AUDIT OF COVID-19 WARD PERFORMANCE AND PRACTICE IN THE COVID-19 PANDEMIC: FUTURE DIRECTIONS FOR UNDERSTANDING: A RETROSPECTIVE STUDY

Abstract

A retrospective study was conducted to assess the trend of the COVID-19 pandemic in the COVID Ward emergency and COVID Ward treatment departments of the Department of COVID Ward at POF Hospital Wah Cantt from January 2021 to January 2022. Data on every patient admitted to the COVID Ward department over a year was gathered retroactively. The following demographic factors were recorded: diagnosis, COVID-19 work-up, admission specialization, and COVID-19 ward vs. conservative therapy. In total, there were 156 patients, with 108 being primarily men (70.4%). Of these patients, 90 (72%) were admitted via the clinic, and 124 (46%) were admitted in May. One hundred five patients (62.8%) had a COVID-19 PCR, 135 had a chest x-ray (90.2%), and 56 patients (31.4%) had a chest HRCT. The orthopedic COVID Ward was the most common department for operational interventions, with 88.4% of patients undergoing operative care, despite the general COVID Ward being the busiest service line with 89 total patient admissions (43.1%). The study found that the existing local protocols for patient flow and COVID-19 crisis management are effective and practical. Hospitals should be prepared to redirect their resources to high-volume specialties like orthopaedics and general COVID Wards after the later COVID-19 waves. Arteriovenous fistula formation is a simple yet crucial technique that should only be discontinued in the event of a labor shortage.

Full text

Biological and Clinical Sciences Research Journal
eISSN: 2708-2261; p
,
ISSN: 2958-4728
www.bcsrj.com
DOI: https://doi.org/10.54112/bcsrj.v2024i1.719
Biol. Clin. Sci. Res. J., Volume, 2024: 719
[Citation: Afridi, F., Ghayas, F., Anwar, S., Sheikh, M.A. (2024). Audit of COVID-19 ward performance and practice in
the COVID-19 pandemic: future directions for understanding: a retrospective study. Biol. Clin. Sci. Res. J., 2024: 719.
doi: https://doi.org/10.54112/bcsrj.v2024i1.719]
1
Original Research Article
AUDIT OF COVID-19 WARD PERFORMANCE AND PRACTICE IN THE COVID-19 PANDEMIC: FUTURE
DIRECTIONS FOR UNDERSTANDING: A RETROSPECTIVE STUDY
AFRIDI F, GHAYAS F, ANWAR S*, SHEIKH MA
POF Hospital Wah Cantt, Pakistan
*Corresponding author's email address: sadiaanwar823@ gmail.com
(Received, 09th November 2023, Revised 08th January 2024, Published 21st February 2024)
Abstract: A retrospective study was conducted to assess the trend of the COVID-19 pandemic in the COVID Ward emergency and
COVID Ward treatment departments of the Department of COVID Ward at POF Hospital Wah Cantt from January 2021 to January
2022. Data on every patient admitted to the COVID Ward department over a year was gathered retroactively. The following
demographic factors were recorded: diagnosis, COVID-19 work-up, admission specialization, and COVID-19 ward vs.
conservative therapy. In total, there were 156 patients, with 108 being primarily men (70.4%). Of these patients, 90 (72%) were
admitted via the clinic, and 124 (46%) were admitted in May. One hundred five patients (62.8%) had a COVID-19 PCR, 135 had
a chest x-ray (90.2%), and 56 patients (31.4%) had a chest HRCT. The orthopedic COVID Ward was the most common department
for operational interventions, with 88.4% of patients undergoing operative care, despite the general COVID Ward being the busiest
service line with 89 total patient admissions (43.1%). The study found that the existing local protocols for patient flow and COVID-
19 crisis management are effective and practical. Hospitals should be prepared to redirect their resources to high-volume
specialties like orthopaedics and general COVID Wards after the later COVID-19 waves. Arteriovenous fistula formation is a
simple yet crucial technique that should only be discontinued in the event of a labor shortage.
Keywords: COVID-19 Emergencies, Pandemic Trends, Treatment Modalities
Introduction
Global healthcare systems have been severely hit by the
COVID-19 pandemic, which has disrupted several medical
specializations, including COVID-19 ward services.
Healthcare institutions faced never-before-seen difficulties
in administering patient care while guaranteeing the safety
of both patients and healthcare personnel as the virus spread
quickly. To improve patient outcomes and mitigate its
consequences, it is essential to comprehend the implications
of the pandemic on COVID-19 ward practice. Recent
research indicates that the COVID-19 pandemic has
significantly decreased the number of COVID Ward
operations performed worldwide; estimates of the fall in
elective surgeries during the outbreak's height range from
30% to 80% (2020; James et al., 2022). These cuts mainly
resulted from personnel constraints, reallocating resources,
and worries about virus transmission in hospital settings
(Glasbey et al., 2021). As a result, patients needing COVID
Ward procedures experienced postponements,
cancellations, or changes to their treatment schedules,
which might affect their clinical results (Prachand et al.,
2020). Apart from reducing non-emergency procedures, the
pandemic presented difficulties in handling COVID-19
ward crises. Hospitals saw increased COVID-19
admissions, which put more demand on hospital resources
and could impact how quickly emergency COVID Ward is
provided (Thornton, 2020).
Furthermore, managing COVID-19 ward crises became
more difficult due to the need for strict infection control
measures and personal protective equipment (PPE), which
made it necessary for healthcare institutions to adjust to
changing conditions quickly (de Leeuw et al., 2020).
Particularly noticeable has been the pandemic's effect on
COVID-19 ward practice in low- and middle-income
countries (LMICs) like Pakistan. The pandemic's
consequences on COVID Ward services were made worse
by the particular difficulties encountered by LMICs,
including their lack of access to PPE, limited healthcare
infrastructure, and socioeconomic inequality (Zar et al.,
2020). Notwithstanding these difficulties, healthcare
professionals in low- and middle-income countries (LMICs)
showed grit and creativity in responding to the changing
needs of the pandemic, underscoring the significance of
local context in determining healthcare solutions (Meara et
al., 2015).To guide future preparation efforts, it is critical to
evaluate the patterns in COVID-19 ward emergencies and
treatments, given the continuing nature of the pandemic and
the possibility of subsequent waves. Evaluation of the
COVID-19 pandemic's effects on COVID-19 ward practice
at POF Hospital Wah Cantt, Pakistan, from January 2020 to
January 2021 is the goal of this retrospective audit. By
examining demographic variables, diagnostic methods,
admission patterns, and treatment strategies, this research
aims to pinpoint obstacles and prospects for enhancing
COVID-19 ward care in the face of the current public health
emergency.
Methodology
This retrospective study was conducted at the Department
of COVID Ward at POF Hospital Wah Cantt, Pakistan, and
covered the period from January 2021 to January 2022. All

Biol. Clin. Sci. Res. J., Volume, 2024: 719 Afridi et al., (2024)
[Citation: Afridi, F., Ghayas, F., Anwar, S., Sheikh, M.A. (2024). Audit of COVID-19 ward performance and practice in
the COVID-19 pandemic: future directions for understanding: a retrospective study. Biol. Clin. Sci. Res. J., 2024: 719.
doi: https://doi.org/10.54112/bcsrj.v2024i1.719]
2
patients admitted to the COVID Ward department had
retrospective data collected during the study period. Data on
diagnosis, COVID-19 workup, therapeutic approach
(COVID-19 vs. conservative), admission specialty, and
demographics were recorded. Descriptive statistics, such as
percentages and frequencies for categorical variables, were
used to analyze the data. The study aimed to evaluate trends
in COVID-19 ward procedures and emergency room visits
during the COVID-19 pandemic.
Results
Out of the 156 patients included in the study, In our analysis,
72% of admissions happened via the clinic, and 70.4% of
patients were male. With 46% of admissions, May had the
highest rate. A chest X-ray was taken in 90.2% of patients,
and in 31.4% and 62.8% of cases, a COVID-19 PCR was
conducted. With 88.4% of cases, the orthopedic COVID
Ward was the most often performed intervention; overall
patient admissions were most significant for the general
COVID Ward, at 43.1%. These results emphasise the need
for orthopedic and general COVID-19 treatment during the
COVID-19 pandemic, the prevalence of male patients, the
importance of outpatient services, and the heterogeneity in
diagnostic use.
Table 1: Patients' Classification based on admission diagnosis (n = 156).
Fractures 24 (14)
Acute
Gall
bladder
disease
13
(9)
Carcinomas
13
(9)
Diabetic
foot
21
(6.73)
Other traumas (incl. but not limited to RTA/Crush injury/stab wound/gunshot wound/Blast
injury/bite wound/hemothorax)
10 (07)
Abscess
8
(4.8)
End
-
stage
renal
disease
8
(4.2)
Nonspecific
pain
abdomen
7
(3.2)
Hernias
7
(3.8)
Acute
Appendicitis
7
(3)
Intestinal
obstruction
6
(4)
Gut
Perforation
5
(2.8)
Soft
tissue
infections
5
(2.5)
Miscellaneous
5
(1.8)
Acute
Pancreatitis
5
(3.2)
Head
injury
4
(3.2)
Hemorrhoids
4
(1.8)
Acute
limb
ischemia
4
(1.2)
Deep
venous
thrombosis
3
(1.2)
Chronic/critical
limb
ischemia
5
(1.4)
Pleural
effusion/empyema
4
(1.2)
Nerve
injury
4
(0.8)
Burns
2
(0.8)
Renal
Calculus
2
(0.8)
Nasal
pathologies
1
(0.2)
Cataracts
1
(0.2)
Osteomyelitis
1
(0.2)
Total
156

Biol. Clin. Sci. Res. J., Volume, 2024: 719 Afridi et al., (2024)
[Citation: Afridi, F., Ghayas, F., Anwar, S., Sheikh, M.A. (2024). Audit of COVID-19 ward performance and practice in
the COVID-19 pandemic: future directions for understanding: a retrospective study. Biol. Clin. Sci. Res. J., 2024: 719.
doi: https://doi.org/10.54112/bcsrj.v2024i1.719]
3
Table 2: Summary of COVID-19 Workup among COVID Ward Patients (n = 156)
Diagnostic Method Number of Patients Percentage
COVID
-
19 PCR
56
62.8%
Chest X
-
ray
60
90.2%
Chest HRCT
40
31.4%
Table 3: Admission Specialization and Patient Distribution (n = 156)
Admission Specialization Number of Patients Percentage
Clinic
90
72%
Other
66
28%
Discussion
The results obtained from this retrospective audit provide
insight into how the COVID-19 epidemic affected COVID
Ward practice and performance at POF Hospital Wah Cantt
in Pakistan. The tendencies that have been noticed provide
significant insights into several aspects of the pandemic,
including patient demographics, diagnostic techniques,
admission patterns, and treatment modalities.
Comprehending these processes is crucial to optimising
COVID-19 Ward treatment delivery despite persistent
public health issues. The majority of patients in this study
were male (70.4%), which is consistent with previous
research that suggests men are more likely than women to
have COVID-19 Ward problems (Budhiraja et al., 2020).
Furthermore, the vast majority of admissions made via the
clinic (72%) emphasise how crucial outpatient services are
for making COVID Ward treatment more accessible,
especially during a pandemic when hospital resources may
be limited. The rise in admissions recorded in May (46%)
could be attributed to the effects of local COVID-19
outbreaks or adjustments in how people seek medical
attention due to worries about the pandemic. To reduce the
risk of transmission between COVID-19 patients and
healthcare professionals, it is crucial to conduct a
comprehensive preoperative evaluation that includes
COVID-19 screening, as shown by the high use of
diagnostic modalities such as chest X-ray (90.2%) and
COVID-19 PCR (62.8%) (Collaborative and Morton,
2020).
Nonetheless, the very low chest HRCT utilization (31.4%)
raises the possibility of variations in diagnostic procedures
or resource limitations, necessitating more research. Despite
the pandemic, orthopedic COVID Ward was the most
frequently performed COVID Ward procedure (88.4%),
suggesting a sustained need for musculoskeletal treatment.
On the other hand, the general COVID Ward accounted for
43.1% of all patient admissions, emphasizing its function as
a primary specialty in managing a wide range of COVID-19
ward problems, including emergencies(Chia and Turner,
2022; Meisha, 2021; Zhang et al., 2020). The tendencies
that have been noticed highlight the COVID Ward services'
adaptation and resilience to the changing needs of the
pandemic. Local procedures for managing COVID-19
crises and patient flow seem workable and efficient,
supporting providing COVID-19 ward treatment even under
challenging situations. Hospitals should be on the lookout
for future COVID-19 waves and be ready to redirect
resources to high-volume specialties like orthopedic and
general COVID Ward (Kumar et al., 2021). It is essential to
recognize the limitations of this research, such as its
retrospective methodology and single-center character,
which may restrict the study's applicability. Subsequent
studies must investigate supplementary elements impacting
COVID-19 ward procedures throughout the pandemic and
assess the enduring consequences on medical results and
healthcare provision (Sulis et al., 2022).
Conclusion
Our study highlights how local policies that are now in
place may effectively manage COVID Ward treatment
during the COVID-19 pandemic. In future waves,
hospitals should plan to reallocate resources to high-
volume specialties like general COVID Wards and
orthopedics. Maintaining critical COVID Ward services
is still crucial to crisis management.
Declarations
Data Availability statement
All data generated or analyzed during the study are included
in the manuscript.
Ethics approval and consent to participate
Approved by the department Concerned.
Consent for publication
Approved
Funding
Not applicable
Conflict of interest
The authors declared absence of conflict of interest.
Author Contribution
FARYAL AFRIDI (Resident Medicine FCPS)
Conception of Study, Final approval of manuscript.
Manuscript revisions, critical input.
FARRAKH GHAYAS (MD Resident)
Coordination of collaborative efforts.
Data acquisition, analysis.
Manuscript drafting.
SADIA ANWAR (Senior Medical Officer)
Coordination of collaborative efforts.
Study Design, Review of Literature
Conception of Study, Development of Research
Methodology Design, Study Design,, Review of manuscript,
final approval of manuscript.
MAHEEN ATEEQ SHEIKH (Resident Medicine FCPS)
Data entry and Data analysis, drafting article.
Data acquisition, analysis.
Coordination of collaborative efforts.

Biol. Clin. Sci. Res. J., Volume, 2024: 719 Afridi et al., (2024)
[Citation: Afridi, F., Ghayas, F., Anwar, S., Sheikh, M.A. (2024). Audit of COVID-19 ward performance and practice in
the COVID-19 pandemic: future directions for understanding: a retrospective study. Biol. Clin. Sci. Res. J., 2024: 719.
doi: https://doi.org/10.54112/bcsrj.v2024i1.719]
4
References
Elective surgery cancellations due to the COVID-19
pandemic: global predictive modelling to inform
surgical recovery plans. Journal of British
Surgery 107, 1440-1449.
Budhiraja, S., Soni, A., Jha, V., Indrayan, A., Dewan, A.,
Singh, O., Singh, Y. P., Chugh, I., Arora, V., and
Pande, R. (2020). Clinical Profile of First 1000
COVID-19 cases admitted at tertiary care
hospitals and the correlates of their mortality: an
Indian experience. MedRxiv, 2020.11.
16.20232223.
Chia, M. A., and Turner, A. W. (2022). Benefits of
integrating telemedicine and artificial intelligence
into outreach eye care: stepwise approach and
future directions. Frontiers in Medicine 9,
835804.
Collaborative, C., and Morton, D. (2020). Mortality and
pulmonary complications in patients undergoing
surgery with perioperative SARS-CoV-2
infection. surgery 5, 7.
de Leeuw, R. A., Burger, N. B., Ceccaroni, M., Zhang, J.,
Tuynman, J., Mabrouk, M., Soldevila, P. B.,
Bonjer, H. J., Ankum, P., and Huirne, J. (2020).
COVID-19 and laparoscopic surgery: scoping
review of current literature and local expertise.
JMIR public health and surveillance 6, e18928.
Glasbey, J. C., Nepogodiev, D., Simoes, J. F., Omar, O., Li,
E., Venn, M. L., Abou Chaar, M. K., Capizzi, V.,
Chaudhry, D., and Desai, A. (2021). Elective
cancer surgery in COVID-19–free surgical
pathways during the SARS-CoV-2 pandemic: an
international, multicenter, comparative cohort
study. Journal of Clinical Oncology 39, 66.
James, A., De Jong, A., Jeanmougin, T., Blanie, A.,
Figueiredo, S., Goffin, P., Le Guen, M., Kantor,
E., Cipriani, F., and Campion, S. (2022).
Characteristics and outcomes of patients
undergoing anesthesia while SARS-CoV-2
infected or suspected: a multicenter register of
consecutive patients. BMC anesthesiology 22, 46.
Kumar, S., Bharti, A. K., and Amin, R. (2021).
Decentralized secure storage of medical records
using Blockchain and IPFS: A comparative
analysis with future directions. Security and
Privacy 4, e162.
Meara, J. G., Leather, A. J., Hagander, L., Alkire, B. C.,
Alonso, N., Ameh, E. A., Bickler, S. W., Conteh,
L., Dare, A. J., and Davies, J. (2015). Global
Surgery 2030: evidence and solutions for
achieving health, welfare, and economic
development. The lancet 386, 569-624.
Meisha, D. E. (2021). Comparison of compliance with
infection control practices among dental students
in Saudi Arabia before and during the COVID-19
pandemic. Risk management and healthcare
policy, 3625-3633.
Prachand, V. N., Milner, R., Angelos, P., Posner, M. C.,
Fung, J. J., Agrawal, N., Jeevanandam, V., and
Matthews, J. B. (2020). Medically necessary,
time-sensitive procedures: scoring system to
ethically and efficiently manage resource scarcity
and provider risk during the COVID-19
pandemic. Journal of the American College of
Surgeons 231, 281-288.
Sulis, G., Sayood, S., and Gandra, S. (2022). Antimicrobial
resistance in low-and middle-income countries:
current status and future directions. Expert review
of anti-infective therapy 20, 147-160.
Thornton, J. (2020). Covid-19: A&E visits in England fall
by 25% in week after lockdown. British Medical
Journal Publishing Group.
Zar, H. J., Dawa, J., Fischer, G. B., and Castro-Rodriguez,
J. A. (2020). Challenges of COVID-19 in children
in low-and middle-income countries. Paediatric
respiratory reviews 35, 70-74.
Zhang, A. S., Myers, M., Kee, C. J., McClary, K. N., Barton,
R. S., and Massey, P. A. (2020). Adapting
orthopaedic surgery training programs during the
COVID-19 pandemic and future directions.
Arthroscopy, Sports Medicine, and Rehabilitation
2, e683-e696.
Open Access This article is licensed under a Creative
Commons Attribution 4.0 International License, which
permits use, sharing, adaptation, distribution and
reproduction in any medium or format, as long as you give
appropriate credit to the original author(s) and the source,
provide a link to the Creative Commons licence, and
indicate if changes were made. The images or other third
party material in this article are included in the article’s
Creative Commons licence, unless indicated otherwise in a
credit line to the material. If material is not included in the
article’s Creative Commons licence and your intended use
is not permitted by statutory regulation or exceeds the
permitted use, you will need to obtain permission directly
from the copyright holder. To view a copy of this licence,
visit http://creativecommons.org/licen ses/by/4.0/. © The
Author(s) 2023