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The interdisciplinary central emergency department is increasingly establishing itself as the new gold standard of inpatient emergency care. Not all emergency patients whose complaints need to be assessed with the resources of an emergency department are ultimately admitted as inpatients. For all other emergencies, correct allocation decisions must be made at an early stage and preferred paths for clarification and treatment that relieve hospital emergency rooms must be offered. Qualification requirements for emergency care staff have so far been highly inconsistent for the three sectors. It is also necessary to jointly establish quality assurance measures for the cooperation between the outpatient and inpatient sectors as well as the emergency medical services.Die interdisziplinäre zentrale Notaufnahme (ZNA) als neuer Goldstandard der stationären Notfallversorgung setzt sich zunehmend durch. Nicht alle Notfallpatientinnen und -patienten, deren Beschwerden mit den Mitteln einer Notaufnahme abgeklärt werden müssen, werden letztlich auch stationär aufgenommen. Für alle anderen Notfälle müssen frühzeitig korrekte Allokationsentscheidungen getroffen und präferierte Pfade zur Abklärung und Behandlung angeboten werden, welche die Krankenhausnotaufnahmen entlasten. Qualifikationsanforderungen an das Personal der Notfallversorgung sind bisher sehr uneinheitlich für die drei Sektoren. Es gilt zudem, gemeinsam qualitätssichernde Maßnahmen für die Zusammenarbeit zwischen ambulantem und stationärem Sektor sowie dem Rettungsdienst zu etablieren.

Purpose This retrospective study aims to analyze the distribution of demand and the duration of the diagnostic workup of suspected pulmonary embolism (PE) using computed tomography pulmonary angiography (CTPA). Methods Time data from physical examination to report creation were identified for each CTPA in 2013 and 2018 at a tertiary hospital. Multivariable multinomial logistic and linear regression models were used to evaluate differences between 3 time intervals (I1: 6am-2pm, I2: 2pm-10pm, I3: 10pm-6am). A cosinor model was applied to analyze the amount of CTPA per hour. Results The relative demand for CTPA from the emergency room was lower in l1 compared to l2 and l3 (I1/I2: odds ratio (OR) 0.84, 95 % confidence interval (CI) 0.78−0.91; I1/I3: OR 0.80, 95 % CI 0.72−0.89; peak 4:23 pm). Requests for in-patients displayed a tendency towards I1 (I1/2: OR 1.15, 95 % CI 1.06–1.24; l1/l3: OR 1.19, 95 % CI 1.07–1.33; peak 1:54 pm). The time from CTPA request to study was shorter in I3 compared to I1 and I2 in 2013 (I1/I3: ratio 5.23, 95 % CI 3.38–8.10; I2/I3: ratio 3.50, 95 % CI 2.24–5.45) and 2018 (I1/I3: ratio 2.27, 95 % CI 1.60–3.22; I2/I3: ratio 2.11, 95 % CI 1.50–2.97). This applied similarly to fatal cases (I1/I3: ratio 2.91, 95 % CI 1.78–4.75; I2/I3: ratio 2.45, 95 % CI1.52−3.95). Conclusions The temporal distribution of demand for CTPA depends on the sector of patient care and the processing time differs substantially during the day. Time series analysis can reveal such coherences and may help to optimize workflows in radiology departments.

1AbstractBackgroundThe ongoing SARS-CoV-2 pandemic presents a unique challenge for diagnostic laboratories around the world. Automation of workflows in molecular diagnostics are instrumental for coping with the large number of tests ordered by clinicians, as well as providing fast-tracked rapid testing for highly urgent cases. In this study we evaluated a SARS-CoV-2 LDT for the NeuMoDx 96 system, a fully automated device performing extraction and real-time PCR.MethodsA publicly available SARS-CoV-2 RT-PCR assay was adapted for the automated system. Analytical performance was evaluated using in-vitro transcribed RNA and clinical performance was compared to the cobas 6800-based reference assay within the lab.ResultsThe NeuMoDx-sarbeco-LDT displayed good analytical performance with an LoD of 95.55 cp/ml and no false positives during evaluation of cross-reactivity. A total of 176 patient samples were tested with both the Sarbeco-LDT and the reference assay. Positive and negative agreement were 100% and 99.2% respectively. Invalid-rate was 6.3%.ConclusionThe NeuMoDx-sarbeco-LDT showed analytical and clinical performance comparable to the cobas6800-based reference assay. Due to its random-access workflow concept and rapid time-to-result of about 80 minutes, the device is very well suited for providing fast-tracked SARS-CoV-2 diagnostics for urgent clinical samples in the hospital setting.HighlightsA publicly available SARS-CoV-2 RT-PCR assay was adapted and evaluated on the open mode of the NeuMoDx 96 system (Qiagen)The assay showed comparable analytical and clinical performance to the reference assayFast turn-around times (80 minutes) and random-access workflow of the system makes the assay well suited for urgent clinical samples.