Overcrowding analysis in emergency department through indexes: a single center study.

INTRODUCTION: Overcrowding in the Emergency Department (ED) is one of the major issues that must be addressed in order to improve the services provided in emergency circumstances and to optimize their quality. As a result, in order to help the patients and professionals engaged, hospital organizations must implement remedial and preventative measures. Overcrowding has a number of consequences, including inadequate treatment and longer hospital stays; as a result, mortality and the average duration of stay in critical care units both rise. In the literature, a number of indicators have been used to measure ED congestion. EDWIN, NEDOCS and READI scales are considered the most efficient ones, each of which is based on different parameters regarding the patient management in the ED. METHODS: In this work, EDWIN Index and NEDOCS Index have been calculated every hour for a month period from February 9th to March 9th, 2020 and for a month period from March 10th to April 9th, 2020. The choice of the period is related to the date of the establishment of the lockdown in Italy due to the spread of Coronavirus; in fact on 9 March 2020 the Italian government issued the first decree regarding the urgent provisions in relation to the COVID-19 emergency. Besides, the Pearson correlation coefficient has been used to evaluate how much the EDWIN and NEDOCS indexes are linearly dependent. RESULTS: EDWIN index follows a trend consistent with the situation of the first lockdown period in Italy, defined by extreme limitations imposed by Covid-19 pandemic. The 8:00-20:00 time frame was the most congested, with peak values between 8:00 and 12:00. on the contrary, in NEDOCS index doesn't show a trend similar to the EDWIN one, resulting less reliable. The Pearson correlation coefficient between the two scales is 0,317. CONCLUSION: In this study, the EDWIN Index and the NEDOCS Index were compared and correlated in order to assess their efficacy, applying them to the case study of the Emergency Department of "San Giovanni di Dio e Ruggi d'Aragona" University Hospital during the Covid-19 pandemic. The EDWIN scale turned out to be the most realistic model in relation to the actual crowding of the ED subject of our study. Besides, the two scales didn't show a significant correlation value.

A Fuzzy Inference System for the Assessment of Indoor Air Quality in an Operating Room to Prevent Surgical Site Infection.

Indoor air quality in hospital operating rooms is of great concern for the prevention of surgical site infections (SSI). A wide range of relevant medical and engineering literature has shown that the reduction in air contamination can be achieved by introducing a more efficient set of controls of HVAC systems and exploiting alarms and monitoring systems that allow having a clear report of the internal air status level. In this paper, an operating room air quality monitoring system based on a fuzzy decision support system has been proposed in order to help hospital staff responsible to guarantee a safe environment. The goal of the work is to reduce the airborne contamination in order to optimize the surgical environment, thus preventing the occurrence of SSI and reducing the related mortality rate. The advantage of FIS is that the evaluation of the air quality is based on easy-to-find input data established on the best combination of parameters and level of alert. Compared to other literature works, the proposed approach based on the FIS has been designed to take into account also the movement of clinicians in the operating room in order to monitor unauthorized paths. The test of the proposed strategy has been executed by exploiting data collected by ad-hoc sensors placed inside a real operating block during the experimental activities of the "Bacterial Infections Post Surgery" Project (BIPS). Results show that the system is capable to return risk values with extreme precision.