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2.
Med J (Ft Sam Houst Tex) ; (PB 8-21-01/02/03): 34-36, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33666910

RESUMO

BACKGROUND: The COVID-19 pandemic creates unique challenges for healthcare systems. While mass casualty protocols and plans exist for trauma-induced large-scale resource utilization events, contagious infectious disease mass casualty events do not have such rigorous procedures established. COVID-19 forces Emergency Departments (EDs) to simultaneously treat seriously ill patients and evaluate large influxes of 'worried well'-while maintaining both staff and patient safety. METHODS: The objectives of this project are to create an avenue to evaluate large surges of patients while minimizing hospital-acquired infections. After identifying areas for improvement and anticipating potential failures, we devised eight healthcare delivery innovations to address those areas and meet our objectives: (1) Parallel ED Lanes (2) Universal Respiratory Precautions (3) Respiratory Drive Through (RDT) (4) Medical Company (5) Provider Triage (6) ED Quarterback Patient Liaison (EDQB) (7) Virtual Registration (8) Virtual Ward. RESULTS: To date, no staff members have contracted COVID-19 within the ED footprint. Our RDT has seen 16,994 patients and the medical company 1,109. Provider triage has redirected 465 patients, while our EDQB has interacted with 532 and redirected 93 patients for same-day appointments with their Primary Care Manager (PCM). CONCLUSION: The system of care establish at our Military Treatment Facility (MTF) has been effective in maximizing staff and patient safety, while providing a new patient-centered healthcare delivery apparatus.


Assuntos
/prevenção & controle , Infecção Hospitalar/prevenção & controle , Serviço Hospitalar de Emergência/organização & administração , Hospitais Militares , Controle de Infecções/organização & administração , Triagem/organização & administração , /diagnóstico , Infecção Hospitalar/diagnóstico , Infecção Hospitalar/transmissão , Humanos , Centros de Atenção Terciária
3.
J Laryngol Otol ; 135(3): 241-245, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33648611

RESUMO

OBJECTIVE: Utilisation of the Head and Neck Cancer Risk Calculator version 2 has been recommended during the coronavirus disease 2019 pandemic for the assessment of head and neck cancer referrals. As limited data were available, this study was conducted to analyse the use of the Head and Neck Cancer Risk Calculator version 2 in clinical practice. METHOD: Patients undergoing telephone triage in a two-week wait referral clinic were included. Data were collected and analysed using appropriate methods. RESULTS: Sixty-four patients in the study were risk-stratified into low-risk (51.6 per cent, 33 of 64), moderate-risk (14.1 per cent, 9 of 64) and high-risk (34.4 per cent, 22 of 64) groups. Of the patients, 53.1 per cent (34 of 64) avoided an urgent hospital visit, and 96.9 per cent (62 of 64) were cancer free, while 3.1 per cent (2 of 64) were found to have a head and neck malignancy. The sensitivity, specificity, negative predictive value and accuracy were 50.00 per cent, 66.13 per cent, 99.92 per cent and 66.11 per cent, respectively. CONCLUSION: It is reasonable to use the calculator for triaging purposes, but it must always be accompanied by a meticulous clinical thought process.


Assuntos
/epidemiologia , Neoplasias de Cabeça e Pescoço/diagnóstico , Otolaringologia/organização & administração , Encaminhamento e Consulta/organização & administração , Consulta Remota/organização & administração , Triagem/organização & administração , /prevenção & controle , Humanos , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Medição de Risco , Sensibilidade e Especificidade , Telefone , Fatores de Tempo , Reino Unido
4.
Ital J Pediatr ; 47(1): 47, 2021 Mar 03.
Artigo em Inglês | MEDLINE | ID: mdl-33658068

RESUMO

BACKGROUND: Coronavirus Disease-19 (COVID-19) has rapidly become a pandemic emergency, distressing health systems in each affected country. Preparation strategies for managing this pandemic have been keys to face the COVID-19 surge all over the world and all levels of care. MATERIALS AND METHODS: During the epidemic, the Italian society of pediatric emergency-urgency (SIMEUP) promoted a national survey aiming to evaluate preparedness and response of pediatric emergency departments (PED) critical in ensuring optimal management of COVID-19 cases. RESULTS: Our results suggest that Italian PED have promptly set a proactive approach to the present emergency. 98.9% of the hospitals have defined special pathways and assistive protocols concerning the management of pediatric COVID-19 cases. The highest percentage of application of the measures for preventive and protective for COVID-19 concerned the use of personal protective equipments. CONCLUSIONS: Results show that the following measures for pediatric patients, admitted in PED, have been promptly implemented throughout the whole country: eg. use of protective devices, pre-triage of patients accessing the hospital. Despite COVID-19 being a new threat, we have shown that by developing an easy-to-follow decision algorithm and clear plans for the interventional platform teams, we can ensure optimal health care workers and patients' safety.


Assuntos
/prevenção & controle , Serviço Hospitalar de Emergência/organização & administração , Controle de Infecções/organização & administração , Medicina de Emergência Pediátrica/organização & administração , /epidemiologia , Criança , Protocolos Clínicos , Hospitalização , Humanos , Itália , Equipamento de Proteção Individual , Inquéritos e Questionários , Triagem/organização & administração
5.
BMJ Health Care Inform ; 28(1)2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33685943

RESUMO

OBJECTIVES: Identifying those individuals requiring medical care is a basic tenet of the pandemic response. Here, we examine the COVID-19 community triage pathways employed by four nations, specifically comparing the safety and efficacy of national online 'symptom checkers' used within the triage pathway. METHODS: A simulation study was conducted on current, nationwide, patient-led symptom checkers from four countries (Singapore, Japan, USA and UK). 52 cases were simulated to approximate typical COVID-19 presentations (mild, moderate, severe and critical) and COVID-19 mimickers (eg, sepsis and bacterial pneumonia). The same simulations were applied to each of the four country's symptom checkers, and the recommendations to refer on for medical care or to stay home were recorded and compared. RESULTS: The symptom checkers from Singapore and Japan advised onward healthcare contact for the majority of simulations (88% and 77%, respectively). The USA and UK symptom checkers triaged 38% and 44% of cases to healthcare contact, respectively. Both the US and UK symptom checkers consistently failed to identify severe COVID-19, bacterial pneumonia and sepsis, triaging such cases to stay home. CONCLUSION: Our results suggest that whilst 'symptom checkers' may be of use to the healthcare COVID-19 response, there is the potential for such patient-led assessment tools to worsen outcomes by delaying appropriate clinical assessment. The key features of the well-performing symptom checkers are discussed.


Assuntos
/diagnóstico , Informática em Saúde Pública/organização & administração , Avaliação de Sintomas/métodos , Triagem/organização & administração , Autoavaliação Diagnóstica , Letramento em Saúde/estatística & dados numéricos , Humanos , Japão , Singapura
7.
Am J Respir Crit Care Med ; 203(3): 287-295, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-33522881

RESUMO

The burdens of the coronavirus disease (COVID-19) pandemic have fallen disproportionately on disadvantaged groups, including the poor and Black, Latinx, and Indigenous communities. There is substantial concern that the use of existing ICU triage protocols to allocate scarce ventilators and critical care resources-most of which are designed to save as many lives as possible-may compound these inequities. As governments and health systems revisit their triage guidelines in the context of impending resource shortages, scholars have advocated a range of alternative allocation strategies, including the use of a random lottery to give all patients in need an equal chance of ICU treatment. However, both the save-the-most-lives approach and random allocation are seriously flawed. In this Perspective, we argue that ICU triage policies should simultaneously promote population health outcomes and mitigate health inequities. These ethical goals are sometimes in conflict, which will require balancing the goals of maximizing the number of lives saved and distributing health benefits equitably across society. We recommend three strategies to mitigate health inequities during ICU triage: introducing a correction factor into patients' triage scores to reduce the impact of baseline structural inequities; giving heightened priority to individuals in essential, high-risk occupations; and rejecting use of longer-term life expectancy and categorical exclusions as allocation criteria. We present a practical triage framework that incorporates these strategies and attends to the twin public health goals of promoting population health and social justice.


Assuntos
/epidemiologia , Cuidados Críticos/organização & administração , Disparidades em Assistência à Saúde/organização & administração , Triagem/organização & administração , Populações Vulneráveis/estatística & dados numéricos , Disparidades nos Níveis de Saúde , Humanos
11.
Lancet Respir Med ; 9(4): 430-434, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33450202

RESUMO

The COVID-19 pandemic strained health-care systems throughout the world. For some, available medical resources could not meet the increased demand and rationing was ultimately required. Hospitals and governments often sought to establish triage committees to assist with allocation decisions. However, for institutions operating under crisis standards of care (during times when standards of care must be substantially lowered in the setting of crisis), relying on these committees for rationing decisions was impractical-circumstances were changing too rapidly, occurring in too many diverse locations within hospitals, and the available information for decision making was notably scarce. Furthermore, a utilitarian approach to decision making based on an analysis of outcomes is problematic due to uncertainty regarding outcomes of different therapeutic options. We propose that triage committees could be involved in providing policies and guidance for clinicians to help ensure equity in the application of rationing under crisis standards of care. An approach guided by egalitarian principles, integrated with utilitarian principles, can support physicians at the bedside when they must ration scarce resources.


Assuntos
/terapia , Cuidados Críticos/organização & administração , Alocação de Recursos para a Atenção à Saúde/organização & administração , Pandemias/prevenção & controle , Triagem/organização & administração , Comitês Consultivos/organização & administração , Comitês Consultivos/normas , Cuidados Críticos/economia , Cuidados Críticos/normas , Cuidados Críticos/estatística & dados numéricos , Tomada de Decisões Gerenciais , Saúde Global/economia , Saúde Global/normas , Alocação de Recursos para a Atenção à Saúde/economia , Alocação de Recursos para a Atenção à Saúde/normas , Política de Saúde , Humanos , Colaboração Intersetorial , Pandemias/economia , Guias de Prática Clínica como Assunto , Padrão de Cuidado/economia , Triagem/normas
12.
Am J Emerg Med ; 40: 6-10, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33326911

RESUMO

BACKGROUND: A suicide bomber attack occurred in Somalia's capital city of Mogadishu on October 14, 2017. Over 500 people died, making it the third largest suicide bombing attack in world history. In this study, we aimed to share our experience and to discuss the importance of triage and prehospital care systems. METHODS: These retrospective data included data from patients who suffered from severe explosions. Patient triage was performed using the START (Simple Triage and Rapid Treatment) triage algorithm at the entrance of the hospital. The patients included in the study were classified according to their age, sex, triage code, location of their major injury, department to which they were admitted, and discharge and/or exit status. RESULTS: The patients included 188 (74.6%) males, and the mean age was 30.94 ± 12.23 years (range, 1-80 years). Eighty-six (34.1%) patients were marked with a red code indicating major injury, and 138 (54.8%) patients had superficial injuries. A total of 173 (68.7%) patients were managed in the emergency department (ED), and 7 (2.8%) patients died in the first 24 h. Multiple trauma injuries were detected in 43 (17.1%) patients, and 31 (12.3%) patients were admitted to the orthopedics department. CONCLUSION: Disaster management in a terrorist event requires rapid transport, appropriate triage, effective surgical approaches, and specific postoperative care. In this event, almost all patients were brought to the ED by lay rescuers. Appropriate triage algorithms for the public can be designed; for instance, green code: walking patient; yellow code: patient who is moving and asking for help; red code: unmoving or less mobile patient who is breathing; black code: nonbreathing patient.


Assuntos
Traumatismos por Explosões/terapia , Serviços Médicos de Emergência/organização & administração , Incidentes com Feridos em Massa , Trabalho de Resgate , Terrorismo , Transporte de Pacientes/métodos , Triagem/organização & administração , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Somália
13.
Thorax ; 76(3): 302-312, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33334908

RESUMO

The surge in cases of severe COVID-19 has resulted in clinicians triaging intensive care unit (ICU) admissions in places where demand has exceeded capacity. In order to assist difficult triage decisions, clinicians require clear guidelines on how to prioritise patients. Existing guidelines show significant variability in their development, interpretation, implementation and an urgent need for a robust synthesis of published guidance. To understand how to manage which patients are admitted to ICU, and receive mechanical ventilatory support, during periods of high demand during the COVID-19 pandemic, a systematic review was performed. Databases of indexed literature (Medline, Embase, Web of Science, and Global Health) and grey literature (Google.com and MedRxiv), published from 1 January until 2 April 2020, were searched. Search terms included synonyms of COVID-19, ICU, ventilation, and triage. Only formal written guidelines were included. There were no exclusion criteria based on geographical location or publication language. Quality appraisal of the guidelines was performed using the Appraisal of Guidelines for Research and Evaluation Instrument II (AGREE II) and the Appraisal of Guidelines for Research and Evaluation Instrument Recommendation EXcellence (AGREE REX) appraisal tools, and key themes related to triage were extracted using narrative synthesis. Of 1902 unique records identified, nine relevant guidelines were included. Six guidelines were national or transnational level guidance (UK, Switzerland, Belgium, Australia and New Zealand, Italy, and Sri Lanka), with one state level (Kansas, USA), one international (Extracorporeal Life Support Organization) and one specific to military hospitals (Department of Defense, USA). The guidelines covered several broad themes: use of ethical frameworks, criteria for ICU admission and discharge, adaptation of criteria as demand changes, equality across health conditions and healthcare systems, decision-making processes, communication of decisions, and guideline development processes. We have synthesised the current guidelines and identified the different approaches taken globally to manage the triage of intensive care resources during the COVID-19 pandemic. There is limited consensus on how to allocate the finite resource of ICU beds and ventilators, and a lack of high-quality evidence and guidelines on resource allocation during the pandemic. We have developed a set of factors to consider when developing guidelines for managing intensive care admissions, and outlined implications for clinical leads and local implementation.


Assuntos
/epidemiologia , Cuidados Críticos/organização & administração , Hospitalização , Humanos , Respiração Artificial , Triagem/organização & administração
14.
Emergencias (Sant Vicenç dels Horts) ; 32(6): 395-402, dic. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-197991

RESUMO

OBJETIVOS: Desarrollar un modelo predictivo de ingreso hospitalario desde triaje de los pacientes atendidos en el servicio de urgencias hospitalario (SUH) con el nivel poco urgente-no urgente de prioridad de visita. MÉTODO: Estudio observacional de cohortes retrospectivo unicéntrico. Se incluyeron los episodios de pacientes > 15años con niveles IV-V MAT-SET atendidos en un SUH durante 2015. Se evaluaron 14 variables demográficas, datos de proceso y constantes vitales. La variable dependiente fue el ingreso hospitalario. Se utilizaron modelos de regresión basados en ecuaciones de estimación generalizadas. RESULTADOS: Se incluyeron 53.860 episodios, 3.430 (6,4%) ingresaron. La mediana de edad fue de 44,5 años (RIC31,1-63,9), 54,1% mujeres. Un 19,3% de los episodios tenían registrados las constantes vitales (CV). El modelo con mayor capacidad predictiva incluía las siguientes variables: edad ≥ 85 años (ORa = 6,72; IC 95%: 5,26-8,60), sexo masculino (ORa = 1,46; IC 95% 1,28-1,66), procedencia de atención primaria (ORa = 1,94; IC 95% 1,64-2,29), de otro hospital de agudos (ORa = 11,22; IC 95% 4,42-28,51), llegada en ambulancia (ORa = 3,72; IC 95%:3,16-4,40),consulta previa a urgencias las 72 horas previas (ORa = 2,15; IC 95% 1,60-2,87), presión arterial sistólica ≥ 150mmHg (ORa = 0,83; IC 95%:0,71-0,97), presión arterial diastólica < 60 mmHg (ORa = 1,57; IC 95% 1,25-1,98), temperatura axilar > 37ºC (ORa = 2,29; IC 95% 1,91-2,74), frecuencia cardiaca > 100 latidos/minuto (ORa 1,65; IC 95%1,40-1,96) y saturación basal de oxígeno < 93% (ORa = 2,66; IC 95% 1,86-3,81) y 93-95% (ORa = 1,70; IC 95%1,42-2,05). El área bajo la curva COR fue de 0,82 (IC 95% 0,80-0,83). CONCLUSIONES: Este modelo predictivo permitiría identificar desde el triaje a aquellos pacientes que, siendo poco urgentes o no urgentes, tienen mayor probabilidad de ingreso y darles una atención diferencial dentro del mismo nivel de prioridad


OBJECTIVE: To develop a model to predict hospital admission of patients in cases assessed as nonurgent or semi-urgent on emergency department triage. METHODS: Single-center observational study of a retrospective cohort. We included cases of patients older than 15 years whose emergency was classified as level IV-V according to the Andorran-Spanish triage model (MAT-SET, the Spanish acronym). Fourteen independent variables included demographic and care process items as well as vital signs. The dependent variable was hospital admission. The regression models were based on generalized estimating equations. RESULTS: A total of 53 860 episodes were included; 3430 patients (6.4%) were admitted. The median (interquartile range) age was 44.5 (31.1-63.9) years, and 54.1% were female. Vital signs were recorded in 19.3% of the episodes. The model that best predicted admission included the following variables: age > 84 years (adjusted odds ratio [aOR], 6.72; 95% CI,5.26-8.60); male sex (aOR, 1.46; 95% CI, 1.28-1.66); referral from a primary care center (aOR, 1.94; 95% CI, 1.64-2.29); referral from another acute-care hospital (aOR, 11.22; 95% CI, 4.42-28.51); arrival by ambulance (aOR, 3.72; 95% CI,3.16-4.40); revisit < 72 hours (aOR, 2.15; 95% CI, 1.60-2.87); systolic blood pressure ≥ 150 mmHg (aOR, 0.83; 95% CI,0.71-0.97); diastolic blood pressure < 60 mmHg (aOR, 1.57; 95% CI, 1.25-1.98); axillary temperature > 37°C (aOR, 2.29;95% CI, 1.91-2.74); heart rate > 100 beats/min (aOR, 1.65; 95% CI, 1.40-1.96); baseline oxygen saturation in arterialblood (SaO2) < 93% (aOR, 2.66; 95% CI, 1.86-3.81); and SaO293%-95% (aOR, 1.70; 95% CI, 1.42-2.05). The area under the receiver operating characteristic curve for the model was 0.82 (95% CI; 95% CI, 0.80-0.83). CONCLUSION: The model predicts which patients are more likely to be admitted after their cases were initially considered non urgent or semi-urgent on triage. Patients found to be at risk can then be given greater attention than others in the same triage level


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Hospitalização , Previsões/métodos , Triagem/organização & administração , Serviço Hospitalar de Emergência/normas , Estudos de Coortes , Triagem/normas , Estudos Retrospectivos , Valor Preditivo dos Testes , Análise Multivariada
15.
Eur Rev Med Pharmacol Sci ; 24(21): 11440-11444, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33215467

RESUMO

OBJECTIVE: A computerized system of telephone consultation has been experimented at the Pediatric Emergency Department (ED) of Policlinico Gemelli Hospital in Rome during the outbreak of Coronavirus Disease 2019 (COVID-19). MATERIALS AND METHODS: Twenty monothematic items with a series of questions to evaluate child's clinical conditions have been set up in order to evaluate the different situations according to their severity. All items were highlighted according to conventional scores corresponding to the different answers (yes/no) given by the child's parents. This system has been implemented with large diffusion of computer programs and applications by the availability of a computer station in every ED room. RESULTS: The system allows healthcare workers to establish the medical check-up urgency which may be immediate, within the next 24 hours or scheduled in the pediatric ward. Therefore, it has been implemented a telephone triage consultation with a standardized method. CONCLUSIONS: Telephone consultation during outbreaks, considering the risks of contagion, allows healthcare workers to decrease the concern of families and to reduce indiscriminate access to ED. The remote approach will not solve logistic and setting problems related to COVID-19 outbreak17, but it would be a valid tool to improve medical evaluation without deep change in infrastructure and clinical organization.


Assuntos
Infecções por Coronavirus/prevenção & controle , Serviço Hospitalar de Emergência/organização & administração , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Encaminhamento e Consulta/organização & administração , Telefone , Triagem/organização & administração , Betacoronavirus/patogenicidade , Criança , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/virologia , Implementação de Plano de Saúde , Acesso aos Serviços de Saúde/organização & administração , Humanos , Itália/epidemiologia , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Pneumonia Viral/virologia , Avaliação de Programas e Projetos de Saúde , Centros de Atenção Terciária/organização & administração , Fatores de Tempo
16.
Eur Rev Med Pharmacol Sci ; 24(21): 11445-11454, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33215472

RESUMO

In Italy, SARS-CoV-2 outbreak registered a high transmission and disease rates. During the acute phase, oncologists provided to re-organize services and prioritize treatments, in order to limit viral spread and to protect cancer patients. The progressive reduction of the number of infections has prompted Italian government to gradually loosen the national confinement measures and to start the "Second phase" of measures to contain the pandemic. The issue on how to organize cancer care during this post-acute SARS-CoV-2 phase appears crucial and a reassessment of healthcare services is needed requiring new models of care for oncological patients. In order to address major challenges in cancer setting during post-acute SARS-CoV-2 phase, this work offers multidimensional solutions aimed to provide a new way to take care of cancer patients.


Assuntos
Controle de Doenças Transmissíveis/organização & administração , Infecções por Coronavirus/prevenção & controle , Oncologia/organização & administração , Modelos Organizacionais , Neoplasias/terapia , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Betacoronavirus/patogenicidade , Técnicas de Laboratório Clínico/normas , Controle de Doenças Transmissíveis/normas , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Serviços Hospitalares de Assistência Domiciliar/organização & administração , Serviços Hospitalares de Assistência Domiciliar/normas , Humanos , Itália/epidemiologia , Oncologia/normas , Neoplasias/diagnóstico , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Triagem/organização & administração , Triagem/normas
17.
Emergencias ; 32(5): 320-331, 2020 09.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-33006832

RESUMO

OBJECTIVES: To estimate the impact of the coronavirus disease 2019 (COVID-19) pandemic on the organization of Spanish hospital emergency departments (EDs). To explore differences between Spanish autonomous communities or according to hospital size and disease incidence in the area. MATERIAL AND METHODS: Survey of the heads of 283 EDs in hospitals belonging to or affiliated with Spain's public health service. Respondents evaluated the pandemic's impact on organization, resources, and staff absence from work in March and April 2020. Assessments were for 15-day periods. Results were analyzed overall and by autonomous community, hospital size, and local population incidence rates. RESULTS: A total of 246 (87%) responses were received. The majority of the EDs organized a triage system, first aid, and observation wards; areas specifically for patients suspected of having COVID-19 were newly set apart. The nursing staff was increased in 83% of the EDs (with no subgroup differences), and 59% increased the number of physicians (especially in large hospitals and locations where the COVID-19 incidence was high). Diagnostic tests for the severe acute respiratory syndrome coronavirus 2 were the resource the EDs missed most: 55% reported that tests were scarce often or very often. Other resources reported to be scarce were FPP2 and FPP3 masks (38% of the EDs), waterproof protective gowns (34%), and space (32%). More than 5% of the physicians, nurses, or other emergency staff were on sick leave 20%, 19%, and 16% of the time. These deficiencies were greatest during the last half of March, except for tests, which were most scarce in the first 15 days. Large hospital EDs less often reported that diagnostic tests were unavailable. In areas where the COVID-19 incidence was higher, the EDs reported higher rates of staff on sick leave. Resource scarcity differed markedly by autonomous community and was not always associated with the incidence of COVID-19 in the population. CONCLUSION: The COVID-19 pandemic led to organizational changes in EDs. Certain resources became scarce, and marked differences between autonomous communities were detected.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Pesquisas sobre Serviços de Saúde , Pandemias , Pneumonia Viral/epidemiologia , Absenteísmo , Adulto , Técnicas de Laboratório Clínico , Infecções por Coronavirus/diagnóstico , Surtos de Doenças , Serviço Hospitalar de Emergência/organização & administração , Recursos em Saúde/provisão & distribução , Necessidades e Demandas de Serviços de Saúde , Mão de Obra em Saúde/estatística & dados numéricos , Número de Leitos em Hospital , Hospitais Públicos/organização & administração , Hospitais Públicos/estatística & dados numéricos , Humanos , Incidência , Recursos Humanos em Hospital/estatística & dados numéricos , Pneumonia Viral/diagnóstico , Alocação de Recursos , /etiologia , Espanha/epidemiologia , Triagem/organização & administração
19.
Emerg Med J ; 37(12): 773-777, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33127743

RESUMO

BACKGROUND: Public health mitigation strategies in British Columbia during the pandemic included stay-at-home orders and closure of non-essential services. While most primary physicians' offices were closed, hospitals prepared for a pandemic surge and emergency departments (EDs) stayed open to provide care for urgent needs. We sought to determine whether ED paediatric presentations prior and during the COVID-19 pandemic changed and review acuity compared with seasonal adjusted prior year. METHODS: We analysed records from 18 EDs in British Columbia, Canada, serving 60% of the population. We included children 0-16 years old and excluded those with no recorded acuity or discharge disposition and those left without being seen by a physician. We compared prepandemic (before the first COVID-19 case), early pandemic (after first COVID-19 case) and peak pandemic (during public health emergency) periods as well as a similar time from the previous year. RESULTS: A reduction of 57% and 70% in overall visits was recorded in the children's hospital ED and the general hospitals EDs, respectively. Average daily visits declined significantly during the peak-pandemic period (167.44±40.72) compared with prepandemic period (543.53±58.8). Admission rates increased mainly due to the decrease in the rate of visits with lower acuity. Children with complaints of 'fever' and 'gastrointestinal' symptoms had both the largest overall volume and per cent reduction in visits between peak-pandemic and prior year (79% and 74%, respectively). CONCLUSION: Paediatric emergency medicine attendances were reduced to one-third of normal numbers during the 2020 COVID-19 lockdown in British Columbia, Canada, with the reduction mainly seen in minor illnesses that do not usually require admission.


Assuntos
Infecções por Coronavirus/epidemiologia , Medicina de Emergência/organização & administração , Serviço Hospitalar de Emergência/organização & administração , Hospitais Pediátricos/organização & administração , Pneumonia Viral/epidemiologia , Adolescente , Betacoronavirus/patogenicidade , Colúmbia Britânica/epidemiologia , Criança , Pré-Escolar , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Emergências/epidemiologia , Medicina de Emergência/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Acesso aos Serviços de Saúde/organização & administração , Acesso aos Serviços de Saúde/estatística & dados numéricos , Hospitais Pediátricos/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Masculino , Pandemias/prevenção & controle , Admissão do Paciente/estatística & dados numéricos , Alta do Paciente/estatística & dados numéricos , Pneumonia Viral/diagnóstico , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Triagem/organização & administração , Triagem/estatística & dados numéricos
20.
Ann Ital Chir ; 91: 345-351, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33055390

RESUMO

INTRODUCTION: The recent Sars-CoV2 pandemic has dramatically slowed patients' access to our clinic for vascular pathology when the contagion curve peaked. The need to restore the assistance activity has led us to adopt new individual prophylaxis and hygiene measures. METHODS: Doctors and staff must wear dedicated clothes. Mask and gloves are mandatory for patients. A visit is scheduled every 60 minutes to allow the sanitation of the rooms. The day before the visit patients are contacted by telephone for the Covid-19 risk triage. In the presence of symptoms the visit is postponed. In the presence of other risk factors a IgG/IgM Rapid Test for Covid-19 is performed on admission to the clinic. In the presence of fever, if an extraordinary rapid test cannot be performed, the visit must be postponed. Rapid test positive patients cannot be visited: they are placed in solitary confinement at their home waiting for a nasopharyngeal swab for Covid-19. When the rapid test is positive, immediate room sanitation also occurs. The rooms dedicated to the outpatient clinic as well as medical and not medical instruments are disinfected. CONCLUSION: The one adopted can be a useful management model for any type of care activity in order to guarantee the safety of patients and all the staff. KEY WORDS: COVID-19, Management, vascular, Outpatient clinic.


Assuntos
Betacoronavirus , Cardiologia/organização & administração , Técnicas de Laboratório Clínico , Infecções por Coronavirus/prevenção & controle , Controle de Infecções/métodos , Ambulatório Hospitalar/organização & administração , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Anticorpos Antivirais/sangue , Agendamento de Consultas , Betacoronavirus/imunologia , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Desinfecção , Formulários como Assunto , Hospitais Universitários/organização & administração , Humanos , Higiene/normas , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Controle de Infecções/organização & administração , Controle de Infecções/normas , Itália/epidemiologia , Nasofaringe/virologia , Equipamento de Proteção Individual , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Guias de Prática Clínica como Assunto , Avaliação de Sintomas , Termometria , Triagem/organização & administração
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