Clinical Profile and Practices of Safety Measures of Patients Who Have Attended Outpatient Unit of a Tertiary Care Teaching Hospital in South ...
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
Jebmh.com Original Research Article
Clinical Profile and Practices of Safety Measures of Patients Who Have
Attended Outpatient Unit of a Tertiary Care Teaching Hospital in
South India during National Lockdown Period
Sindhu B.S.1, Sujatha S.2, Soumya Alex3, Gadha Lakshmi Rajendran4
1, 2, 3, 4
Department of Otorhinolaryngology, Government Medical College, Trivandrum, Kerala, India.
A BS T R A C T
BACKGROUND
Government Medical College, Thiruvananthapuram, was converted to a Covid Corresponding Author:
hospital but there was no shutdown or restriction of functioning of routine non- Dr. Sujatha S.,
Additional Professor,
Covid treatment services. Objectives were to study the clinical profile of patients
Department of Otorhinolaryngology,
visiting ENT outpatient department during national lockdown period, evaluate the
Government Medical College,
usage of safety practices by patients to protect from Covid-19 infection and
Trivandrum, Kerala, India.
determine the proportion of patients using teleconsultation services. E-mail: drssent@gmail.com
METHODS DOI: 10.18410/jebmh/2021/9
This is a descriptive study. All patients, who attended and / or given dates to visit
the ENT outpatient department during study period were included in the study. How to Cite This Article:
Data collected was analysed using SPSS software version 25. Sindhu BS, Sujatha S, Alex S, et al.
Clinical profile and practices of safety
measures of patients who have attended
RESULTS
outpatient unit of a tertiary care teaching
Among patients who visited the outpatient department, 54.3 % were males. hospital in South India during national
Majority belonged to age group of above 40 years. 82 % of old patients on follow- lockdown period. J Evid Based Med
up could not attend outpatient because of lack of transportation. Majority of new Healthc 2021;8(01):43-47. DOI:
cases were road traffic accidents and acute infections of ear and nose. Although 10.18410/jebmh/2021/9
majority had access to treatment from hospitals in their locality, they did not utilise
the option. 98 % were aware of COVID-19 infection and were practicing safety Submission 25-08-2020,
Peer Review 01-09-2020,
precautions. Only 13 patients out of 219 were using the facility of teleconsultation. Acceptance 19-11-2020,
Published 04-01-2021.
CONCLUSIONS
This study reveals a wide gap in the present method of implementation of referrals Copyright © 2021 Sindhu B.S. et al.
to tertiary care. E medicine and teleconsultation services should be encouraged This is an open access article
distributed under Creative Commons
and used effectively. High rate of adoption of the safety measures among the Attribution License [Attribution 4.0
public was another highlight obtained from this study. International (CC BY 4.0)]
KEYWORDS
Clinical Profile, COVID-19, Government Medical College, National Lockdown,
Safety Practices
J Evid Based Med Healthc, pISSN - 2349-2562, eISSN - 2349-2570 / Vol. 8 / Issue 01 / Jan. 04, 2021 Page 43
Jebmh.com Original Research Article
BACKGROUND / self-limiting and as a collateral to this question, whether
the referral system in the public health sector is not being
India reported the first case of SARS-CoV-2 case on January utilised in the conceived manner.
23, 2020, in the state of Kerala in southern India, where a There is no available data in literature from India to
student with a history of travel to Wuhan presented with answer this question. After conducting this study, we may
respiratory symptoms. This was followed by two more be able to shed light on the reasons why the outpatient
similar cases on consecutive days.1 The World Health department of ENT, Government Medical College,
Organization since then has declared the outbreak to be a Trivandrum is flooded with patients. If the volume of
global pandemic.2 patients attending tertiary care outpatient departments can
In this time of global pandemic, India united to confront be reduced, manpower can be directed more effectively, to
the pandemic by observing janata curfew on March 22, 2020 other areas like teaching and research.
and a 21-day total national lockdown from March 26 to April
14, 2020, limiting the movement of the entire population to
prevent the spread of the Covid-19 pandemic.3 Among the O bj e c t i ve s
number of restrictions imposed, the most impactful has been 1. To study the clinical profile of patients who visited ENT
restricting people from stepping out of their homes. In outpatient department of Government Medical College
addition, all transport services – road, air, and rail have been Thiruvananthapuram during national lockdown period
suspended with exceptions for transportation of essential (March 26 – April 14 2020).
goods, fire engines, police, and emergency services. There 2. To find out the usage of safety practices by these
has been a significant impact of this suspension on health- patients to protect from Covid-19 infection.
care systems.4 3. To find out the proportion of patients using
Outpatient department of ENT, Government Medical teleconsultation services.
College Thiruvananthapuram is a tertiary care referral
teaching hospital. It caters an average of 300 Outpatients
per day, including 20 – 25 diagnostic endoscopies and 30 - METHODS
35 audiology testing before the emergence of Covid-19
pandemic. Though declared as a referral centre, patients This is a tertiary care teaching hospital level descriptive
complaining of headache of long-term duration, itching ears, study. All 219 patients, who attended and / or given dates
chronic foreign body sensation of throat etc. constitute to visit the ENT outpatient of Government Medical College,
around 20 - 30 % of everyday Outpatient cases. This Medical Thiruvananthapuram, during March 26 to April 14 were
College was converted to a Covid hospital but there was no included in the study. Patients not willing to participate in
shutdown or restriction of functioning of routine non-Covid the study were excluded from the study.
treatment services.
In the field of ENT, clinical examination and invasive
procedures on the respiratory tract and on airway-connected Data Collection Procedure
cavities expose people to direct transmission of SARS–CoV- Details of all patients, including clinical diagnosis were taken
2 by inhalation of contaminated droplets or ocular from E health records. All of them were contacted over
projection, or to indirect transmission by contact with phone, informed about the study and interviewed at a
contaminated hands, surfaces or objects5. Medical and prefixed time of their convenience using semi-structured
surgical procedures are therefore considered to put questionnaire on safety measures taken for Covid
practitioners and nursing staff at high risk when they come prevention, reasons for not visiting ENT outpatient on given
into contact with patients either confirmed or suspected to date (if so), availability and use of referral system and usage
have Covid-196. Because of this threat of infection, most of of teleconsultation was recorded.
the private ENT centres restricted their services. So a rise in Data was coded and entered into master chart.
number of patients in ENT outpatient in medical college was Quantitative data was expressed in mean and standard
expected, but it reduced to an average of 10 - 15 patients deviation. Qualitative data was expressed in proportions.
per day, from 300 before lockdown. A brief situation analysis Data was entered in MS excel and analysed using SPSS
revealed that, the reduction of patients in ENT outpatient software version 25.
during this pandemic could be attributed to transportation
difficulties in the lockdown of the state, fear among people
regarding contracting corona virus in the hospital and also Ethical Considerations
due to the fact that patients might have attended local Protocol of this study was approved by the institutional
hospitals for most of the minor or self-limiting illnesses. This review board and human ethical committee of Medical
naturally led to studying these questions using scientific College, Thiruvananthapuram, in accordance with the
methods viz. whether the high patient load in non-pandemic Helsinki Declaration of 1975 revised in 2000. (HEC No. 03/
period was due to patients visiting medical college outpatient 16/2020/ MCT dated 12/05/2020).
department for ailments which may be categorised as minor
J Evid Based Med Healthc, pISSN - 2349-2562, eISSN - 2349-2570 / Vol. 8 / Issue 01 / Jan. 04, 2021 Page 44Jebmh.com Original Research Article
RESULTS Regarding cases given dates for follow up 151 old
outpatient cases were given dates during lockdown period
for follow up. Out of this, only 27 patients visited outpatient
Of the total 219 patients, 119 (54.3 %) were males and rest
department on the given date (Table 2). Majority were acute
100 were females. Majority belonged to age group above 40
exacerbation of chronic sinusitis (19 %). Vertigo (11 %)
years (47 %). 38 % belonged to age group of 17 - 40 years
chronic suppurative otitis media (11 %), benign paroxysmal
and rest 16 % were below 17 years of age.
positional vertigo (11 %), acute tonsillitis (7 %), GERD (7
Outpatient tickets were divided into old and new and
%), otitis externa (7 %), impacted ear wax (7 %), road
percentage of distribution was calculated (Figure I). Majority
traffic accidents, hypothyroidism, bilateral ethmoid polyp,
was old outpatient tickets (151 numbers) given for follow-
ear canal dermatitis and acute otitis media cases also
up. 68 (31 %) new patients visited outpatient department
attended outpatient department on the given dates. No
during the time of lockdown. Although 151 patients were
cases of adenoiditis, allergic rhinitis, aphthous ulcers,
given dates for follow up during these times, only 27 patients
malignancy larynx, oral cavity and oropharynx, headache,
came to outpatient department on the given date. 82 % of
otomycosis and upper respiratory tract infection attended
patients did not come for review.
outpatient department for follow up. GERD (13 %), chronic
suppurative otitis media (12 %), impacted ear wax (7 %),
external canal dermatitis (7 %), benign paroxysmal
Diagnosis of New Patients in ENT
positional vertigo (7 %), vertigo (2 %), tracheostomy (1 %),
Outpatient Department
otitis externa (1 %), acute otitis media (1 %) and acute
Of the 68 patients visiting the ENT outpatient, 21 % were
exacerbation of chronic sinusitis (1 %) also did not come for
road traffic accidents referred from local hospital. Acute
follow up.
otitis media and otitis externa constituted 7 % of the total
which was the second commonest diagnosis. Acute
exacerbation of chronic sinusitis, carcinoma tongue and
epistaxis cases were 6 % each. Vertigo (3 %), malignant
otitis externa (3 %), acute suppurative otitis media (2 %),
foreign body ear (2 %), GERD (2 %), headache (2 %),
otomycosis (2 %), sudden sensorineural hearing loss (2 %),
carcinoma larynx with stridor (2 %), impacted wax in ear (2
%), acute pharyngitis, a / acute tonsillitis, benign
paroxysmal positional vertigo, chronic suppurative otitis
media, facial palsy, tinnitus also constituted in small
Figure 1. Percentage Distribution of the Sample
proportions (Table 1). According to Outpatient Ticket
New Old
Diagnosis
Count Percent Count Percent
a / c tonsilitis 1 1.5 2 1.3
a / c,c / c sinusitis 4 5.9 6 4.0
a / c pharyngitis 1 1.5 0 0.0
Adenoiditis 0 0.0 18 11.9
Allergic rhinitis 0 0.0 18 11.9
Allergy 0 0.0 7 4.6
AOM 5 7.4 2 1.3
52.5
Aphthous ulcer 0 0.0 1 0.7
ASOM 2 2.9 0 0.0
BPPV 1 1.5 11 7.3
Ca larynx 1 1.5 1 0.7 1.0
Ca larynx (follow up) 1 1.5 1 0.7
Ca oropharynx 0 0.0 1 0.7 No Reference (47%)
Ca tongue 4 5.9 1 0.7 Nurse (1%) Doctor (53%)
CSOM 1 1.5 18 11.9
EC dermatitis 0 0.0 10 6.6 Figure 2. Percentage Distribution of the Sample
Epistaxis 4 5.9 0 0.0
Ethmoid polyp 0 0.0 1 0.7 According to Referral
Facial palsy 1 1.5 0 0.0
FB ear 2 2.9 0 0.0
Fish bone 1 1.5 0 0.0
GERD 2 2.9 18 11.9
Headache 2 2.9 8 5.3
Hypothyroidism 0 0.0 1 0.7
MOE 3 4.4 0 0.0
Otitis externa 5 7.4 3 2.0
Otomycosis 2 2.9 5 3.3
RTA 14 20.6 1 0.7
SSNHL 2 2.9 0 0.0
Stridor 2 2.9 0 0.0
Tinnitus 1 1.5 0 0.0
Tracheostomy 1 1.5 1 0.7
URI 0 0.0 1 0.7
Vertigo 3 4.4 5 3.3
Wax 2 2.9 10 6.6
Figure 3. Percentage Distribution of the Sample
Table 1. Distribution of Diagnosis Based on
According to Awareness of Covid-19
New / Old Outpatient Ticket
J Evid Based Med Healthc, pISSN - 2349-2562, eISSN - 2349-2570 / Vol. 8 / Issue 01 / Jan. 04, 2021 Page 45Jebmh.com Original Research Article
Follow Up not come for review. The only reason for this abstinence was
Diagnosis No Yes
told as non-availability of transportation vehicles due to the
Count Percent Count Percent
a / c tonsillitis 0 0.0 2 7.4 lockdown. These patients did not go to any other treatment
a / c on c / c sinusitis 1 0.8 5 18.5 centres and they either continued with earlier given
Adenoiditis 18 14.5 0 0.0
Allergic rhinitis 18 14.5 0 0.0 medications, or took no treatment. Of the 68 new patients,
Allergy 7 5.6 0 0.0
AOM 1 0.8 1 3.7
21 % were RTA referred from local hospital. Infections of
Aphthous ulcer 1 0.8 0 0.0 the ear and sinuses were next in common.
BPPV 8 6.5 3 11.1
Ca larynx 1 0.8 0 0.0
Although, 94 % of the total patients had access for
Ca larynx (follow up) 1 0.8 0 0.0 treatment at near locality, only 62 % used that facility. Of
Ca oropharynx 1 0.8 0 0.0
Ca tongue 1 0.8 0 0.0 the 95 patients who attended ENT outpatient department,
CSOM 15 12.1 3 11.1 47 % had no reference at all. This shows the need of
EC dermatitis 9 7.3 1 3.7
Ethmoid polyp 0 0.0 1 3.7 establishing strict guidelines for issuing outpatient tickets for
GERD 16 12.9 2 7.4 referred cases only.
Headache 8 6.5 0 0.0
Hypothyroidism 0 0.0 1 3.7 Majority (98 %) were aware of Covid-19 infection and
Otitis externa 1 0.8 2 7.4 were practising safety precautions of usage of mask, social
Otomycosis 5 4.0 0 0.0
RTA 0 0.0 1 3.7 distancing of minimum 1 meter, and hand wash using soap
Tracheostomy 1 0.8 0 0.0 / sanitiser. The fact that 4 patients were unaware of the
URI 1 0.8 0 0.0
Vertigo 2 1.6 3 11.1 situation, should be taken with due importance. With no
Wax 8 6.5 2 7.4
effective pharmacological interventions or vaccine available
Table 2. Distribution of Diagnosis Based on Follow Up
in imminent future, reducing the rate of infection should be
Using Tele-Consultation Count Percent considered as first priority.7 The main benefit of physical
No 206 94.1 distancing measures is to prevent onward transmission of
Yes 13 5.9
SARS-CoV-2 infection. The use of face mask and frequent
Table 3. Percentage Distribution of the Sample
According to Tele-Consultation Usage hand wash is also protective for both healthcare workers and
people in the community.7
Data on availability of local treatment and reference, 94 In this study only 5 % of people in the community were
% of the total patients had access for treatment at nearby using teleconsultation facility. The Ministry of Health and
locality. Only 62 % used local treatment facility. Of the 95 Family Welfare released the telemedicine guidelines in India
patients who attended ENT outpatient department, 47 % on 25th March 2020 (Governors, 2020) following this, a
had no reference at all. 53 % were referred by local doctor consenting process was included in the e-consult. At times
and 1 % by nursing officer (Figure 2). The only reason for of public health emergencies like a pandemic. Tele-
not attending outpatient department on given date was non consultations, help in deciding if the case requires
availability of transportation in 100 % cases and they did not emergency medical care or not.8 A virtual triage either using
take treatment from elsewhere. smart phones or webcam enabled computers allow patients
Safety practices taken by these patients to protect from to be efficiently screened, is both patient centred and
Covid-19 infection; majority (98 %) were aware of COVID- conducive to self-quarantine, and it protects patients,
19 infection and were practising safety precautions of usage clinicians and the community from exposure.9
of mask, social distancing, and hand wash using soap /
sanitiser, but 4 patients were unaware of the situation but
among them one patient was practising all the three safety C O N C L US I O N S
measures (Figure 3).
Regarding tele-consultation, only 13 patients out of 219 There is a wide gap in the present method of implementation
were using the facility of tele-consultation and rest 95 % of referrals to a tertiary care. It is evident from the study
were not using it (Table 3). that the high volume of patients in the outpatient
department can be reduced by proper enhancement and
strengthening of primary and secondary care systems.
DISCUSSION Efforts to rationalise resource utilisation in public health also
merits mention. E medicine and tele-consultation services
should be encouraged and used effectively. High rate of
A descriptive study was conducted on 219 patients, who
adoption of the safety measures among the public was
attended and / or given dates for follow up visit to ENT
another highlight obtained through this study. Future studies
outpatient department of Government Medical College,
can be conducted on outcome analysis of those patients who
Thiruvananthapuram during national lockdown period
have not attended this outpatient department during
(March 26 to April 14). In this study, 119 (54.3 %) were
lockdown period.
males and rest 100 were females. Majority belonged to age
group above 40 years (47 %).
Data sharing statement provided by the authors is available with the
Although 151 patients were given date for follow up full text of this article at jebmh.com.
during these times, only 27 patients came to outpatient Financial or other competing interests: None.
department on the given date and mainly included acute Disclosure forms provided by the authors are available with the full
infections of nose and PNS and vertigo. 82 % of patients did text of this article at jebmh.com.
J Evid Based Med Healthc, pISSN - 2349-2562, eISSN - 2349-2570 / Vol. 8 / Issue 01 / Jan. 04, 2021 Page 46Jebmh.com Original Research Article
REFERENCES [5] https://www.worldometers.info/coronavirus/
[6] Chen P, Mao L, Nassis GP, et al. Coronavirus disease
[1] Khanna RC, Honavar SG. All eyes on Coronavirus— (COVID‑19): The need to maintain regular physical
What do we need to know as ophthalmologists. Indian activity while taking precautions. J Sport Health Sci
J Ophthalmol 2020;68(4):549-553. 2020;9(2):103-104.
[7] Chu DK, Akl EA, Duda S, et al. Physical distancing, face
[2] https://www.who.int/emergencies/diseases/
masks and eye protection to prevent person to person
novel‑coronavirus‑ 2019. [Last accessed on Mar 31,
transmission of SARS-CoV-2 and COVID-19: a
2020].
systematic review and meta-analysis. Lancet
[3] Nair AK, Gandhi RA, Natarajan S. Effect of COVID‑19
2020;395(10242):1973-1987.
related lockdown on ophthalmic practice and patient
care in India: Results of a survey. Indian J
https://doi.org/10.1016/S0140-6736(20)31142-
Ophthalmol 2020;68(5):725-730. http://www.ijo.in) 9.
[4] Dhar H, Datta S. Experience of treating head and neck [8] Couloignera V, Schmerberb S, Nicollasc R, et al.
cancers in government and private health‑care systems COVID-19 and ENT Surgery. European Annals of
during the COVID-19 pandemic: a viewpoint with Otorhinolaryngology, Head and Neck Diseases
summary of existing guidelines. Cancer Research 2020;137(3):161-166.
Statistics and Treatment 2020;3(5):123-126. [9] Holander JE, Carr BG. Virtually perfect? Telemedicine
http://www.crstonline.com for Covid-19. N Engl J Med 2020;382(18):1679-1681.
J Evid Based Med Healthc, pISSN - 2349-2562, eISSN - 2349-2570 / Vol. 8 / Issue 01 / Jan. 04, 2021 Page 47You can also read
