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Ann R Coll Surg Engl ; 103(7): 487-492, 2021 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-34192487

RESUMEN

INTRODUCTION: In response to the COVID-19 pandemic, our emergency general surgery (EGS) service underwent significant restructuring, including establishing an enhanced ambulatory service and undertaking nonoperative management of selected pathologies. The aim of this study was to compare the activity of our EGS service before and after these changes. METHODS: Patients referred by the emergency department were identified prospectively over a 4-week period beginning from the date our EGS service was reconfigured (COVID) and compared with patients identified retrospectively from the same period the previous year (Pre-COVID), and followed up for 30 days. Data were extracted from handover documents and electronic care records. The primary outcomes were the rate of admission, ambulation and discharge. RESULTS: There were 281 and 283 patients during the Pre-COVID and COVID periods respectively. Admission rate decreased from 78.7% to 41.7%, while there were increased rates of ambulation from 7.1% to 17.3% and discharge from 6% to 22.6% (all p<0.001). For inpatients, mean duration of admission decreased (6.9 to 4.8 days), and there were fewer operative or endoscopic interventions (78 to 40). There were increased ambulatory investigations (11 to 39) and telephone reviews (0 to 39), while early computed tomography scan was increasingly used to facilitate discharge (5% vs 34.7%). There were no differences in 30-day readmission or mortality. CONCLUSIONS: Restructuring of our EGS service in response to COVID-19 facilitated an increased use of ambulatory services and imaging, achieving a decrease of 952 inpatient bed days in this critical period, while maintaining patient safety.


Asunto(s)
COVID-19/prevención & control , Servicio de Urgencia en Hospital/organización & administración , Tratamiento de Urgencia/estadística & datos numéricos , Cirugía General/organización & administración , Servicio de Cirugía en Hospital/organización & administración , Adulto , Anciano , Procedimientos Quirúrgicos Ambulatorios/estadística & datos numéricos , COVID-19/diagnóstico , COVID-19/epidemiología , COVID-19/transmisión , Tratamiento Conservador/estadística & datos numéricos , Servicio de Urgencia en Hospital/normas , Servicio de Urgencia en Hospital/estadística & datos numéricos , Tratamiento de Urgencia/métodos , Tratamiento de Urgencia/normas , Femenino , Estudios de Seguimiento , Cirugía General/normas , Cirugía General/estadística & datos numéricos , Mortalidad Hospitalaria , Humanos , Control de Infecciones/organización & administración , Control de Infecciones/normas , Masculino , Persona de Mediana Edad , Pandemias/prevención & control , Readmisión del Paciente/estadística & datos numéricos , Seguridad del Paciente/normas , Estudios Prospectivos , Derivación y Consulta/organización & administración , Derivación y Consulta/normas , Derivación y Consulta/estadística & datos numéricos , Estudios Retrospectivos , SARS-CoV-2/aislamiento & purificación , Servicio de Cirugía en Hospital/normas , Servicio de Cirugía en Hospital/estadística & datos numéricos
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