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Factors associated with difficulty in hospital acceptance during the COVID-19 pandemic period in Osaka Prefecture,
Yusuke Katayama1,2, Kenta Tanaka3, Shunichiro Nakao2
1The Working Group to Analyze the Emergency Medical Care System in Osaka Prefecture, Osaka, Japan.
Insights
Difficulty in hospital acceptance (DIH) during COVID-19 surges was linked to low SpO2, high fever, and peak epidemic waves. Understanding these factors is crucial for improving emergency medical system responses.
Area of Science:
- Emergency Medicine
- Public Health
- Infectious Disease Epidemiology
Background:
- Emergency medical systems (EMS) faced challenges in COVID-19 patient treatment and hospital placement.
- Difficulty in hospital acceptance (DIH) emerged as a critical performance indicator for EMS in Japan.
- The Osaka emergency information Research Intelligent Operation Network system (ORION) dataset was utilized to investigate DIH factors.
Purpose of the Study:
- To identify and analyze factors associated with difficulty in hospital acceptance (DIH) during the COVID-19 pandemic.
- To provide insights for optimizing emergency patient management during infectious disease outbreaks.
Main Methods:
- A retrospective descriptive study analyzed data from January 1, 2019, to December 31, 2021.
- Multivariable logistic regression was employed to determine factors associated with DIH.
- Adjusted odds ratios (AOR) and 95% confidence intervals (CI) were calculated.
Main Results:
- Out of 1,078,850 patients, 3.8% experienced DIH.
- Low SpO2 (≤80%) and high body temperature (38.0-38.9°C) were significantly associated with DIH.
- The 3rd and 4th COVID-19 waves showed the highest odds of DIH.
Conclusions:
- Key factors influencing DIH during the COVID-19 pandemic include SpO2 levels, body temperature, and the epidemic wave.
- Proactive planning and adaptive strategies are essential for efficient emergency patient acceptance during pandemics.
Background:
In many countries, emergency medical systems were responsible for initial treatment of patients with COVID-19. Generally, acceptance by medical institutions may not be sufficient, and it may take much time to determine the medical institution to which to transport the patient. This problem is termed "difficulty in hospital acceptance (DIH)," and it is used as a key performance indicator in the assessment of the EMS in Japan. The purpose of this study was to reveal the factors associated with the DIH during the COVID-19 pandemic using dataset in the ORION (Osaka emergency information Research Intelligent Operation Network system).
Methods:
This was a retrospective descriptive study with a 3-year study period from January 1, 2019 to December 31, 2021. We included patients who were recorded in the ORION system during the study period. The primary endpoint was defined as DIH. Multivariable logistic regression model was used to assess factors associated with DIH during the COVID-19 pandemic and calculated their adjusted odds ratio (AOR) and associated 95% confidence interval (CI).
Results:
1,078,850 patients included in this study. Of them, 41,140 patients (3.8%) experienced DIH and 1,037,710 patients (96.2%) did not experience DIH. The median age was 71 years (IQR: 45-82), and 543,760 patients (50.4%) were male. In this study, SpO2, body temperature, and epidemic period of COVID-19 were associated with difficulty in hospital acceptance. The highest AOR of SpO2 was 80% or less (AOR: 1.636, [95% CI: 1.532-1.748]), followed by 81-85% (AOR: 1.584, [95% CI: 1.459-1.721]). The highest AOR of body temperature was 38.0-38.9°C (AOR: 1.969 [95% CI: 1.897-2.043]), followed by 39°C or higher (AOR: 1.912 [95% CI: 1.829-1.998]). The highest AOR of epidemic period of COVID-19 was the 4th wave (AOR: 2.134, [95% CI: 2.065-2.205]), followed by the 3rd wave (AOR: 1.842, [95% CI: 1.785-1.901]).
Conclusion:
In this study, we revealed factors associated with the DIH during the COVID-19 pandemic. As various factors are involved in the spread of an unknown infectious disease, it is necessary not only to plan in advance but also to take appropriate measures according to the situation in order to smoothly accept emergency patients.
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