García Santos José M, Plasencia Martínez Juana M, Fabuel Ortega Pablo, Lozano Ros Marina, Sánchez Ayala María Carmen, Pérez Hernández Gloria, Menchón Martínez Pedro
Radiology Department, University General Hospital Morales Meseguer, C/ Marqués de Los Vélez, s/n., 30008, Murcia, Spain.
Primary Care Health Center Vistabella-La Flota, 6th Health Area, Comunidad Autónoma de la Región de Murcia, Murcia, Spain.
Insights Imaging. 2021 Jan 4;12(1):1. doi: 10.1186/s13244-020-00954-8.
Possible COVID-19 pneumonia patients (ppCOVID-19) generally overwhelmed emergency departments (EDs) during the first COVID-19 wave. Home-confinement and primary-care phone follow-up was the first-level regional policy for preventing EDs to collapse. But when X-rays were needed, the traditional outpatient workflow at the radiology department was inefficient and potential interpersonal infections were of concern. We aimed to assess the efficiency of a primary-care high-resolution radiology service (pcHRRS) for ppCOVID-19 in terms of time at hospital and decision's reliability.
We assessed 849 consecutive ppCOVID-19 patients, 418 through the pcHRRS (home-confined ppCOVID-19 with negative-group 1- and positive-group 2-X-rays) and 431 arriving with respiratory symptoms to the ED by themselves (group 3). The pcHRRS provided X-rays and oximetry in an only-one-patient agenda. Radiologists made next-step decisions (group 1: pneumonia negative, home-confinement follow-up; group 2: pneumonia positive, ED assessment) according to X-ray results. We used ANOVA and Bonferroni correction, Student T, Chi tests to analyse changes in the ED workload, time-to-decision differences between groups, potential delays in patients acceding through the ED, and pcHRRS performance for deciding admission.
The pcHRRS halved ED respiratory patients (49.2%), allowed faster decisions (group 1 vs. home-discharged group 2 and group 3 patients: 0:41 ± 1:05 h; 3:36 ± 2:58 h; 3:50 ± 3:16 h; group 1 vs. all group 2 and group 3 patients: 0:41 ± 1:05 h; 5.25 ± 3.08; 5:36 ± 4:36 h; group 2 vs. group 3 admitted patients: 5:27 ± 3:08 h vs. 7:42 ± 5:02 h; all p < 0.001) and prompted admission (84/93, 90.3%) while maintaining time response for ED patients.
Our pcHRRS may be a more efficient entry-door for ppCOVID-19 by decreasing ED patients and making expedited decisions while guaranteeing social distance.
在新冠疫情第一波期间，疑似新冠病毒肺炎患者（ppCOVID - 19）通常使急诊科不堪重负。居家隔离和基层医疗电话随访是防止急诊科不堪重负的一级区域政策。但当需要进行X光检查时，放射科传统的门诊工作流程效率低下，且存在潜在的人际感染风险。我们旨在从住院时间和决策可靠性方面评估基层医疗高分辨率放射学服务（pcHRRS）对ppCOVID - 19患者的效率。
我们评估了849例连续的ppCOVID - 19患者，其中418例通过pcHRRS评估（居家隔离的ppCOVID - 19患者，X光检查结果为阴性的第1组和阳性的第2组），431例自行出现呼吸道症状前往急诊科（第3组）。pcHRRS在单人就诊流程中提供X光检查和血氧饱和度测量。放射科医生根据X光检查结果做出下一步决策（第1组：肺炎阴性，居家隔离随访；第2组：肺炎阳性，急诊科评估）。我们使用方差分析和Bonferroni校正、学生t检验、卡方检验来分析急诊科工作量的变化、组间决策时间差异、通过急诊科就诊的患者可能出现的延误以及pcHRRS决定入院的表现。
pcHRRS使急诊科呼吸道患者数量减半（49.2%），能够更快做出决策（第1组与居家出院的第2组和第3组患者相比：0:41 ± 1:05小时；3:36 ± 2:58小时；3:50 ± 3:16小时；第1组与所有第2组和第3组患者相比：0:41 ± 1:05小时；5.25 ± 3.08；5:36 ± 4:36小时；第2组与第3组入院患者相比：5:27 ± 3:08小时 vs. 7:42 ± 5:02小时；所有p < 0.001），并促使患者入院（84/93，90.3%），同时保持对急诊科患者的响应时间。
我们的pcHRRS可能是ppCOVID - 19患者更高效的就诊途径，通过减少急诊科患者数量并在保证社交距离的同时加快决策速度。
