Department of Biomedical Sciences, Universita degli Studi di Padova, Padova, Italy
Emergency Department, San Bassiano Hospital, ULSS7 Pedemontana, Bassano del Grappa, Italy.
Emerg Med J. 2022 Jul;39(7):554-558. doi: 10.1136/emermed-2021-212056. Epub 2022 Mar 23.
To accommodate and separate the large numbers of patients going to hospital with COVID-19, many EDs had to create new pathways for patients. We describe the outcomes of patients treated in a nurse-led alternate care site (ACS) at our hospital.
This was a retrospective study of outcomes of patients managed at the ACS of 'San Bassiano' Hospital ED, Bassano del Grappa, Italy between 9 March and 16 April 2020. Self-presenting patients aged 5 years and older, suspected of having COVID-19, were initially diverted to the ACS. Patients with a National Early Warning Score ≥5 or with a desaturation ≥4% after the walking test were sent back to the main ED COVID-19 path for further evaluation and medical attention and were not further followed up. In the ACS, patients received a CXR, blood samples and a nasopharyngeal swab to test for SARS-CoV-2, and were sent home. An emergency physician reviewed the results later and called the patient back 5-6 hours later with instructions to return for medical evaluation of abnormal findings, or to seek their general practitioner's attention. Patients received a follow-up phone call 15 days later to learn of their course.
A total of 487 patients were fully managed in the ACS and discharged home. Of the 392 (80.5%) patients with no abnormalities after the workup and instructed to stay at home, 29 reattended the ED in the next 15 days, and 13 were admitted. Among the 95 patients asked to return and receive medical attention, 20 were admitted and of those discharged, 3 reattended the ED within 15 days. At 15 days, no patient was deceased or received invasive ventilation; one admitted patient received non-invasive ventilation.
A nurse-led ACS diverted a substantial proportion of patients from main ED resources without associated negative clinical outcomes.
为了容纳和分流大量因 COVID-19 而前往医院的患者，许多急诊部不得不为患者创建新的通道。我们描述了在我们医院的护士主导的替代护理点 (ACS) 治疗的患者的结局。
这是一项回顾性研究，研究对象为 2020 年 3 月 9 日至 4 月 16 日期间在意大利 Bassano del Grappa 的“San Bassiano”医院急诊科 ACS 接受治疗的患者的结局。自我呈现的年龄在 5 岁及以上、疑似患有 COVID-19 的患者最初被分流至 ACS。行走试验后 National Early Warning Score ≥5 或有 4%以上的血氧饱和度下降的患者被送回主 ED COVID-19 通道进行进一步评估和医疗关注，不再进一步随访。在 ACS，患者接受了胸部 X 光检查、血液样本和鼻咽拭子以检测 SARS-CoV-2，并被送回家。一名急诊医生随后查看了结果，并在 5-6 小时后给患者打电话，告知他们返回 ACS 评估异常发现，或寻求全科医生的关注。患者在 15 天后接到随访电话以了解他们的病情。
共有 487 名患者在 ACS 中得到全面管理并出院回家。在检查后无异常且被指示留在家中的 392 名（80.5%）患者中，29 名在接下来的 15 天内重新就诊于 ED，其中 13 名患者被收治入院。在被要求返回并接受医疗关注的 95 名患者中，20 名患者被收治入院，出院的患者中，有 3 名在 15 天内再次就诊 ED。在 15 天内，没有患者死亡或接受有创通气；一名收治入院的患者接受了无创通气。
护士主导的 ACS 将大量患者从主 ED 资源中分流出来，而没有产生相关的负面临床结局。
