Access block and prolonged length of stay in the emergency department are associated with a higher patient mortality rate

Access block,known as exit block or boarding,is defined as a situation in which patients who are admitted or planned for admission remain in the emergency department(ED)as they are unable to be transferred to an inpatient unit within a reasonable time frame(no longer than 8 hours).[1,2]Access block often occurs due to insufficient hospital capacity and is a major issue in emergency medicine.[3]

The economic burden of influenza-associated outpatient visits and hospitalizations in China: a retrospective survey

Background:The seasonal influenza vaccine coverage rate in China is only 1.9%.There is no information available on the economic burden of influenza-associated outpatient visits and hospitalizations at the national level,even though this kind of information is important for informing national-level immunization policy decision-making.Methods:A retrospective telephone survey was conducted in 2013/14 to estimate the direct and indirect costs of seasonal influenza-associated outpatient visits and hospitalizations from a societal perspective.Study participants were laboratory-confirmed cases registered in the National Influenza-like Illness Surveillance Network and Severe Acute Respiratory Infections Sentinel Surveillance Network in China in 2013.Patient-reported costs from the survey were validated by a review of hospital accounts for a small sample of the inpatients.Results:The study enrolled 529 outpatients(median age:eight years;interquartile range[IQR]:five to 20 years)and 254 inpatients(median age:four years;IQR:two to seven years).Among the outpatients,22.1%(117/529)had underlying diseases and among the inpatients,52.8%(134/254)had underlying diseases.The average total costs related to influenza-associated outpatient visits and inpatient visits were US$155(standard deviation,SD US$122)and US$1,511(SD US$1,465),respectively.Direct medical costs accounted for 45 and 69%of the total costs related to influenza-associated outpatient and inpatient visits,respectively.For influenza outpatients,the mean cost per episode in children aged below five years(US$196)was higher than that in other age groups(US$129–153).For influenza inpatients,the mean cost per episode in adults aged over 60 years(US$2,735)was much higher than that in those aged below 60 years(US$1,417–1,621).Patients with underlying medical conditions had higher costs per episode than patients without underlying medical conditions(outpatients:US$186 vs.US$146;inpatients:US$1,800 vs.US$1,189).In the baseline analysis,inpatients reported costs were 18%higher than those found in the accounts review(n=38).Conclusion:The economic burden of influenza-associated outpatient and inpatient visits in China is substantial,particularly for young children,the elderly,and patients with underlying medical conditions.More widespread influenza vaccination would likely alleviate the economic burden of patients.The actual impact and cost-effectiveness analysis of the influenza immunization program in China merits further investigation.

Genetic source tracking of an anthrax outbreak in Shaanxi province,China

Background:Anthrax is an acute zoonotic infectious disease caused by the bacterium known as Bacillus anthracis.From 26 July to 8 August 2015,an outbreak with 20 suspected cutaneous anthrax cases was reported in Ganquan County,Shaanxi province in China.The genetic source tracking analysis of the anthrax outbreak was performed by molecular epidemiological methods in this study.Methods:Three molecular typing methods,namely canonical single nucleotide polymorphisms(canSNP),multiple-locus variable-number tandem repeat analysis(MLVA),and single nucleotide repeat(SNR)analysis,were used to investigate the possible source of transmission and identify the genetic relationship among the strains isolated from human cases and diseased animals during the outbreak.Results:Five strains isolated from diseased mules were clustered together with patients’isolates using canSNP typing and MLVA.The causative B.anthracis lineages in this outbreak belonged to the A.Br.001/002 canSNP subgroup and the MLVA15-31 genotype(the 31 genotype in MLVA15 scheme).Because nine isolates from another four provinces in China were clustered together with outbreak-related strains by the canSNP(A.Br.001/002 subgroup)and MLVA15 method(MLVA15-31 genotype),still another SNR analysis(CL10,CL12,CL33,and CL35)was used to source track the outbreak,and the results suggesting that these patients in the anthrax outbreak were probably infected by the same pathogen clone.Conclusions:It was deduced that the anthrax outbreak occurred in Shaanxi province,China in 2015 was a local occurrence.

A practical community-based response strategy to interrupt Ebola transmission in sierra Leone, 2014–2015

Background:The Ebola virus disease spread rapidly in West Africa in 2014,leading to the loss of thousands of lives.Community engagement was one of the key strategies to interrupt Ebola transmission,and practical community level measures needed to be explored in the field and tailored to the specific context of communities.Methods:First,community-level education on Ebola virus disease(EVD)prevention was launched for the community’s social mobilizers in six districts in Sierra Leone beginning in November 2014.Then,from January to May of 2015,in three pilot communities,local trained community members were organized to engage in implementation of EVD prevention and transmission interruption measures,by involving them in alert case report,contact tracing,and social mobilization.The epidemiological indicators of transmission interruption in three study communities were evaluated.Results:A total of 6016 community social mobilizers from 185 wards were trained by holding 279 workshops in the six districts,and EVD message reached an estimated 631680 residents.In three pilot communities,72 EVD alert cases were reported,with 70.8%of them detected by trained local community members,and 14 EVD cases were finally identified.Contact tracing detected 64.3%of EVD cases.The median duration of community infectivity for the cases was 1 day.The secondary attack rate was 4.2%,and no third generation of infection was triggered.No health worker was infected,and no unsafe burial and noncompliance to EVD control measures were recorded.The community-based measures were modeled to reduce 77 EVD cases,and the EVD-free goal was achieved four months earlier in study communities than whole country of Sierra Leone.Conclusions: The community-based strategy of social mobilization and community engagement was effective in casedetection and reducing the extent of Ebola transmission in a country with weak health system. The successfullypractical experience to reduce the risk of Ebola transmission in the community with poor resources would potentiallybe helpful for the global community to fight against the EVD and the other diseases in the future.