Fondazione IRCCS Policlinico San Matteo, Department of Emergency Medicine, Pavia, Italy.
University of Pavia, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, Pavia, Italy.
West J Emerg Med. 2021 Jul 16;22(4):860-870. doi: 10.5811/westjem.2021.2.49611.
Healthcare patterns change during disease outbreaks and pandemics. Identification of modified patterns is important for future preparedness and response. Emergency department (ED) crowding can occur because of the volume of patients waiting to be seen, which results in delays in patient assessment or treatment and impediments to leaving the ED once treatment is complete. Therefore, ED crowding has become a growing problem worldwide and represents a serious barrier to healthcare operations.
This observational study was based on a retrospective review of the epidemiologic and clinical records of patients who presented to the Foundation IRCCS Policlinic San Matteo in Pavia, Italy, during the coronavirus disease 2019 (COVID-19) outbreak (February 21-May 1, 2020, pandemic group). The methods involved an estimation of the changes in epidemiologic and clinical data from the annual baseline data after the start of the COVID-19 pandemic.
We identified reduced ED visits (180 per day in the control period vs 96 per day in the pandemic period; P < 0.001) during the COVID-19 pandemic, irrespective of age and gender, especially for low-acuity conditions. However, patients who did present to the ED were more likely to be hemodynamically unstable, exhibit abnormal vital signs, and more frequently required high-intensity care and hospitalization. During the pandemic, ED crowding dramatically increased primarily because of an increased number of visits by patients with high-acuity conditions, changes in patient management that prolonged length of stay, and increased rates of boarding, which led to the inability of patients to gain access to appropriate hospital beds within a reasonable amount of time. During the pandemic, all crowding output indices increased, especially the rates of boarding (36% vs 57%; P < 0.001), "access block" (24% vs 47%; P < 0.001), mean boarding time (640 vs 1,150 minutes [min]; P 0.001), mean "access block" time (718 vs 1,223 min; P < 0.001), and "access block" total time (650,379 vs 1,359,172 min; P < 0.001).
Crowding in the ED during the COVID-19 pandemic was due to the inability to access hospital beds. Therefore, solutions to this lack of access are required to prevent a recurrence of crowding due to a new viral wave or epidemic.
在疾病爆发和大流行期间，医疗模式会发生变化。识别这些变化对于未来的准备和应对非常重要。由于待诊患者数量过多，急诊部（ED）可能会出现拥挤现象，这会导致患者评估或治疗延迟，以及完成治疗后离开 ED 受到阻碍。因此，ED 拥挤已成为全球日益严重的问题，代表着医疗运营的严重障碍。
本观察性研究基于意大利帕维亚圣马泰奥基金会 IRCCS 教学医院在 2019 年冠状病毒病（COVID-19）爆发期间（2020 年 2 月 21 日至 5 月 1 日，大流行组）的回顾性回顾性分析。该方法包括在 COVID-19 大流行开始后，根据年度基线数据估算流行病学和临床数据的变化。
我们发现 COVID-19 大流行期间 ED 就诊量减少（对照期每天 180 次就诊，大流行期每天 96 次就诊；P<0.001），无论年龄和性别如何，尤其是对于低危疾病。然而，确实前往 ED 的患者更有可能出现血流动力学不稳定、生命体征异常，并且更频繁地需要高强度护理和住院治疗。在大流行期间，ED 拥挤情况急剧增加，主要是因为高病情患者就诊人数增加、患者管理方式改变导致住院时间延长以及住院率增加，导致患者无法在合理时间内获得合适的病床。在大流行期间，所有拥挤输出指标均增加，尤其是住院率（36%比 57%；P<0.001）、“准入阻塞”（24%比 47%；P<0.001）、平均住院时间（640 分钟比 1150 分钟[min]；P<0.001）、“准入阻塞”时间（718 分钟比 1223 分钟；P<0.001）和“准入阻塞”总时间（650379 分钟比 1359172 分钟；P<0.001）。
COVID-19 大流行期间 ED 拥挤是由于无法获得病床所致。因此，需要解决这种缺乏准入的问题，以防止由于新的病毒波或流行再次出现拥挤。
