COVID-19 second wave: appropriateness of admissions to the Emergency Department of a main metropolitan hospital in Milan

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Eleonora Bossi
Vincenza Gianfredi
Anna Odone
Davide Valsecchi
Stefano Franchini
Massimiliano Etteri
Guglielmo Cornero
Giuseppina Maria Casiraghi
Nicolò Maimeri
Paolo Federico Beccaria
Elena Moizo
Milena Mucci
Paolo Silvani
Valentina Paola Plumari
Giovanni Borghi
Nicola Pasculli
Alessia La Bruna
Martina Baiardo Redaelli
Antonio Dell'Acqua
Maria Luisa Azzolini
Francesca Guzzo
Ada Carla Alba
Stella Sordoni
Margherita Tozzi
Francesco Giuseppe Nisi
Stefano Fresilli
Alberto Zangrillo
Carlo Signorelli

Keywords

SARS-Cov-2, COVID-19, Emergency Department, Emergency Room, Appropriateness

Abstract

Background: In Europe, Italy and Lombardy, in autumn 2020, there was a steep increase in reported cases due to the second epidemic wave of SARS-Cov-2 infection. We aimed to evaluate the appropriateness of COVID-19 patients’ admissions to the ED of the San Raffaele Hospital.


Methods: We compared data between the inter-wave period (IWP, from 1st to 30th September) and the second wave period (WP, 1st October to 15th November) focusing on the ED presentation, discharge priority colour code and outcomes.


Results: Out of 977 admissions with a SARS-Cov-2 positive swab, 6% were in the IWP and 94% in the WP. Red, yellow and white code increased (these latter from 1.8% to 5.4%) as well as self-presented in yellow and white code. Discharges home increased from 1.8% to 5.4%, while hospitalizations decreased from 63% to 51%.


Discussion: We found a rise in white codes (among self-presented patients), indicating inappropriateness of admissions. The increase in discharges suggests that several patients did not require hospitalization.


Conclusions: The pandemic brought out the fundamental role of primary care to manage patients with low-intensity needs. The important increase in ED admissions of COVID-19 patients caused a reduction of NO-COVID-19 patients, with possible inadequate treatment.


 

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