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

Yıl 2020, , 263 - 283, 20.03.2020

Kurtuluş Açıksarı , Kerem Kınık

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

Cited By: 9

Öz

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. 

Anahtar Kelimeler

Emergency Department, COVID-19, Pandemics

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

Öz

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. 

Anahtar Kelimeler

COVID-19, Pandemik, Acil Servis

Kaynakça

• Zhonghua Liu Xing Bing Xue Za Zhi. [The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19) in China]. Epidemiology Working Group for NCIP Epidemic Response, Chinese Center for Disease Control and Prevention. 10 Şubat 2020;41(2):145-51.
• Yang X, Yu Y, Xu J, Shu H, Xia J, Liu H, vd. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med. 2020;8(5):475-81.
• WHO. Coronavirus Disease (COVID-19) Outbreak. 2020; Erişim adresi: https://www.who.int
• Ali I. COVID-19: Are we ready for the second wave? Disaster Med Public Health Prep. 2020;1-8.
• World Health Organization. Coronavirus Disease 2019 (COVID-19) Situation Report - 49. World Health Organization. [Internet]. 2020. Erişim adresi: https://www.who.int/emergencies/diseases/novelcoronavirus-2019/situation-reports/.
• Coronavirus Disease 2019 (COVID-19) Italian Situation, Press release. [Internet]. Italian Civil Protection.; Erişim adresi: http://www.protezionecivile.it/web/guest/mediacommunication/press-release/detail/-/asset_publisher/default/content/ coronavirus-sono-7-985-i-positivi.
• TC Sağlık Bakanlığı. COVID-19 Erişkin Tedavi Algoritması [Internet]. 2020. Erişim adresi: https://COVID19bilgi.saglik.gov.tr/depo/algoritmalar/COVID19-PLKACILHASTAYONETIMI.pdf
• Demirtas T, Tekiner H. Filiation: A Historical Term the COVID-19 Outbreak Recalled in Turkey. Erciyes Med J. 2020;42(0):0.
• Ageron F-X, Sarasin F, Pasquier M, Carron P-N. [Emergency department : COVID-19 crisis and organizational aspects]. Rev Med Suisse. 06 Mayıs 2020;16(692):924-9.
• Russo T. Pandemic planning. Emerg Med Serv. Ekim 2006;35(10):51-2, 54, 56 passim.
• Muscatello DJ, Bein KJ, Dinh MM. Influenza-associated delays in patient throughput and premature patient departure in emergency departments in New South Wales, Australia: A time series analysis. Emergency Medicine Australasia. Şubat 2018;30(1):77-80.
• Carenzo L, Costantini E, Greco M, Barra FL, Rendiniello V, Mainetti M, vd. Hospital surge capacity in a tertiary emergency referral centre during the COVID-19 outbreak in Italy. Anaesthesia. 04 Nisan 2020;
• Li R, Pei S, Chen B, Song Y, Zhang T, Yang W, vd. Substantial undocumented infection facilitates the rapid dissemination of novel coronavirus (SARS-CoV-2). Science. 01 Mayıs 2020;368(6490):489-93.
• Corman VM, Landt O, Kaiser M, Molenkamp R, Meijer A, Chu DK, vd. Detection of 2019 novel coronavirus (2019-nCoV) by real-time RT-PCR. Euro Surveill. 2020;25(3).
• Long C, Xu H, Shen Q, Zhang X, Fan B, Wang C, vd. Diagnosis of the Coronavirus disease (COVID-19): rRT-PCR or CT? European Journal of Radiology. Mayıs 2020;126:108961.
• Wong HYF, Lam HYS, Fong AH-T, Leung ST, Chin TW-Y, Lo CSY, vd. Frequency and Distribution of Chest Radiographic Findings in COVID-19 Positive Patients. Radiology. 27 Mart 2019;201160.
• Yuan M, Yin W, Tao Z, Tan W, Hu Y. Association of radiologic findings with mortality of patients infected with 2019 novel coronavirus in Wuhan, China. Schildgen O, editör. PLoS ONE. 19 Mart 2020;15(3):e0230548.
• Paglia S. First Line COVID-19. Emergency Department Organizational Management within Epidemic or Pre-Epidemic Outbreak Areas. Operational Guidelines for Emergency Care. Italian Society of Emergency Medicine. (https://www.simeu.it/w/articoli/leggiArticolo/337/dir).