AUCTORES
Globalize your Research
Research Article | DOI: https://doi.org/10.31579/2690-1919/294
1 Mayo Clinic School of Graduate Medical Education, Department of Internal Medicine, Mayo Clinic, Scottsdale, AZ, USA
2 Mayo Clinic Department of Emergency Medicine, Phoenix, AZ, USA
3 Mayo Clinic Department of Health Sciences Research, Scottsdale, AZ, USA
*Corresponding Author: Douglas E. Rappaport. Mayo Clinic Department of Emergency Medicine, Phoenix, AZ, USA.
Citation: Cody A. Cunningham, Douglas E. Rappaport, Nicole R. Hodgson, Kevin M. Drechsel, Andrej Urumov et al. (2022). The effect of a ‘Covid tent’ on Emergency Department efficiency and patient satisfaction: A single site retrospective study, J. Clinical Research and Reports, 12(2) DOI:10.31579/2690-1919/294.
Copyright: © 2022 Douglas E. Rappaport. This is an open-access article distributed under the terms of The Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 18 December 2022 | Accepted: 22 December 2022 | Published: 30 December 2022
Keywords: emergency medicine; covid-19; ed overcrowding; quality improvement
Background:Overcrowding in Emergency Departments is associated with poor patient outcomes and low patient satisfaction; overcrowding has been exacerbated by the ongoing Covid-19 pandemic. One intervention used in both the H1N1 pandemic and the current Covid-19 pandemic is the deployment of temporary structures such as surge tents. Data on the effectiveness of such interventions is currently lacking.
Methods:In this retrospective study, we assess ED length of stay (LOS), percent of patients leaving without being seen, and 72-hour return rate in the time period during tent operation with equivalent time periods before and after tent use. Differences in outcomes were modeled and tested using Generalized Estimating Equations (GEEs) methodology and controlled for emergency severity index (ESI).
Results:Deployment of a Covid tent was associated with reduced LOS (227.5 vs. 214.5 min, ESI-adjusted p = 0.02). Additionally, we observed a significantly reduced rate of patients leaving without being seen (0.8% vs. 0.2%, ESI-adjusted p < 0.001) without any increase in the 72-hour return rate (4.2% vs 4.2%, ESI-adjusted p = 0.98) during the period of Covid tent operations.
Conclusion:This data suggests that the deployment of temporary structures such as tents is an effective means of decompressing EDs in the setting of the Covid-19 pandemic.
Emergency Department (ED) overcrowding is a widespread problem and is associated with poor patient outcomes and low patient satisfaction. Critically ill patients presenting to overcrowded EDs experience a longer duration of mechanical ventilation, longer ICU stays, and higher mortality [1]. However, this problem is not restricted to the critically ill as even lower acuity patients that present to, and are discharged from, overcrowded EDs have a higher risk of death within 10 days [1]. EDs have developed several mitigation strategies to decompress overcrowding including active bed management and the development of ED-ICUs [2, 3].
During the H1N1 influenza pandemic of 2009, EDs faced a surge in patient volumes. In many cases, EDs were forced to accommodate a doubling of their average daily census [4]. Many institutions rapidly expanded ED capacity, typically by repurposing existing hospital space. Some used climate-controlled tents to expand capacity [5]. This strategy is advantageous as it allows for rapid expansion of capacity and allows for isolation of potentially contagious patients outside the main ED. One single center study during the H1N1 pandemic revealed that an outdoor tent was associated with decreased patient elopement rates and reduced ED length of stay without significant changes in ED recidivism [4].
The emergence of the SARS-CoV-2 virus and the resultant Covid-19 pandemic exacerbated ED crowding. Many EDs, particularly those located within the geographic regions that experienced surges of cases, noted a rapid and steep increase in average daily patient census. Of note, many of these census increases have occurred despite precipitous declines in patients presenting with non-Covid-19 chief complaints [6].
Our 35-bed Emergency Department sees approximately 40,000 patients per year at a large tertiary care center and serves the Phoenix Metropolitan area with a population of 4.3 million. Arizona experienced a peak of 4,877 new cases/day (702 new cases per 1M) on July 1, 2020, and a peak hospital census for Covid-19 patients of 3,493 (503 hospitalizations per 1M) on July 15, 2020, during the “summer wave” of the Covid-19 pandemic. To rapidly expand capacity during this surge, we deployed a ‘Covid tent’ in the parking lot across from the main ED entrance that served low and moderate acuity patients with complaints consistent with Covid-19.
There is minimal existent data on the effectiveness of temporary tent structures on ED throughput and patient satisfaction in the setting of Covid-19 [7]. Many institutions deployed these structures based on data from previous pandemics such as the H1N1 influenza pandemic of 2009 [4, 5]. Given the significant differences between H1N1 and Covid-19 (including magnitude of pandemic, patient characteristics, treatment modalities and mortality) data on the effectiveness of this intervention in the setting of Covid-19 is urgently needed. The purpose of this study was to examine the effectiveness of our ‘Covid tent’ by analyzing ED patient length of stay, rate of patients leaving without being seen, and unexpected 72-hour return rate.
Study Design
We operated the tent for 40 days (July 10, 2020 to August 18, 2020) which corresponded to a surge of cases in the Phoenix, AZ metropolitan area. We selected an equivalent period before and after tent operations for comparison (June 19, 2020 to July 8, 2020 and August 19, 2020 to September 8, 2020). We retrospectively measured ED length of stay, percent of patients that left without seeing a provider, and percent of patients that returned to the ED within 72 hours (72-hour return rate) in the period before/after and during Covid tent operations. Our institutional review board identified this project as exempt from full approval process as it was conducted for quality review purposes.
Participant Selection
From July 10, 2020 (tent opening) to August 18, 2020 (tent closure), we assigned patients presenting to the ED between 9 am and 7 pm with symptoms consistent with SARS-CoV-2 infection (respiratory distress, shortness of breath, cough, sore throat, headache, loss of smell, change or loss of taste sensation, chills, body aches/myalgias, nausea, vomiting, or diarrhea) [8] to the Covid tent if they were symptomatic with heart rate < 120> 90 mmHg, respiratory rate < 30> 90%. We also assigned asymptomatic patients presenting to the ED requesting Covid testing to the tent. Patient age and the presence or absence of comorbidities were not used as triage criteria. We treated patients with suspected or confirmed SARS-CoV-2 infection
who were noted to have vital signs outside these parameters in the main
ED due to an increased likelihood of respiratory failure which would necessitate endotracheal intubation, mechanical ventilation, and other critical care interventions. The ED team saw all patients in the main ED after tent closure (7 pm) each evening.
Intervention
The Covid tent was a 2,500 square foot air-conditioned tent located in the parking lot across from the entrance of the main ED. The tent was sufficient to accommodate 5 bedded patients and 5 seated patients. We staffed the tent with 1 emergency physician, 3 RNs, 1 ED tech, and 1 radiology technician. The tent was equipped with portable x-ray capabilities, cardiac monitoring, phlebotomy, supplemental (low flow) oxygen therapy, limited oral/parenteral medications (antipyretics, antibiotics, analgesics, and antiemetics) in addition to IV fluids. If necessary, the tent team obtained additional medications and supplies from the main ED.
Measurements
We measured ED length of stay (in minutes), percentage of patients that left without being seen, and percentage of patients that returned within 72 hours (unexpected 72-hour return rate).
Setting
The Mayo Clinic Arizona Hospital is a 268-bed, urban, tertiary referral center located in Phoenix, AZ. The ED sees approximately 40,000 patients per year and can accommodate 26 roomed patients and 9 hallway patients. The ED serves patients of all ages while the hospital serves patients age ≥ 16 years old.
Statistics
Descriptive statistics are reported by time period (before/after tent deployment vs during tent deployment). Differences in outcomes by time period were modeled and tested using Generalized Estimating Equations (GEEs) methodology to estimate a model of the association between the outcome and time period, controlling for emergency severity index (ESI), and accounting for the association between visits from the same patient. As a secondary analysis, outcomes were compared between tent appropriate (TA) patients seen during the before/after tent time period and patients seen in the tent, also using GEE methods to control for ESI and account for within-patient association. In brief, TA patients were generated by applying the tent triage workflow (see Participant Selection above) to patients who presented to the ED during the before/after tent period. Analysis was performed using SAS 9.4. All tests were two-sided, with p < 0>
During tent operation (July 10, 2020 to August 18, 2020) the ED saw 4,209 patients (main ED + Covid tent) whereas the ED saw 4,596 patients in the equivalent time period before and after tent operation (June 19, 2020 to July 8, 2020 and August 19, 2020 to September 8, 2020). The tent inclusion criteria appropriately triaged patients as only 39 of 4,209 patients (0.92%) required transfer from the tent to the main ED. Conversely, only 3 of 4,209 patients (0.07%) were moved from the main ED to the tent. The demographics of the patients presenting to the ED before/after tent operation and during tent operation are shown in Table 1.
Table 1: Patient-visit demographics by time period
There were no statistical differences in patient age or gender composition between the two time periods. There was a subtle but statistically significant difference in the composition of patient reported race between the two time periods, likely due to the statistical power of the large data set. Of the 4,596 patients seen in the ED before/after tent operations, 4,348 (94.6%) were seen by a physician and 248 (5.4%) were nurse only visits (Table 2).
Table 2: Outcomes by time period
Nurse-only visits were asymptomatic patients presenting to the ED for SARS-CoV-2 nasopharyngeal testing. During the time period that the tent was in use, the department saw 4,209 patients, 3,868 (91.9%) of which were seen by a physician and 341 (8.1%) were nurse-only visits. The Covid tent saw 614 of those patients; 328 (53.4%) were seen by a physician and 286 (46.6%) were nurse-only visits. The acuity of patients presenting to the ED in the periods before/after and during Covid tent operations were similar as evidenced by comparable median ESI scores (3.0 vs. 3.0). Covid tent operation was associated with a shorter LOS compared to before/after tent operations (214.5 min vs. 227.5 min). After adjusting for ESI, the average LOS was 5.75 min shorter (95% CI: 0.81 –
10.68 min) during Covid tent operation (p = 0.02). Covid tent operations were also associated with a reduced rate of patients leaving without being seen (0.8% vs. 0.2%, ESI-adjusted p < 0>p = 0.98).
Next, we assessed the effectiveness of the Covid tent by comparing patients seen within the tent (see participant selection above) with patients who presented in the period before/after the tent was operational but would have been triaged to the tent had it been operational (tent appropriate) (Table 3).
Table 3: Outcomes among Tent Appropriate (TA) vs Tent patients
The average LOS was shorter for patients assigned to the Covid tent compared to tent appropriate patients seen in the period before/after tent deployment (61.7 min vs. 126.8 min). After adjusting for ESI, LOS among tent patients was 24.82 min shorter on average (95% CI: 17.21 – 32.44 min) compared to the LOS of tent appropriate patients (p < 0 xss=removed>
The use of temporary structures such as tents in accommodating the surge of Covid-19 patients is largely predicated on past experiences, such as the H1N1 influenza pandemic. However, Covid-19 poses challenges to the health care system that are unique such as more rapid community spread, and a higher burden of morbidity and mortality compared to influenza [9]. As such, it is critically important to assess the effectiveness of this intervention in the setting of Covid-19. Our single center retrospective study shows that the deployment of a ‘Covid tent’ was associated with a decreased length of stay and a decreased rate of patients leaving without being seen. These outcomes indicate that Covid tents are effective in decompressing crowded emergency departments. Importantly, the increased patient throughput was not associated with an increase in 72-hour return indicating that patients continued to receive appropriate emergency care. Lastly, we have shown that care is delivered faster in the Covid tent compared to “tent appropriate” patients seen in the main ED, likely due to a streamlined workflow. These results are in line with a recent study which found chest radiographs are obtained more expeditiously in a dedicated ‘fever tent’ compared to the usual radiography facilities in the setting of the Covid-19 pandemic [10]. An ED with a shorter length of stay and a decreased rate of patients leaving without being seen could impact patient satisfaction. Indeed, our internal patient satisfaction surveys showed a significant increase in patient satisfaction when comparing the time period when the tent was operational to equivalent time periods before/after tent operations (data not shown). While not assessed in this study, the deployment of surge tents like the one described in this study likely has the additional benefit of separating infectious Covid-19 patients from other susceptible patients thus reducing the likelihood of nosocomial infection.
This study does have several important limitations. This study is retrospective in nature and is single center. Additionally, our institution does not have an inpatient pediatric service and therefore pediatric ED visits are infrequent. As pediatric patients have differential rates of mild vs. severe disease compared to adult patients [11], these results may not be generalizable to pediatric emergency departments.
In this single-center retrospective study, the deployment of a ‘Covid tent’ was associated with a reduced patient LOS and rate of patients leaving without being seen. Additionally, no significant changes in 72-hour return rate were observed. Taken together, these data show that the deployment of temporary structures such as tents are an effective means to decompress EDs in the setting of the current Covid-19 pandemic.
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.
Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.
Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.
We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.
The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.
Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.
Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.
Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.
Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.
Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.
This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.
Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.
The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.
Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.
Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.
Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”
Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner
My Testimonial Covering as fellowing: Lin-Show Chin. The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews.
My experience publishing in Psychology and Mental Health Care was exceptional. The peer review process was rigorous and constructive, with reviewers providing valuable insights that helped enhance the quality of our work. The editorial team was highly supportive and responsive, making the submission process smooth and efficient. The journal's commitment to high standards and academic rigor makes it a respected platform for quality research. I am grateful for the opportunity to publish in such a reputable journal.
My experience publishing in International Journal of Clinical Case Reports and Reviews was exceptional. I Come forth to Provide a Testimonial Covering the Peer Review Process and the editorial office for the Professional and Impartial Evaluation of the Manuscript.
