Process Management and Outcomes of the Emergency Department of a Training and Research Hospital in Turkey During the Coronavirus Disease 2019 Pandemic (TR/ENG)

Year 2020, Issue: Special Issue on COVID 19, 263 - 283, 20.03.2020

Kurtuluş Açıksarı , Kerem Kınık

https://doi.org/10.21673/anadoluklin.740776

Cited By: 9

Abstract

Aim: The cooperation and coordination of the emergency department, which welcomes patients during the management of disasters such as the coronavirus disease 2019 (COVID-19) pandemic with the other clinics in a hospital, facilitates the former’s work. In this research, we studied our hospital’s emergency department management during the COVID-19 pandemic and the outcomes of such management.
Material and Method: In this study, the process followed by patients who visited the tertiary emergency department between March 1, 2020, and April 30, 2020, the preparations made in the emergency department in response to the COVID-19 pandemic via management of confirmed and suspected cases, and the COVID-19 preliminary triage system and its outcomes were evaluated. The statistical significance level was accepted as p < 0.05.
Results: An increase in the total arrival rate (from 50.1% to 66.8%; p < 0.01) was identified in March 2020 compared to March 2019, and a decrease in the total arrival rate was identified in April 2020 (from 49.9% to 33.2%; p < 0.01) compared to April 2019. Admission to all clinics was identified as having decreased 1.35 times and the number of consultations for infectious diseases identified as having increased 3.81 times in April 2020 compared to March 2020. A total of 89.2% of the computed tomography chest scans requested from the emergency department between March 21, 2020, and April 30, 2020, were due to suspected COVID-19. A preliminary triage center was set up outside the emergency department to isolate these patients. Approximately 66.6% of the suspected COVID-19 patients in March 2020 and 91% in April 2020 were discharged for home isolation and followed up with. Arrivals at the emergency department decreased by 66.7% (p < 0.01) during the curfews in April but increased by 142.9% on the first day after the curfews (p < 0.01).
Conclusion: Pandemics are unforeseen circumstances that deeply influence the operations of both emergency departments and the entire hospital. Emergency departments require a multidisciplinary management system to make and implement decisions quickly via cooperation and coordination with other clinics in the hospital during the management of disasters like the COVID-19 pandemic. 

Keywords

Emergency Department, COVID-19, Pandemics

Türkiye’de bir Eğitim Araştırma Hastanesi Acil Servisinde Koronavirus Hastalığı 2019 Pandemi Sürecinin Yönetimi ve Sonuçları (TR/ENG)

Abstract

Amaç: COVID-19 pandemisi gibi afetlerin yönetiminde hastaları ilk karşılayan acil servislerin hastanedeki diğer kliniklerle olan iş birliği ve koordinasyonu acil servislerin işleyişini kolaylaştırmaktadır. Çalışmamızda COVID-19 salgınındaki acil servis yönetimimizi ve bunun sonuçlarını araştırdık.

Gereç ve Yöntemler: Bu çalışmada 1 Mart 2020 ile 30 Nisan 2020 tarihleri arasındaki 3.basamak bir acil servise başvuran hastaların süreci ve bu süreçteki Covid-19 tanılı ve şüpheli vakaların yönetimi ile acil servisteki Covid-19 pandemisine cevap için yapılan hazırlıklar ve Covid-19 ön triyaj sistemi ve sonuçları değerlendirildi. İstatistik anlamlılık düzeyi olarak p<0,05 alındı.

Bulgular: 2019 göre 2020 Mart ayı toplam başvuru oranında artış olduğu (p<0.01; %50,1’den %66,8’e), Nisan ayı toplam başvuru oranında ise düşüş olduğu (p <0.01; %49,9’dan %33,2’ye), saptandı. 2020 Nisan ayında Mart ayına göre tüm kliniklere hasta yatışı 1,35 kat azaldığı, enfeksiyon hastalıkları konsültasyon sayısının 3,81 kat arttığı saptandı. 21 Mart ile 30 Nisan 2020 tarihleri arasında acil servisten istenen toraks bilgisayarlı tomografilerinin %89,2’sinin nedeni COVID-19 şüphesi ile olmuştu. Acil servisin dışında COVID-19 şüpheli hastalar ayrımı için ön triyaj kuruldu. 2020 Mart ayında COVID-19 şüpheli hastaların %66,6’sı, Nisan ayında ise %91’i evde izolasyona gönderilerek takip edildi. Nisan ayında sokağa çıkma yasağı uygulanan günlerde acil servis başvuruları %66,7 azalırken (p<0,01) sokağa çıkma yasağının bittiği günlerdeki acil servis başvuruları %142,9 artmıştı (p<0,01).

Sonuç: Pandemiler önceden öngörülemeyen durumlardır ve tüm hastane ile beraber acil servis işleyişini derinden etkilemektedir. COVID-19 pandemisi gibi afetlerin yönetiminde acil servislerin hastanedeki diğer kliniklerle olan iş birliği ve koordinasyonu ile hızlı kararlar alıp uygulayabilen multidisipliner yönetim sistemine ihtiyaçları vardır. 

Keywords

COVID-19, Pandemik, Acil Servis

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