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


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


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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[1] P. Romagnani, G. Gnone, F. Guzzi, S. Negrini, A. Guastalla, F. Annunziato, S. Romagnani and R. De Palma, “The COVID-19 infection: lessons from the Italian experience,” J Public Health Pol, vol. 41, pp. 238-244, 2020.
[2] C. Signorelli, A. Odone, V. Gianfredi , E. Bossi, D. Bucci, A. Oradini-Alacreu, B. Frascella, M. Capraro, F. Chiappa, L. Blandi and F. Ciceri, “The spread of COVID-19 in six western metropolitan regions: a false myth on the excess of mortality in Lombardy and the defense of the city of Milan,” Acta Biomed [Internet], vol. 91, no. 2, pp. 23-30, 11 May 2020.
[3] C. Signorelli, A. Odone, V. Gianfredi , E. Bossi, D. Bucci, A. Oradini-Alacreu, B. Frascella, M. Capraro, F. Chiappa, L. Blandi and F. Ciceri, “COVID-19 mortality rate in nine high-income metropolitan regions,” Acta Biomed [Internet], vol. 91, no. 9-S, pp. 7-18, 20 Jul 2020.
[4] A. Odone, D. Delmonte, T. Scognamiglio and C. Signorelli, “COVID-19 deaths in Lombardy, Italy: data in context ,” The Lancet Public Health, vol. 5, no. 6, p. e310, 24 Apr 2020.
[5] “Dashboard Protezione Civile,” [Online]. Available: . [Accessed 03 Gennaio 2020].
[6] “Characteristics of SARS-CoV-2 patients dying in Italy - Report based on available data on April 28th, 2021,” Istituto Superiore di Sanità, Roma, 2021.
[7] F. Paciullo, D. Giannandrea, V. Gianfredi, F. Borgognoni, P. Verdecchia, P. L'Angiocola and M. Monti, “Epidemiology of emergency calls for time-dependent acute illnesses during COVID-19 outbreak in Umbria region (Italy),” Ann Ig, vol. 33, no. 2, pp. 198-200, Mar-Apr 2021.
[8] A. Zangrillo, L. Beretta, P. Silvani, S. Colombo, A. Scandroglio, A. Dell'Acqua, E. Fominskiy, G. Landoni, G. Monti, M. Azzolini, F. Monaco, A. Oriani, A. Belletti, M. Sartorelli, O. Pallanch, O. Saleh, C. Sartini, P. Nardelli, G. Lombardi, F. Morselli, T. Scquizzato, A. Frontera, A. Ruggeri, R. Scotti, A. Assanelli, L. Dagna, P. Rovere-Querini , A. Castagna, P. Scarpellini, D. Di Napoli, A. Ambrosio, F. Ciceri and M. Tresoldi, “Fast reshaping of intensive care unit facilities in a large metropolitan hospital in Milan, Italy: facing the COVID-19 pandemic emergency,” Crit Care Resusc, vol. 22, no. 2, pp. 91-94, 1 Apr 2020.
[9] Atto di Intesa Ministero della salute - Conferenza Stato-Regioni, G.U. n. 285, 7 dicembre 2001.
[10] E. Palma, D. Antonaci, A. Colì and G. Cicolini, “Analysis of emergency medical services triage and dispatch errors by registered nurses in Italy,” J Emerg Nurs, vol. 40, no. 5, pp. 476-83, Sep 2014 .
[11] L. Tsai , C. Chien, C. Chen , C. Chaou , C. Ng and M. Lo, “Impact of the Coronavirus Disease 2019 Pandemic on an Emergency Department Service: Experience at the Largest Tertiary Center in Taiwan,” Risk Manag Healthc Policy, vol. 14, pp. 771-777, 2021.
[12] B. Boserup , M. McKenney , Elkbuli A and A. Elkbuli, “The impact of the COVID-19 pandemic on emergency department visits and patient safety in the United States,” Am J Emerg Med, vol. 38, no. 9, pp. 1732-1736, Sep 2020.
[13] J. Giamello, S. Abram, S. Bernardi and G. Lauria, “The emergency department in the COVID-19 era. Who are we missing?,” European Journal of Emergency Medicine, vol. 27, no. 4, pp. 305-306, Aug 2020.
[14] K. Danhieux, V. Buffel, A. Pairon, A. Benkheil, R. Remmen, E. Wouters and J. van Olmen , “The impact of COVID-19 on chronic care according to providers: a qualitative study among primary care practices in Belgium,” BMC Fam Pract, vol. 21, no. 255, 5 Dec 2020.
[15] A. Amerio , A. Odone , A. Aguglia , V. Gianfredi, L. Bellini, D. Bucci , G. Gaetti, M. Capraro , S. Salvati , G. Serafini , C. Signorelli, M. Amore and S. Ghaemi, “La casa de papel: A pandemic in a pandemic,” J Affect Disord, vol. 277, pp. 53-54, 1 Dec 2020.
[16] A. Amerio, A. Aguglia , A. Odone, V. Gianfredi, G. Serafini , C. Signorelli and M. Amore, “Covid-19 pandemic impact on mental health of vulnerable populations,” Acta Biomed [Internet], vol. 91, no. 9-S, pp. 95-96, 20 Jul 2020.
[17] Regional Decision n. 3379 of 09/05/2012 - Further information regarding heatlhcare in relation ti Decision n. 2633 0f 06/12/2011 "Determinations regarding the management of the Regional Health Service for the year 2012".
[18] S. Rawaf, N. Luke, F. Stigler, D. Kringos, H. Yamamoto and C. van Weel, “& On behalf of the Global Forum on Universal Health Coverage and Primary Health Care. Lessons on the COVID-19 pandemic, for and by primary care professionals worldwide,” European Journal of General Practice, vol. 26, no. 1, pp. 129-133, 2020.

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