewardship programs (ASP) to reduce overprescribing of antibiotics, which is a major contributor to antimicrobial resistance. 

While this has been effective in reducing unnecessary antibiotic use by as much as 36% in inpatient settings, EDs are an exception, where approximately 10 million outpatient antibiotic prescriptions are written annually in the U.S. Data shows that up to 50% of the prescriptions were inappropriate or unnecessary.

ED, Inpatient Volumes Stuck Despite Some Hospital Visit Recovery

From RevCycle Intelligence:

Fear of COVID-19 transmission and greater use of alternative care settings are stalling hospital visit recovery across key service lines, while others are starting to near pre-pandemic levels, according to experts at TransUnion Healthcare.

In a new analysis of over 500 hospitals, the company found that hospital visit volumes for more treatment settings “slowed to a standstill” for most of the summer.

In particular, emergency department (ED) visits remained down by 25 percent through mid-August compared to pre-pandemic levels. This was the same level observed eight weeks prior, the company noted.

Red-Zone Report: New Rural Infections Jump 30% in Last Week

From the Daily Yonder:

The number of new Covid-19 infections in rural America jumped by 30% last week, reversing a short-lived decline in new cases and putting a record number of rural counties on the red-zone list.

New deaths from Covid-19 also grew last week, increasing by 20% and bringing the total number of rural Americans who have died as a result of the pandemic to 18,128.

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Waste generation by hospital emergency departments is highlighted for first time

Press Release:

Emergency departments of hospitals generate significant amounts of environmentally harmful waste which could be reduced through basic changes to disposal policies and practices, while producing lower operating costs, researchers from Massachusetts General Hospital (MGH) have found. Efforts to optimize the daily waste stream through improvements such as switching from disposable to reusable items in the ED, better sorting of infectious waste, and more effective recycling of items like glass and aluminum could have meaningful impact both environmentally and financially, according to the study published in the Western Journal of Emergency Medicine.

“People working in emergency departments have no idea how much waste they routinely generate, nor that the environmental impact is totally at odds with their professional mission to improve health and save lives,” says Jonathan E. Slutzman, MD, investigator in the Department of Emergency Medicine at MGH and senior author of the study. “A greater awareness of the harm that’s being done, along with the opportunities that are available to turn that situation around, should be on the agenda of every hospital in America.”

Healthcare facilities in the U.S. generate 6,600 metric tons of waste each day, making them the second largest contributor to landfill waste (next to the food industry). They also produce 10 percent of all greenhouse gas emission as well as other pollutants known to adversely affect human health. The MGH investigation is the first to quantify and characterize the volume of waste emanating from emergency departments. To that end, researchers conducted a 24-hour waste audit in July 2019 at MGH’s Level 1 trauma center in Boston. The team collected, manually sorted into separate categories, and weighed each waste stream component. It also calculated direct pollutant emissions from ED waste disposal activities.

Among the findings was that 85 percent of all items disposed of as regulated medical waste (RMW) — the most hazardous ED materials that must be deposited in red bags and autoclaved to render them safe prior to being sent to landfills — did not meet the criteria for regulated medical waste. “We always want healthcare workers to err on the side of caution when it comes to waste disposal, but the fact is regulated medical waste costs up to ten times as much to dispose of as solid waste,” notes Sarah Hsu, with the Warren Alpert Medical School at Brown University, and lead author of the study. “But if we could divert through better sorting some fraction of medical waste that now goes into red biohazard bags to regular solid waste, it would open up significant cost-saving opportunities for hospitals.”

Another area rife with opportunity, according to the researchers, is transitioning from the use of disposable devices to more durable, reusable alternatives that would lead to waste reduction and supply savings. One example is the laryngoscope, commonly used in the ED to insert a breathing tube into the trachea, which could be reprocessed onsite and safely used multiple times rather than discarding it after a single use. Rethinking the use of plastic packaging, which was estimated by the MGH study to be responsible for over 40 percent of all emergency department solid waste, also holds the potential for significant waste reduction. MGH, for its part, asks suppliers to ship products in non-disposable bulk packaging, whenever possible, enabling reuse. Suppliers are also “debulking” items at distribution centers, enabling packaging to be reused from that point rather than being shipped all the way to the hospital.

To determine the best opportunities for waste reduction, Slutzman suggests that hospitals conduct their own audits of emergency department waste. “Gaining a full awareness of the problem and its downstream consequences on the health of the community is an important first step toward a solution,” he says. “In addition to audits, hospitals should assemble all stakeholders around the table to explore alternatives to their current waste disposal practices. Our study shows that significant improvements can be made to optimize ED waste management, and as healthcare professionals we owe it to our patients and the community to take responsible action.”

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Slutzman is also an instructor in emergency medicine at Harvard Medical School. Lead author Hsu is a medical student at Brown University. Co-authors include Cassandra Thiel, PhD, assistant professor in the Department of Population Health, NYU Medical School, and Michael Mello, MD, MPH, professor of emergency medicine at the Alpert Medical School, Brown University.

About the Massachusetts General Hospital

Massachusetts General Hospital, founded in 1811, is the original and largest teaching hospital of Harvard Medical School. The MGH Research Institute conducts the largest hospital-based research program in the nation, with an annual research budget of more than $1 billion and comprises more than 8,500 researchers working across more than 30 institutes, centers and departments. In August 2020 the MGH was named #6 in the nation by U.S. News & World Report in its list of “America’s Best Hospitals.”

Half of physicians report anger, anxiety over pandemic

From Becker’s:

The COVID-19 is placing a heavy burden on U.S. physicians, with many reporting feeling hopeless, angry or burned out, according to a survey from the Physicians Foundation.

The foundation surveyed 2,334 physicians nationwide Aug. 17-25 about how the pandemic has affected their well-being. Thirty-six percent of them practiced primary care, and 64 percent were in other specialties. 

Half of physicians said they’ve experienced inappropriate anger, tearfulness or anxiety over how the pandemic is affecting their practice or employment.

COVID-19 hospitalizations hit record numbers in Missouri. Experts worry about rural hospitals

From the Post-Dispatch:

Experts warned on Monday that a continued rise in COVID-19 hospitalizations in Missouri could lead to over-burdened hospitals, especially in rural areas.

Missouri’s hospitalization numbers have been trending upward for weeks. And contrary to the early months of the pandemic, case numbers have recently risen the most in rural areas.

“Not only are the numbers rising, but the numbers are rising in places that don’t have as robust a resource built into their communities,” said Missouri Hospital Association spokesman Dave Dillon.

Nearly 70% of N95 masks from China fail U.S. filtration standards

From Modern Healthcare (paywall):

ECRI is now advising its provider members not to use N95 respirator masks from China when treating suspected or confirmed COVID-19 patients.

Link to ECRI