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The impact of SARS on hospital performance

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Abstract and Figures

During the SARS epidemic, healthcare utilization and medical services decreased significantly. However, the long-term impact of SARS on hospital performance needs to be further discussed. A municipal hospital in Taipei City was shut down for a month due to SARS and then became the designated SARS and infectious disease hospital for the city. This study collected the outpatient, inpatient and emergency service volumes for every year from April to March over four years. Average monthly service amount +/- standard deviation were used to compare patient volume for the whole hospital, as well as the outpatient numbers accessing different departments. The ARIMA model of outpatient volume in the pre-SARS year was developed. The average monthly service volume of outpatient visits for the base year 2002 was 52317 +/- 4204 visits per month, and number for 2003 and the following two years were 55%, 82% and 84% of the base year respectively. The average emergency service volume was 4382 +/- 356 visits per month at the base year and this became 45%, 77% and 87% of the base year for the following three years respectively. Average inpatient service volume was 8520 +/- 909 inpatient days per month at the base year becoming 43%, 81% and 87% of the base year for the following three years respectively. Only the emergency service volume had recovered to the level of a non-significant difference at the second year after SARS. In addition, the departments of family medicine, metabolism and nephrology reached the 2002 patient number in 2003. The ARIMA (2,1,0) model was the most suitable for outpatient volume in pre-SARS year. The MAPE of the ARIMA (2,1,0) model for the pre-SARS year was 6.9%, and 43.2%, 10.6%, 6.2% for following 3 years. This study demonstrates that if a hospital is completely shut down due to SARS or a similar disease, the impact is longer than previous reported and different departments may experience different recover periods. The findings of this study identify subspecialties that are particularly vulnerable in an infectious disease designated hospital and such hospitals need to consider which subspecialties should be included in their medical structure.
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BMC Health Services Research
Open Access
Research article
The impact of SARS on hospital performance
Dachen Chu
†1,3
, Ran-Chou Chen*
†2,3
, Chia-Yu Ku
3
and Pesus Chou
†1
Address:
1
Community Medicine Research Center and Institute of Public Health, National Yang-Ming University, Taipei, Taiwan,
2
Department of
Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan and
3
Taipei City Hospital, 33 Sec. 2 Chun Hwa
Road, Taipei, Taiwan
Email: Dachen Chu - dad57@tpech.gov.tw; Ran-Chou Chen* - chenranchou@yahoo.com.tw; Chia-Yu Ku - A2414@tpech.gov.tw;
Pesus Chou - pschou@ym.edu.tw
* Corresponding author †Equal contributors
Abstract
Background: During the SARS epidemic, healthcare utilization and medical services decreased
significantly. However, the long-term impact of SARS on hospital performance needs to be further
discussed.
Methods: A municipal hospital in Taipei City was shut down for a month due to SARS and then
became the designated SARS and infectious disease hospital for the city. This study collected the
outpatient, inpatient and emergency service volumes for every year from April to March over four
years. Average monthly service amount ± standard deviation were used to compare patient volume
for the whole hospital, as well as the outpatient numbers accessing different departments. The
ARIMA model of outpatient volume in the pre-SARS year was developed.
Results: The average monthly service volume of outpatient visits for the base year 2002 was 52317
± 4204 visits per month, and number for 2003 and the following two years were 55%, 82% and 84%
of the base year respectively. The average emergency service volume was 4382 ± 356 visits per
month at the base year and this became 45%, 77% and 87% of the base year for the following three
years respectively. Average inpatient service volume was 8520 ± 909 inpatient days per month at
the base year becoming 43%, 81% and 87% of the base year for the following three years
respectively. Only the emergency service volume had recovered to the level of a non-significant
difference at the second year after SARS. In addition, the departments of family medicine,
metabolism and nephrology reached the 2002 patient number in 2003. The ARIMA (2,1,0) model
was the most suitable for outpatient volume in pre-SARS year. The MAPE of the ARIMA (2,1,0)
model for the pre-SARS year was 6.9%, and 43.2%, 10.6%, 6.2% for following 3 years.
Conclusion: This study demonstrates that if a hospital is completely shut down due to SARS or a
similar disease, the impact is longer than previous reported and different departments may
experience different recover periods. The findings of this study identify subspecialties that are
particularly vulnerable in an infectious disease designated hospital and such hospitals need to
consider which subspecialties should be included in their medical structure.
Published: 6 November 2008
BMC Health Services Research 2008, 8:228 doi:10.1186/1472-6963-8-228
Received: 3 June 2008
Accepted: 6 November 2008
This article is available from: http://www.biomedcentral.com/1472-6963/8/228
© 2008 Chu et al; licensee BioMed Central Ltd.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0
),
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Background
Severe Acute Respiratory Syndrome (SARS) is a viral respi-
ratory disease caused by a coronavirus (SARS-CoV). SARS
has caused a significant impact on psychosocial and legis-
lative regulation [1-4]. SARS brought about not only rela-
tively discernable economic losses [5], but also observable
damage to healthcare organizations, and this has resulted
in a lower healthcare utilization rate [6,7].
During the SARS epidemic, there were many reports that
looked into healthcare utilization and decreases in medi-
cal service volume [8]. However, most of them explored
only one department of the hospital or over a very short
period of time. No reports have studied the influence on
whole hospital performance and followed the long-term
impact on the recovery. A municipal hospital in Taipei
was shut down for a month due to SARS [3], and after-
wards became the designated SARS and infectious disease
hospital for the city in addition to its general regional hos-
pital's character. This study collects the service volumes of
all departments in this hospital from one year before and
for three years after the SARS outbreak. No similar study
has been published previously.
Methods
The municipal hospital in Taipei City studied here is a
general and teaching hospital with 450 beds. The depart-
ments in this hospital include internal medicine, surgery,
OBS/GYN, pediatrics, radiology and pathology. The hos-
pital underwent a SARS outbreak during April 2003. Fifty-
nine hospital workers were infected and this led to seven
deaths [1,3]. To halt the outbreak of SARS infection, the
hospital was shut down to allow evacuation of hospital-
ized patients and workers gradually over 10 days. Twenty-
five days after that, the hospital was fully vacated and ster-
ilization carried out. Outpatient services were first reo-
pened after 35 days of quarantine. Inpatient and
emergency services were reopened after 65 days. Subse-
quently, in addition to its general regional hospital func-
tion, the hospital became the infectious disease
designated hospital for the Taipei area, and receives infec-
tious disease patients, undergoes preparedness exercises
and admits tuberculosis patients.
In order to compare the recovery situation after SARS, this
study follows the numbers of outpatients, emergency
patients and inpatients from 2002 to 2006. The patient
numbers for emergency and outpatient services, and
number of patient days for inpatient service were used as
quantitative evaluations and are expressed as the average
monthly services amount ± standard deviation. The hos-
pital was shut down during April 2003, and therefore the
study collected the services volume from every April to
next March. Year 2002 was selected as the base year of this
study. The service volume of 2003, which is when SARS
was occurred, and of the two years after that, were com-
pared to the 2002 data. The study was approved by the
ethics committee of the Taipei City Hospital Hoping
branch.
Statistically analysis by repeat measurement ANOVA
(SPSS for Windows 15.0) was utilized in this study to
compare the variation over 4 years. If the service volume
for a specific area and year was less than the base year, and
showed a significant difference (p < 0.05), then this year
was considered to be still recovering. Based on this recov-
ery situation, all the departments can be divided into four
groups; these are departments that recovered in the year
SARS happened, departments that recovered in the first
year after SARS, departments that recovered in the second
year after SARS, and finally departments still not yet recov-
ered. The autoregressive integrated moving average
(ARIMA) model of outpatient volume in the pre-SARS
year was developed. Various permutations of the order of
correlation and order of integration (I) were computed to
choose the optimal combination of parameters based on
the mean square error. Partial correlogram graphs and
correlograms were used to select the order of moving aver-
age (MA) and autoregressive (AR) terms in the model.
Based on the best model selected, the mean absolute per-
centage error (MAPE) was used to measure the quality of
fit of the service volume of outpatients during the SARS,
and two years after SARS period [9].
During the four years of this study, the economic aspects
that affected the hospital's performances remained the
same, include beds and medical specialties. Furthermore,
the number of similar hospitals in local area did not
change. The organization of the healthcare system and its
reimbursement still come from the Taiwan National
Health Insurance (NHI) system [10]. In addition, there
were also no significant policy changes with respect to
NHI payment policy in these four years. Moreover, the
neighborhood population of this hospital underwent no
obvious change (the neighborhood population was
173,637 in 2002 and had become 171,092 in 2006) [11].
However, in addition to the general regional hospital, the
hospital was also now designated as an infectious disease
hospital.
Results
The average monthly number of outpatient visits at base
year was 52317 ± 4204. The numbers for the year SARS
that happened and the following two years were 55%
(28950 ± 11731), 82% (42906 ± 4047) and 84% (43715
± 2758) of the base year respectively (Table 1). Average
emergency numbers was 4382 ± 356 visits per month at
base year. This number decreased to 45% (1975 ± 1242)
of the base year for the year SARS happened, and came
back to 77% (3395 ± 345) during the first year after SARS,
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and 87% (3824 ± 346) of the base year during the second
year after SARS. The average inpatient service volume was
8520 ± 909 inpatient days per month at base year. The
number decreased to 43% (3678 ± 2350) of base year for
the year SARS happened, and came back to 81% (6863 ±
486) and 87% (7371 ± 471) of the base year for the fol-
lowing two years. Only the emergency service volumes
recovered to the level of non-significant difference at the
second year after SARS. Services volumes for outpatients
and inpatients were still significant different (p < 0.05).
Using the pre-SARS year as the training dataset in the
ARIMA model, the ARIMA IAR (2,1,0) model was the
most suitable. Similar result about the delayed recovery of
outpatient services is noted (figure 1). The MAPE of the
ARIMA (2,1,0) model for the pre-SARS year was 6.94%.
The MAPE for the year of SARS was 43.24%, improving to
10.58% for the 1
st
post-SARS year, and to 6.20% for the
2
nd
post-SARS year.
On examining the various outpatient departments, family
medicine, metabolism and nephrology recovered during
the year that SARS happened. Family medicine was even
higher than the base year during the first and second years
after SARS. Nephrology was also higher than the base year
during the second year after SARS. The departments that
recovered during the first year after SARS included neurol-
ogy, cardiology, infectious diseases, neurosurgery, urol-
ogy, plastic surgery, dentistry and psychiatry. Among
these, psychiatry was even higher than the base year. Pedi-
atrics recovered during the second year after SARS. The
departments that still have not recovered include general
surgery, ophthalmology, orthopedics, ENT, internal med-
icine, pulmonary medicine, gastroenterology, OBS/GYN,
dermatology, rehabilitation and Chinese medicine (Table
2). The numbers of physicians were 165 for the base year,
162 for the SARS year, 170 for the first year after SARS, and
173 for the second year after SARS. The numbers of physi-
cians in each department were also similar for these years
with differences ranging from 0 to 2 physicians.
Discussion
The SARS crisis at this municipal hospital during April
2003 resulted in a reduction in outpatient, emergency and
inpatient services to 45%, 55% and 57% respectively,
The ARIMA (2,1,0) model was the most suitable by using the pre-SARS year as the training datasetFigure 1
The ARIMA (2,1,0) model was the most suitable by using the pre-SARS year as the training dataset. Delayed
recovery of out-patient services is noted. The MAPE of the ARIMA (2,1,0) model for the pre-SARS year was 6.9% , 43.2% for
the year during SARS attack, 10.6% of the 1
st
post-SARS year, and improving to 6.2% of the 2
nd
post-SARS year.
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compared to the previous year. The delayed recovery of
outpatient service was also noted during and in the first
year after SARS by the ARIMA model. After the SARS epi-
demic, the hospital became the infectious disease desig-
nated hospital for the Taipei area in additional to
retaining its character as a general regional hospital. Many
factors caused the changes in hospital performance, such
as patient transfer to other hospitals, reduction of health-
care manpower due to death, sequelae to staff infection
and staff turnover. In addition, the publicity related to the
change in the hospital status to an infectious disease unit
influenced performance. In the few years since SARS, hos-
pital performance has improved continuously. However,
only emergency services had recovered by the second year
after SARS. Outpatient and inpatient services had still not
recovered by 2006.
If we consider outpatient services, in the neighboring
countries, certain reports have indicated a 20% to 59%
decrease during the SARS epidemic only [12-14]. Vlantis
reported that the weekly outpatient clinic attendance
showed a decline of 59% and the daily admission rate by
84% for the division of otorhinolaryngology head and
neck surgery at an academic tertiary referral hospital in
Hong Kong [14]. None of the reported hospitals were shut
down during the event. The outpatient service volume in
Table 1: Average monthly service volumes of the outpatient, inpatient and emergency services before, during and after the SARS
epidemic
Year Pre-SARS mean ± SD During SARS mean ±
SD
% Post SARS (1
st
yr)
mean ± SD
% Post SARS (2
nd
yr)
mean ± SD
%
Outpatients
$
52317 ± 4204 28950 ± 11731* 55 42906 ± 4047* 82 43715 ± 2758* 84
Emergency services
$
4382 ± 356 1975 ± 1242* 45 3395 ± 345* 77 3824 ± 346 87
Inpatients
$
8520 ± 909 3678 ± 2350* 43 6863 ± 486* 81 7371 ± 471* 87
* p < 0.05, significantly less than the Pre-SARS year (2002)
$
Outpatient and emergency service volumes: number of visits, inpatient service volumes: number of inpatient days.
Table 2: The average monthly numbers for outpatients using different departments. (mean ± SD)
Recovery yr. Department Pre-SARS During SARS Post SARS (1
st
yr) Post SARS (2
nd
yr)
1
st
-year recovery
Nephrology 1522 ± 375 1486 ± 829 1589 ± 703 2855 ± 134 †
Family medicine 2103 ± 873 1510 ± 797 3674 ± 975 † 3739 ± 945 †
Metabolism 2151 ± 623 1674 ± 670 2131 ± 266 1894 ± 273
2
nd
-year recovery
Psychiatry 1093 ± 298 815 ± 325 * 1341 ± 142 † 1239 ± 131
Neurosurgery 545 ± 207 355 ± 159 * 626 ± 49 611 ± 59
Urology 1701 ± 443 1028 ± 446 * 1699 ± 142 1807 ± 132
Neurology 1900 ± 117 1239 ± 467 * 1877 ± 160 1876 ± 143
Plastic surgery 329 ± 73 128 ± 87 * 337 ± 51 316 ± 40
Cardiology 3723 ± 748 2790 ± 1091* 3699 ± 286 3498 ± 270
Dentist 852 ± 516 462 ± 198 * 638 ± 83 790 ± 161
Infectious diseases 1144 ± 991 303 ± 286 * 677 ± 94 633 ± 112
3
rd
-year recovery
Pediatrics 1867 ± 215 764 ± 387* 1144 ± 190 * 1518 ± 728
No recovery by the 4
th
year
Ophthalmology 4207 ± 443 2627 ± 1032 * 3169 ± 358 * 3578 ± 339 *
Orthopedics 2808 ± 251 1537 ± 593 * 2274 ± 200 * 2366 ± 142 *
General surgery 1812 ± 217 982 ± 435 * 1506 ± 192 * 1461 ± 101*
ENT 3592 ± 410 1750 ± 752 * 2194 ± 213 * 2104 ± 117 *
Gastroenterology 3071 ± 818 1801 ± 629 * 1911 ± 381 * 1799 ± 243 *
Dermatology 2244 ± 398 1070 ± 373 * 1720 ± 264 * 1735 ± 132 *
Chinese medicine 3510 ± 386 1466 ± 805 * 3126 ± 778 2647 ± 281 *
Rehabilitation 1619 ± 132 702 ± 360* 964 ± 139* 919 ± 83*
Internal medicine 6414 ± 1159 2380 ± 1073 * 3513 ± 398 * 3542 ± 189 *
Pulmary medicine 602 ± 175 370 ± 171 * 301 ± 213* 327 ± 75 *
Obs/Gyn 3177 ± 429 1562 ± 670 * 2392 ± 314 * 2259 ± 691*
* p < 0.05: significant less than the pre-SARS year (2002).
p < 0.05: significant higher than the pre-SARS year (2002)
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this study shows a longer recovery period and the reason
maybe relate to the 35 days of shut down.
There were also huge recovery differences between the dif-
ferent departments even though the physicians' numbers
are similar over these four years. Family medicine, metab-
olism and nephrology departments have recovered
quickly. Moreover, patient visits to family medicine and
nephrology were even higher than before SARS. This indi-
cates that chronic patients who need long-term treatment
tend to go back to their former local hospital to receive
their treatments. The patient visits to psychiatry decreased
during the year SARS happened, and were obviously
increased the year after SARS. This suggests that people
may have needed to rely on psychiatry treatment after the
SARS epidemic. Outpatient visits to surgery recovered
slower. Only urology, plastic surgery and neurosurgery
recovered in the year after SARS, and all others have not
recovered as yet. Thus, the general public may not wish to
receive surgery from an infectious disease designated hos-
pital that once underwent an emergency shut down. As a
result, the recovery of inpatient services is definitely
affected. Inpatient services usually come from outpatient
and emergency transfers. Therefore, recovery of the inpa-
tient service volume is much slower than outpatient and
emergency services.
We observe recovery differences across different depart-
ments. However, the limitation of this study is that we are
unable to explain the failure of certain departments to
return to normal service levels in terms of the quantitative
and statistical measurements of some variables that may
affecting the performance of the hospital. A population
based survey of patient's willingness and physicians' atti-
tude such as the KAP (knowledge, attitude, practice)
might help in this.
Emergency department (ED) visits during SARS were
decreased worldwide when the available literature is con-
sidered [6,8,13,15]. The duration of the impact on each
hospital as described in these papers is not the same, with
one decreased for three months [16], another had recov-
ered by the end of year 2003 after SARS [17], and another
had recovered during the second year after SARS [18]. In
this study, ED visits only recovered during the second year
after SARS. There was no change in the ED numbers in the
local area. Some papers have suggested that the decrease
in ED visits can have different impacts on different subdi-
visions. For example, non-critical ED patient visits may
decrease more than the critical patient visits [17,19]. One
possible reason for the delay in ED service recovery at this
hospital is that non-critical patient chose to go to other
hospitals, and this needs further research. Alternatively, a
patient response to the emergency whole hospital shut
down may have occurred or there may be a mixture of
both factors.
The impacts caused by SARS were very serious, especially
on global economics and health care. In order to control
the epidemic, the Department of Health, Executive Yuan,
Taiwan, designated some public hospitals to admit major
infectious disease patients. This measure had a positive
effect on controlling the epidemic [3], and reminds peo-
ple of the importance that public hospitals have in public
health, preventive medicine, and the prevention of infec-
tious diseases. Even three years after SARS, the nation still
maintains the ideology of a designated hospital, and has
expanded the prevention network national wide. Under
the threat of new epidemics, an infectious disease desig-
nated hospital has to face the issue of losses in its operat-
ing performance. The medical standards and ideology of
the designated hospital are always affected.
At present, medical expenditure is increasing dramatically
everywhere in the world. It is very important for an infec-
tious disease designated hospital to maintain its self-suffi-
cient operation when the public health budget is under
threat. Self-sufficient operation can reduce the need for a
government subsidy and allow the maintenance of an
adequate number of physicians as well as the quality of
medical services at such a general hospital. Although the
outpatient and inpatient services did not completely
recovered from SARS during first year, the hospital had
reached 84% to 86% of the baseline service volume dur-
ing the second year after SARS. Therefore, the hospital
should be capable of self-sufficiency as a designated hos-
pital. In particular, the family medicine, metabolism and
nephrology departments were hardly influenced by the
shut down. In addition, some other departments had
recovered by the second year. Therefore, these depart-
ments were able to maintain a sufficient number of physi-
cians in the absence of an infection emergency. If another
outbreak of major infectious disease occurs, the physi-
cians in the above mentioned departments would be able
to participate directly in prevention tasks. An adequate
number of physicians are essential for the success of an
infectious disease designated hospital. Thus, the findings
of this study should provide a direction for other infec-
tious disease designated hospitals to consider when decid-
ing what subspecialties should be included in their
makeup. If an infectious disease designated hospital
includes a certain subspecialty and the physicians can
operate self-sufficiently during ordinary times, the govern-
ment only has to subside such a hospital during the year
of the epidemic and the year after that. The hospital can
become self-sufficient again quickly once everyday opera-
tions return.
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Conclusion
In conclusion, this study demonstrates that if the whole
hospital is shut down during an infectious disease out-
break, the impact is much longer than other studies have
shown. The outpatient and inpatient services in this exam-
ple had not completely recovered by the second year after
SARS. Emergency services were the fastest recovering
department, but even this unit did not recover until the
second year after SARS. Among outpatient services, family
medicine, metabolism and nephrology recovered better
than the others. Surgery needs a longer recovery period.
This study provides the decision maker with information
regards choices when managing an infectious disease des-
ignated hospital and is a reference resource for future pub-
lic policy crisis management decisions during acute
infectious disease outbreaks.
Competing interests
The authors declare that they have no competing interests.
Authors' contributions
DC conceived of the study, performed the statistical anal-
ysis, and wrote the manuscript. RCC participated in study
design, coordination, and interpretation of the manu-
script. CYK drafted the manuscript and collected data. PC
participated in the design of the study, interpretation of
the statistical analysis, and coordination. All authors read
and approved the final manuscript.
Acknowledgements
We would like to thank all the members of Hoping Hospital, Taipei, who
were present during the SARS outbreak in 2003.
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... 161 (50.2%) of the subjects in group I were women, and 160 (49.8%) were men, while 102 (54%) of the subjects in group II were women, and 87 (46%) were men (p = 0.41). The number of admissions in group I and II were 1 (1-1) and 3 (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12), respectively (p < 0.001). ...
... This reduction in healthcare services is mainly due to the fear of becoming infected [4]. Studies during previous coronavirus epidemics have shown that seeking health care by inpatient and outpatient patients remained low almost 4 years after the resolution of the epidemic [5]. Similar results have been reported during the novel coronavirus pandemic, too. ...
Article
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Background. The novel coronavirus pandemic (COVID-19) has caused significant change in the daily life of humans, as well as in access to medical care. Objectives. We aimed to compare the general characteristics, medical diagnoses and laboratory data of patients referred to the outpatient internal medicine clinics of our institution and to observe relevant factors that correlate with the number of hospital admissions in this population. Material and methods. Patients who visited our outpatient clinics of internal medicine between March 2020 and June 2020 were enrolled. Age, gender, medical diagnoses, number of admissions, cause of admission and laboratory parameters on first admission were recorded. Patients who visited outpatient clinics only once were grouped as group I, and patients admitted more than once were grouped as group II. General characteristics and laboratory data of groups I and II were compared. Results. Patients with cancer were more common in group II compared to group I (p<000.1). Haemoglobin (Hb) (p = 0.001) was significantly lower, and red cell distribution width (RDW) (p = 0.007) was significantly higher in group II compared to group I. RDW was positively (r = 0.23, p < 0.001) correlated, and Hb inversely (r = -0.19, p < 0.001) correlated, with the number of hospital admissions in the study population. Conclusions. We think that decreased Hb and increased RDW values in patients during the pandemic should alert physicians for possible recurrent hospital admissions in the near future and may promote taking measures to reduce multiple medical admissions. Key words: COVID-19, red cell distribution width, hemoglobin, internal medicine.
... This review shows that vaccination rates and the use of paediatric health care materially decreased during the pandemic. Research on prior health care crises showed similar findings, such as reductions in vaccine coverage during the Ebola outbreak in 2014 (Elston et al., 2017) and lower PED visit rates during the SARS epidemic in 2003 (Chu et al., 2008). To improve the understanding of the impacts on health care, the full spectrum of paediatric health care should be assessed. ...
Article
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It is pertinent to examine potentially detrimental impacts of the coronavirus disease 2019 (COVID-19) pandemic on young people. We conducted a review to assess the health impacts of the COVID-19 pandemic on children and adolescents. Databases of MEDLINE, Embase and the Cochrane Library were searched in June 2020, using keywords for ‘children’, ‘adolescents’ and ‘COVID-19’. English papers discussing young people in context to the COVID-19 pandemic were included. Quality of selected studies was evaluated and scored. Of the 2013 identified articles, 22 met the inclusion criteria, including 11 cohort studies, ten cross-sectional studies and one report. Five main issues emerged: Increased mental health conditions, declines in presentations to paediatric emergency departments, declines in vaccination rates, changes in lifestyle behaviour (mainly decreased physical activity for specific groups of children), and changes in paediatric domestic violence and online child sexual abuse. There are early indications that the COVID-19 pandemic is impacting the health of young people, and this is amplified for those with existing health conditions and vulnerabilities. Despite this, there is limited insight into the protective factors for young people’s health and wellbeing, as well as how the impacts of the pandemic can be mitigated in both the short and long term.
... This trend was also observed after England's first COVID-19 lockdown, and similar findings have been observed in previous pandemics. [8][9][10][11][12] Australian government authorities provided information regarding COVID-19 transmission early in this pandemic, but the long-term ramifications of delaying health care utilisation were not immediately highlighted. 13,14 Paediatric ED attendances decreased after the first wave to as many as nine fewer daily presentations in May and remained low throughout the second wave. ...
Article
Objective The COVID-19 pandemic in Australia coincided with an early trend of reduced visits to the emergency department (ED), but to determine which patients presented less requires closer evaluation. Identifying which patient groups are presenting less frequently will provide a better understanding of health care utilisation behaviours during a pandemic and inform healthcare providers of the potential challenges in managing these groups.Methods This single-centre retrospective study examined trends in presentations in 2020 to a private, mixed paediatric and adult ED in an inner city suburb within the state of Victoria that treats both COVID-19 and non-COVID-19 patients. The 2019 dataset was used as a reference baseline for comparison. All analyses were performed using baseline characteristics and triage data.ResultsThe total number of visits to the ED dropped from 24 775 in 2019 to 22 754 in 2020, representing an overall reduction of 8%. Significant reductions in daily presentations and admissions from the ED were observed in the months immediately following the peak of the two COVID-19 waves in the state of Victoria. Visits by those in the 0- to 17-year age group, triage categories 4 and 5 and musculoskeletal presentations were also reduced for most of 2020. Gastrointestinal/abdominal and urological/renal presentations were reduced immediately after the first COVID-19 wave, whereas infectious diseases visits were reduced during and after the second COVID-19 wave.Conclusions These findings add to the growing body of evidence regarding emergency care underutilisation during the COVID-19 pandemic. Reduced private ED presentations were observed overall and in paediatric patients, lower acuity triage categories, musculoskeletal, abdominal/gastrointestinal and urological/renal presentations during the first wave, whereas infectious disease cases were reduced during the second wave.What is known about the topic?During the first and second waves of COVID-19 in Victoria, ED visits were reduced in the public sector across all diagnostic categories and all triage categories. The effect of the COVID-19 pandemic on private ED attendance is less well known.What does this paper add?Total visits to the private ED during the first and second waves of COVID-19 were reduced across all major diagnostic categories except cardiac presentations. During this same period, visits for triage categories 4 and 5 were significantly reduced.What are the implications for practitioners?ED underutilisation during the initial two waves of the COVID-19 pandemic is apparent in both the private and public sector. Patients should be encouraged not to delay seeking urgent medical care during the pandemic.
... Routine health services decreased by an estimated 18% during the 2014-2015 Ebola outbreak in West Africa, resulting in thousands of potentially preventable deaths [1]. Also, following the severe acute respiratory syndrome (SARS) outbreak in China, clinic and emergency room visits at a hospital in Taipei City dropped to 55% and 45%, respectively, in 2003 compared with the previous year [2]. A study in Qatar revealed that the overall utilization of primary health care services declined to 50% in April of 2020 during the surge of local Coronavirus disease of 2019 (COVID-19) spread [3]. ...
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Background The impacts of the COVID-19 pandemic on health services offered to patients with non-communicable diseases, including chronic neurological illnesses, are diverse and universal. We used a self-reported questionnaire to investigate these impacts on neurology patients in Jordan and assess their knowledge and attitudes towards the pandemic. Results Most respondents had positive attitudes towards the COVID-19 pandemic, with 96% reporting they believed in the seriousness of the pandemic and adhered to prevention measures. Nearly 97% resorted to the internet and media outlets for medical information about the pandemic. About one in five clinic visitors had their appointments delayed due to interruption of health services. A similar portion of patients with MS, epilepsy, and migraine or tension headache reported medication interruptions during the pandemic. One in two patients reported new events or worsening illness since the start of the pandemic, and sleep disturbances were reported by nearly one in three patients who had epilepsy or headache. Conclusion The COVID-19 pandemic’s impacts on patients with neurological illnesses in Jordan were deep and diverse. Meanwhile, the majority of surveyed neurology patients demonstrated a positive attitude towards the pandemic.
... Experience with severe acute respiratory syndrome almost 20 years ago revealed significant drops in healthcare service utilisation in the most affected regions 40 and long periods before some rates returned to baseline. 41 Given the growing evidence about unnecessary care since then, it may be more beneficial for populations and their health systems if utilisation rates of some services do not return to prepandemic levels. Addressing genuine unmet need and winding back the harm and waste of unnecessary care are not conflicting interests, but rather two sides of a coherent strategy to efficiently improve human health. ...
Article
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Objectives To determine the extent and nature of changes in utilisation of healthcare services during COVID-19 pandemic. Design Systematic review. Eligibility Eligible studies compared utilisation of services during COVID-19 pandemic to at least one comparable period in prior years. Services included visits, admissions, diagnostics and therapeutics. Studies were excluded if from single centres or studied only patients with COVID-19. Data sources PubMed, Embase, Cochrane COVID-19 Study Register and preprints were searched, without language restrictions, until 10 August, using detailed searches with key concepts including COVID-19, health services and impact. Data analysis Risk of bias was assessed by adapting the Risk of Bias in Non-randomised Studies of Interventions tool, and a Cochrane Effective Practice and Organization of Care tool. Results were analysed using descriptive statistics, graphical figures and narrative synthesis. Outcome measures Primary outcome was change in service utilisation between prepandemic and pandemic periods. Secondary outcome was the change in proportions of users of healthcare services with milder or more severe illness (eg, triage scores). Results 3097 unique references were identified, and 81 studies across 20 countries included, reporting on >11 million services prepandemic and 6.9 million during pandemic. For the primary outcome, there were 143 estimates of changes, with a median 37% reduction in services overall (IQR −51% to −20%), comprising median reductions for visits of 42% (−53% to −32%), admissions 28% (−40% to −17%), diagnostics 31% (−53% to −24%) and for therapeutics 30% (−57% to −19%). Among 35 studies reporting secondary outcomes, there were 60 estimates, with 27 (45%) reporting larger reductions in utilisation among people with a milder spectrum of illness, and 33 (55%) reporting no difference. Conclusions Healthcare utilisation decreased by about a third during the pandemic, with considerable variation, and with greater reductions among people with less severe illness. While addressing unmet need remains a priority, studies of health impacts of reductions may help health systems reduce unnecessary care in the postpandemic recovery. PROSPERO registration number CRD42020203729.
... Nurses, for example were rarely mentioned in the interviews while some sources suggest that in the past they have been a vital link between management and work 'on the ground' but are no longer sufficiently represented in management (Van Merode & Brouwer, 2020). Although largely outside of the scope of this study, our findings also resonate with concerns about decisions to (temporarily) shut down select medical services impacting on some patients disproportionately (Chu et al., 2008). Further research is needed to investigate whether (permanent or semi-permanent) infrastructural adaptations employed during the Covid-19 pandemic have made physically accessing healthcare services more challenging for particular user groups. ...
Conference Paper
During the first months of the Covid-19 pandemic, crisis management and fast decision-making regarding infrastructural adaptations were key as hospitals faced major challenges while attempting to ensure optimal care. This study aims to gain insight into decision-making processes regarding infrastructural adaptations. Interviews were conducted (in July 2020) with representatives of technical services, facilities and planning departments in six general hospitals in Flanders (Belgium). Interviewees illustrated changes made with building plans, photos and other supportive material. Based on the collected data we identify four main factors affecting decision-making about infrastructural adaptations: enforced measures, demand and supply ‘on the ground’, knowledge acquired over time, and stakeholders’ identities. Whereas the initial approach was predominantly top-down, insights gained into the type of cross-departmental collaboration that was necessary and possible during the Covid-19 crisis may also have value under more regular circumstances to swivel between top-down requirements and design contexts ‘on the ground’.
... The longlasting effect of people's fear of designated SARS cen-ters was reported from the same hospital in Taipei and published in 2008. The long-term results show that the outpatient department of the general surgery department were still treating significantly fewer patients 4 years after the SARS epidemic [17]. ...
Article
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Background Some medical disciplines have reported a strong decrease of emergencies during the coronavirus disease 2019 (COVID-19) pandemic; however, the effect of the lockdown on general surgery emergencies remains unclear. Methods This study is a retrospective, multicenter analysis of general surgery emergency operations performed during the period from 1 March to 15th 2020 lockdown and in the same time period of 2019 in three medical centers providing emergency surgical care to the area Salzburg-North, Austria. Results In total 165 emergency surgeries were performed in the study period of 2020 compared to 287 in 2019. This is a significant decrease of 122 (42.5%) emergency surgeries during the COVID-19 lockdown ( p = 0.005). The length of hospital stay was reduced to 3 days in 2020 compared to 4 in 2019. Appendectomy remained the most performed emergency surgery for both periods; however the number of surgeries was reduced to less than a half, with 72 cases in 2019 and 33 cases in 2020 ( p = 0.118). Emergency colon surgery observed the strongest decrease of 75% from 17 cases in 2019 to 4 in 2020. In addition, the emergency abdominal wall hernia, cholecystectomies for acute cholecystitis, small surgeries and proctological emergencies recorded drops of 70%, 39%, 33% and 47% respectively. The strongest reduction in frequencies of emergency surgeries was reported from the designated COVID center in the examined region. Conclusions Emergency general surgery is an essential service that continues to run under all circumstances. Our data show that COVID-19-related restrictions have resulted in a significant decrease in the utilization of acute surgical care.
Article
Background The coronavirus pandemic changed how we manage and operate patients in orthopaedic practice. Although elective orthopaedic procedures were halted to prevent spread of the disease as well as sustain supplies of essential protective equipment and healthcare workers, trauma services were continued. We studied the orthopaedic trauma cases operated over 6 months of the pandemic, and discuss the protocols used to minimize disease spread. Methods Data was collected for all orthopaedic emergency cases operated at our centre from 1 st March – 10 th August 2020. During this time specific protocols were used for first aid, pre-operative care, inside the operation theatre, post-operative stay as well as for follow ups. Results A total of 851 patients were operated. A sharp decline in surgeries was seen during the lockdown. Average stay in the hospital was 4 days. Only 44% of the patients came for follow-up visits. None of the contacted patients or their relatives developed symptoms or tested positive for COVID after discharge. Conclusion Multiple waves and various mutant strains of COVID-19 have made this pandemic longer than expected. Elective orthopaedic cases cannot be ignored for forever, as it leads to poor quality of life and an increasing burden of such patients. We suggest, that using the protocols used at our centre, we have successfully operated on cases without risking spread of the virus. Thus, we believe it’s time to reinstate elective orthopaedic procedures, in a phased manner.
Article
Background: The coronavirus disease 2019 (COVID-19) pandemic began in December 2019. While it has not yet ended, COVID-19 has already created transitions in health care, one of which is a decrease in medical use for health-related issues other than COVID-19 infection. Korean soldiers are relatively homogeneous in terms of age and physical condition. They show a similar disease distribution pattern every year and are directly affected by changes in government attempts to control COVID-19 with nonpharmaceutical interventions. This study aimed to identify the changes in patterns of outpatient visits and admissions to military hospitals for a range of disease types during a pandemic. Methods: Outpatient attendance and admission data from all military hospitals in South Korea from January 2016 to December 2020 were analyzed. Only active enlisted soldiers aged 18-32 years were included. Outpatient visits where there was a diagnosis of pneumonia, acute upper respiratory tract infection, infectious conjunctivitis, infectious enteritis, asthma, allergic rhinitis, allergic conjunctivitis, atopic dermatitis, urticaria, and fractures were analyzed. Admissions for pneumonia, acute enteritis, and fractures were also analyzed. All outpatient visits and admissions in 2020 for each disease were counted on a weekly basis and compared with the average number of visits over the same period of each year from 2016 to 2019. The corrected value was calculated by dividing the ratio of total weekly number of outpatient visits or admissions to the corresponding medical department in 2020 to the average in 2016-2019. Results: A total of 5,813,304 cases of outpatient care and 143,022 cases of admission were analyzed. For pneumonia, the observed and corrected numbers of outpatient visits and admissions in 2020 decreased significantly compared with the average of other years (P < 0.001). The results were similar for outpatient visits for acute upper respiratory tract infection and infectious conjunctivitis (P < 0.001), while the corrected number of outpatient visits for infectious enteritis showed a significant increase in 2020 (P = 0.005). The corrected number of outpatient visits for asthma in 2020 did not differ from the average of the previous 4 years but the number of visits for the other allergic diseases increased significantly (P < 0.001). For fractures, the observed and corrected numbers of outpatient visits and admissions in 2020 decreased significantly compared with the average of other years (P < 0.001). Conclusion: During the COVID-19 pandemic, outpatient visits to military hospitals for respiratory and conjunctival infections and fractures decreased, whereas visits for allergic diseases did not change or increased only slightly. Admissions for pneumonia decreased significantly in 2020, while those for acute enteritis and fractures also decreased, but showed an increased proportion compared with previous years. These results are important because they illustrate the changing patterns in lifestyle as a result of public encouragement to adopt nonpharmaceutical interventions during the pandemic and their effect on medical needs for both infectious and noninfectious diseases in a select group.
Article
Objective: Different lifestyles may contribute to chronic diseases or a health condition. We aimed to study trends in lifestyle habits among community-dwelling older people. Methods: This retrospective time-trend study enrolled 429 108 participants from the Senior Citizen Health Examination in Taiwan over ten years (2001-2010). We analysed lifestyle habits including smoking, alcohol, betel nut chewing, milk drinking, fruit and vegetable intake, car driving and motorcycle riding. Joinpoint regression was used to identify changes in trend. Results: The overall rate of smoking, alcohol and betel nut chewing was 8.2%, 18.1% and 0.3%, respectively. Smoking rates decreased gradually, but alcohol and betel nut chewing increased. We found that milk drinking, fruit and vegetable intake and car driving initially increased and then later decreased. The change in the trend was in 2003. Conclusion: There were significant turning points in milk drinking, fruit and vegetable intake and car driving. Implementation of strategies to change the behaviors of citizens about the intake of fruit and vegetable and milk drinking is important.
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Using interrupted time-series analysis and National Health Insurance data between January 2000 and August 2003, this study assessed the impacts of the severe acute respiratory syndrome (SARS) epidemic on medical service utilization in Taiwan. At the peak of the SARS epidemic, significant reductions in ambulatory care (23.9%), inpatient care (35.2%), and dental care (16.7%) were observed. People's fears of SARS appear to have had strong impacts on access to care. Adverse health outcomes resulting from accessibility barriers posed by the fear of SARS should not be overlooked.
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To estimate the impact of the severe acute respiratory syndrome (SARS) outbreak in early 2003 on a tertiary care hospital in Taiwan, ROC. The study estimated the utilisation of resources related to infection control, SARS related medical services, and routine medical services, and SARS related medical outcomes at National Cheng Kung University Hospital (NCKUH) from 25 March to 16 June 2003 through a cross sectional survey of hospital records. A mean of 5100 persons per day (95%CI 4580 to 5610) underwent fever screening at the outpatient and emergency department (ED) entrances to the hospital, of which 35 per day (95% CI 30 to 40) were referred for further evaluation for suspected or probable SARS. ED isolation surge capacity was created via 12 new beds outside the ED: eight for SARS assessment, three for patients awaiting in hospital bed assignment, and one for resuscitation. A total of 382 patients were fully evaluated for suspected or probable SARS outside the ED, of which 27 were admitted. The mean numbers of outpatient clinic patient visits, ED visits, ED trauma patient visits, ED admissions, hospital admissions, and operative procedures decreased during the outbreak. Thirty eight patients were hospitalised with suspected SARS, of which three received the final diagnosis of probable SARS. Two patients with probable SARS died. No cases of nosocomial SARS transmission occurred. This SARS outbreak was associated with substantial use of hospital and ED resources aimed at infection control, comparatively less use of resources related to the medical care of patients with suspected or probable SARS, and decreased use of routine medical services.
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The Greater Toronto Area (GTA) was considered a "hot zone" for severe acute respiratory syndrome (SARS) in 2003. In accordance with mandated city-wide infection control measures, the Hospital for Sick Children (HSC) drastically reduced all services while maintaining a fully operational emergency department. Because of the GTA health service suspensions and the overlap of SARS-like symptoms with many common childhood illnesses, this introduced the potential for a change in the volumes of patients visiting the emergency department of the only regional tertiary care children's hospital. We compared HSC emergency department patient volumes, admission rates and length of stay in the emergency department in the baseline years of 2000-2002 (non-SARS years) with those in 2003 (SARS year). The data from the prior years were modeled as a time series. Using an interrupted time series analysis, we compared the 2003 data for the periods before, during and after the SARS periods with the modeled data for significant differences in the 3 aforementioned outcomes of interest. Compared with the 2000-2002 data, we found no differences in visits, admission rates or length of stay in the pre-SARS period in 2003. There were significant decreases in visits and length of stay (p < 0.001) and increases in admission rates (p < 0.001) during the periods in 2003 when there were new and active cases of SARS in the GTA. All 3 outcomes returned to expected estimates coincident with the absence of SARS cases from September to December 2003. During the SARS outbreak in the GTA, the HSC emergency department experienced significantly reduced volumes of patients with low-acuity complaints. This gives insight into utilization rates of a pediatric emergency department during a time when there was additional perceived risk in using emergency department services and provides a foundation for emergency department preparedness policies for SARS-like public health emergencies.
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When an emerging infectious disease like severe acute respiratory syndrome (SARS) strikes suddenly, many wonder the public's overwhelming fears of SARS may deterred patients from seeking routine care from hospitals and/or interrupt patient's continuity of care. In this study, we sought to estimate the influence of pregnant women's fears of severe acute respiratory syndrome (SARS) on their choice of provider, mode of childbirth, and length of stay (LOS) for the delivery during and after the SARS epidemic in Taiwan. The National Health Insurance data from January 01, 2002 to December 31, 2003 were used. A population-based descriptive analysis was conducted to assess the changes in volume, market share, cesarean rate, and average LOS for each of the 4 provider levels, before, during and after the SARS epidemic. Compared to the pre-SARS period, medical centers and regional hospitals dropped 5.2% and 4.1% in market share for childbirth services during the peak SARS period, while district hospitals and clinics increased 2.1% and 7.1%, respectively. For changes in cesarean rates, only a significantly larger increase was observed in medical centers (2.2%) during the peak SARS period. In terms of LOS, significant reductions in average LOS were observed in all hospital levels except for clinics. Average LOS was shortened by 0.21 days in medical centers (5.6%), 0.21 days in regional hospitals (5.8%), and 0.13 days in district hospitals (3.8%). The large amount of patients shifting from the maternity wards of more advanced hospitals to those of less advanced hospitals, coupled with the substantial reduction in their length of maternity stay due to their fears of SARS could also lead to serious concerns for quality of care, especially regarding a patient's accessibility to quality providers and continuity of care.
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The main objective of this study is to apply autoregressive integrated moving average (ARIMA) models to make real-time predictions on the number of beds occupied in Tan Tock Seng Hospital, during the recent SARS outbreak. This is a retrospective study design. Hospital admission and occupancy data for isolation beds was collected from Tan Tock Seng hospital for the period 14th March 2003 to 31st May 2003. The main outcome measure was daily number of isolation beds occupied by SARS patients. Among the covariates considered were daily number of people screened, daily number of people admitted (including observation, suspect and probable cases) and days from the most recent significant event discovery. We utilized the following strategy for the analysis. Firstly, we split the outbreak data into two. Data from 14th March to 21st April 2003 was used for model development. We used structural ARIMA models in an attempt to model the number of beds occupied. Estimation is via the maximum likelihood method using the Kalman filter. For the ARIMA model parameters, we considered the simplest parsimonious lowest order model. We found that the ARIMA (1,0,3) model was able to describe and predict the number of beds occupied during the SARS outbreak well. The mean absolute percentage error (MAPE) for the training set and validation set were 5.7% and 8.6% respectively, which we found was reasonable for use in the hospital setting. Furthermore, the model also provided three-day forecasts of the number of beds required. Total number of admissions and probable cases admitted on the previous day were also found to be independent prognostic factors of bed occupancy. ARIMA models provide useful tools for administrators and clinicians in planning for real-time bed capacity during an outbreak of an infectious disease such as SARS. The model could well be used in planning for bed-capacity during outbreaks of other infectious diseases as well.
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The impact of the severe acute respiratory syndrome (SARS) outbreak in 2003 on the emergency department (ED) medical needs of adult patients has not been elucidated. The purpose of this study was to investigate the demographic and clinical characteristics of ED adult patients before, during and after the SARS epidemic in a SARS-dedicated hospital. A retrospective, ED chart review was conducted, and demographic data were obtained from a computer database, for a total of 17,586 patients. Patient information, including age, gender, mode of arrival, triage category, time of visit, main diagnosis, use of ED services, and status after the ED visit, were collected and compared for pre-, early-, peak-, late-, and post-SARS epidemic stages. Demographic data demonstrated a significant decrease in patient attendances per day, with a mean reduction of 92.5 +/- 8.3 patients (43.7 +/- 3.9% reduction in rate; p < 0.01) during peak- versus pre-epidemic stages, but revealed no differences in patient age and gender. The numbers of patients with ambulance transport, inter-hospital referral, and critical illnesses, including DOA, categorized as triage 1, or admitted to a ward or intensive care unit after the ED visit, were not influenced by the SARS epidemic. The number of patients with upper airway infections and suicide attempts from drug overdoses increased, but not statistically significantly. The number of patients with other diagnoses decreased progressively from early- to peak-epidemic stages, but returned to their earlier levels at the post-epidemic stage. Statistically significant decreases (p < 0.05) were noted in mean attendance at peak-versus pre- and early-epidemic stages for patients with cardiovascular disease, inflammatory or functional bowel disease, endocrine disease, dizziness or vertigo, or trauma. The SARS outbreak did not eliminate the need of critically ill patients for advanced medical support. However, besides an overall decrease in patient numbers, the SARS epidemic markedly altered demographic information, clinical characteristics, and the use of medical services by adult patients in the ED of a SARS-dedicated hospital.
Article
The objective was to describe the impact of severe acute respiratory syndrome (SARS) on the services of the division of otorhinolaryngology-head and neck surgery at an academic tertiary referral hospital in Hong Kong. Descriptive. Records of general and subspecialty outpatient attendance, ward admissions, ward bed occupancy, and elective and emergency surgery were obtained for the period since the SARS outbreak and for an equivalent period before the outbreak. The changes in these parameters were determined against the background of new SARS cases. Since the outbreak of SARS in March 2003, the weekly outpatient clinic attendance has declined by 59%, the number of operations performed by 79%, the average ward bed occupancy rate by 79% and the daily admission rate by 84%. A dramatic increase of 300% in the number of patients defaulting on their outpatient appointments was recorded. The substantial decrease in otorhinolaryngological services at an academic tertiary referral hospital in Hong Kong has been multifaceted. The decrease in attendance at the outpatient clinics reflects the increased number of patients defaulting on their appointments. Nonessential elective surgery was suspended soon after the outbreak, accounting for the decrease in the number of surgical procedures performed and partially for the decrease in ward bed occupancy and ward admissions. The temporary closure of the accident and emergency department contributed to the decrease in ward admissions and emergency surgical procedures. The reduced service offered by the hospital is having an impact on the quality of care available to patients with non-life-threatening otorhinolaryngological conditions.
Article
To examine the effect of provision of information about the infection control in the specific infection disease treatment unit in a city hospital on the outpatient's intention of outpatient service use, respondents who underwent outpatient medical care at the hospital (N = 821) were asked whether or not they intended to continue the outpatient visit at the hospital if a severe acute respiratory syndrome (SARS) patient was admitted to the unit. Although 56% of respondents replied that they could continue to visit the department if a SARS patient was admitted to the unit in the hospital before they read the information, the proportion of those who intended to continue outpatient care significantly increased by 15% after they read it. The logistic regression analyses revealed that respondents who had frequently visited the outpatient department (P < 0.001), those who felt relieved by reading the information about the unit (P < 0.001), and those who did not worry about nosocomial SARS infection inside the hospital (P < 0.001) were significantly more likely to reply that they would continue outpatient visits. We estimated that admission of a SARS patient to the unit would result in a 20% decrease in the cumulative total number of outpatients in the hospital during a 180-day interval after admission of a SARS patient to the unit, and the cumulative total number of outpatients increased by 7% after they read the information. This study suggests that providing outpatients with appropriate information about SARS infection control in the hospital had a statistically significant and substantial impact on the outpatients' intention to continue outpatient visits at the hospital.
Article
Two surveys conducted in Taiwan during the spring 2003 severe acute respiratory syndrome (SARS) epidemic reveal a high degree of concern about the threat posed by SARS to Taiwan and its residents, although respondents believe they are knowledgeable about the risk of SARS and that it is susceptible to individual control. Willingness to pay (WTP) to reduce the risk of infection and death from SARS is elicited using contingent valuation methods. Estimated WTP is high, implying values per statistical life of US dollars 3 to 12 million. While consistent with estimates for high-income countries, these values are substantially larger than previous estimates for Taiwan and may be attributable to the high degree of concern about SARS at the time the data were collected.
Article
Emergency departments (ED) were on the front lines for possible cases of transmission during the severe acute respiratory syndrome (SARS) epidemic. The purpose of this study was to investigate the impact of the SARS catastrophe on an urban ED. The patients' characteristics in an urban ED were collected from March to May 2003 during the SARS outbreak in Taiwan. The crisis period was divided into 2 periods: 30 days before (period 1) and after (period 2) April 21, the date of the first hospital-associated transmission. Problem severity in the ED and stress levels of ED staff during the SARS catastrophe were rated from mild (1 point) to severe (5 points). The number of ED patients declined 33.4% in period 2. There was a 2.1% (95%CI, 0.4-3.8) increase in the percentage of male patients, a 2.5% (95% CI, 1.5-3.7) increase in percentage of fever (>38 degrees C), and a 4.0% (95% CI, 2.6-5.4%) increase in chief complaint of fever in period 2. The number of nontrauma patients younger than 18 years had declined by 44.5% in period 2. The total charge for reimbursement from an insurance institution declined 21.7%. During the SARS outbreak, the most severe stress experienced by either physicians or nurses occurred during emergency resuscitation (median stress rating point, 4; interquartile range, 1). The SARS catastrophe affected the ED visit volume, finances, various patient characteristics, and stress levels in the ED physicians and nurses. EDs must be fully prepared to face the challenges of the next outbreak of SARS or other infectious disease.