AUTHOR=Woodward Josha , Meza Samuel , Richards Dominick , Koro Lacin , Keegan Kevin C. , Joshi Krishna C. , Munoz Lorenzo F. , Byrne Richard W. , John Sayona 

TITLE=The Scope and Impact of the COVID-19 Pandemic on Neuroemergent Patient Transfers, Clinical Care and Patient Outcomes

JOURNAL=Frontiers in Surgery

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/surgery/articles/10.3389/fsurg.2022.914798

DOI=10.3389/fsurg.2022.914798

ISSN=2296-875X

ABSTRACT=Introduction: 
The SARS-CoV-2 (COVID-19) pandemic continues to substantially alter previously established clinical practice patterns and has transformed patient care in American healthcare. However, studies to evaluate the impact of COVID-19 on neuroemergent patient care and associated clinical outcomes are limited. Herein, we describe the impact of COVID-19 on the Neuroemergency Transfer Program (NTP) - a novel, urban, high volume interhospital patient transfer program. 
Objective: 
To evaluate and describe the clinical impact of the COVID-19 pandemic on the NTP. 
Study Design: 
A single-center retrospective study of prospectively collected consecutive neuroemergent patient transfer data between 2018-2021 was analyzed. Adult patients were divided based upon transfer date into a Pre-COVID (PCOV) or COVID cohort. Patient demographics, transfer characteristics and clinical data and outcomes were analyzed.      
Results: 
3,096 patients were included for analysis. Mean age at transfer in the PCOV and COVID cohorts were 62.4±0.36 and 61.1±0.6 years. A significant decrease in mean transfers per month was observed between cohorts (PCOV=97.8 vs. COV=68.2 transfers/month, p<0.01). Total transfer time in the PCOV cohort was 155.1±3.4 minutes which increased to 169.3±12.8 minutes in the COVID cohort (p=0.13). Overall mean transfer distance was significantly longer in the PCOV cohort at 22.0±0.4 miles vs. 20.3±0.67 miles in the COV cohort (p=0.03). The relative frequency of transfer diagnoses was unchanged between cohorts. A significant increase in mean inpatient length of stay was noted, 7.9±0.15 days to 9.6±0.33 days in the PCOV vs. COVID cohorts (p<0.01). Ultimately, no difference in the frequency of good vs. poor clinical outcome were noted between the PCOV (79.8% and 19.4%) vs. COV (78.8% and 20.4%) cohorts. 
Conclusion: 
The impact of COVID-19 on current healthcare dynamics are far reaching. Here, we show a significant decrease in interhospital patient transfers and increased length of stay between a Pre-COVID and COVID cohort. Further work to better elucidate the specific interplay of clinical contributors to account for these changes is indicated.