4 research outputs found
Analysis of creep of wood during water adsorption based on the excitation response theory
Modelling resource requirements and physician staffing to provide virtual urgent medical care for residents of long-term care homes: a cross-sectional study
Background: The coronavirus disease 2019 (COVID-19) outbreak increases the importance of strategies to enhance urgent medical
care delivery in long-term care (LTC) facilities that could potentially reduce transfers to emergency departments. The study objective
was to model resource requirements to deliver virtual urgent medical care in LTC facilities.
Methods: We used data from all general medicine inpatient admissions at 7 hospitals in the Greater Toronto Area, Ontario, Canada,
over a 7.5-year period (Apr. 1, 2010, to Oct. 31, 2017) to estimate historical patterns of hospital resource use by LTC residents. We
estimated an upper bound of potentially avoidable transfers by combining data on short admissions (≤ 72 h) with historical data on the
proportion of transfers from LTC facilities for which patients were discharged from the emergency department without admission.
Regression models were used to extrapolate future resource requirements, and queuing models were used to estimate physician staffing requirements to perform virtual assessments.
Results: There were 235 375 admissions to general medicine wards, and residents of LTC facilities (age 16 yr or older) accounted
for 9.3% (n = 21 948) of these admissions. Among the admissions of residents of LTC facilities, short admissions constituted 24.1%
(n = 5297), and for 99.8% (n = 5284) of these admissions, the patient received laboratory testing, for 86.9% (n = 4604) the patient
received plain radiography, for 41.5% (n = 2197) the patient received computed tomography and for 81.2% (n = 4300) the patient
received intravenous medications. If all patients who have short admissions and are transferred from the emergency department
were diverted to outpatient care, the average weekly demand for outpatient imaging per hospital would be 2.6 ultrasounds, 11.9 computed tomographic scans and 23.9 radiographs per week. The average daily volume of urgent medical virtual assessments would
range from 2.0 to 5.8 per hospital. A single centralized virtual assessment centre staffed by 2 or 3 physicians would provide services
similar in efficiency (measured by waiting time for physician assessment) to 7 separate centres staffed by 1 physician each.
Interpretation: The provision of acute medical care to LTC residents at their facility would probably require rapid access to outpatient
diagnostic imaging, within-facility access to laboratory services and intravenous medication and virtual consultations with physicians.
The results of this study can inform efforts to deliver urgent medical care in LTC facilities in light of a potential surge in COVID-19 casesFahad Razak is supported by an award from the Mak Pak Chiu and Mak-Soo Lai Hing Chair in General Internal Medicine, University of Toronto