Lau K H Vincent, Anand Pria, Greer David M, Cervantes-Arslanian Anna, Phicil Sheila, Moore Jesse, Takahashi Courtney
Department of Neurology, Boston Medical Center, Boston, MA, USA.
Neurohospitalist. 2021 Apr;11(2):125-130. doi: 10.1177/1941874420960323. Epub 2020 Sep 22.
The COVID-19 pandemic has led to shifts in healthcare utilization for patients both with and without COVID-19. We aimed to determine how trends in neurology service admissions during the pandemic may aid in departmental planning by predicting future clinician staffing and other needs. We examined all admissions to the general neurology, stroke, and neurocritical care services from January 31 to May 16, 2020 at our tertiary-care hospital using an electronic health record query, comparing these to analogous data in 2019. We trended admission rates and projected future censuses using logarithmic regression, tracked changes in length of stay (LOS), and quantified shifts in presentations of specific diagnoses. Daily rates of admissions declined sharply during the week of March 13, 2020 (the week after pandemic status was declared by the World Health Organization). On the censoring date, we projected a return to pre-pandemic censuses in the week of June 21 and used this information to make decisions regarding neurology resident schedules. There was a trend toward increased LOS for general neurology and stroke patients between March 27 and April 9, 2020 compared to in 2019, with subsequent decline coinciding with early hospital initiatives. Since March 13, 2020, there has been a trend toward reduced presentations of ischemic stroke, suggesting a need for community education on stroke awareness. Characterizing early trends in neurology admissions may allow physician administrators to plan local and community-level responses to the pandemic.
新冠疫情导致了新冠患者和非新冠患者在医疗服务利用方面的转变。我们旨在确定疫情期间神经科服务入院趋势如何通过预测未来临床医生人员配备及其他需求来辅助科室规划。我们使用电子健康记录查询，检查了2020年1月31日至5月16日期间我们三级医疗医院普通神经科、中风科和神经重症监护服务的所有入院情况，并将其与2019年的类似数据进行比较。我们使用对数回归分析了入院率趋势并预测了未来的普查人数，跟踪住院时间（LOS）的变化，并量化了特定诊断表现形式的变化。2020年3月13日当周（世界卫生组织宣布疫情状态后的一周），每日入院率急剧下降。在审查日期，我们预计6月21日当周将恢复到大流行前的普查人数，并利用这些信息来制定神经科住院医师排班的决策。与2019年相比，2020年3月27日至4月9日期间普通神经科和中风科患者的住院时间有增加的趋势，随后的下降与医院早期举措相吻合。自2020年3月13日以来，缺血性中风的就诊人数有减少的趋势，这表明需要开展关于中风意识的社区教育。了解神经科入院的早期趋势可能使医生管理人员能够规划针对疫情的地方和社区层面的应对措施。
