ABSTRACT
Background: The lockdown related to the SARS-CoV-2 pandemic has imposed profound changes in the interaction of the population with hospitals and emergency departments. The main aim of this research was to evaluate the impact of lockdown on the activity of obstetrics and gynecology emergency department (OGED) in a teaching hospital, hub center, for COVID-19. Methods: The study considers all visits to the OGED with their different triage color codes that represent the clinical severity of each case (from the most severe to the least one: red, yellow, green, white). Data were selected through the "PSNet" triage program and collected anonymously. We analyzed frequency distributions of the variables separately for each woman and calculated mean and standard deviations for continuous variables. We then analyzed the association between factors and outcomes for categorical variables (expressed as a number and percentage of the total) using the chi-square test (χ2). The level of significance was established with p < 0.05. Statistical analysis was performed using SPSS Statistics V20.0. Given the fact that the study has a retrospective observational nature and it is based on an anonymous routine database, approval by the Local Ethics Committee was not necessary. Results: The relative decrease of patients presenting to OGED in 2020 was -50.96%. The percentage of nonpregnant women was significantly lower in 2020 compared to 2019 (p ≤ 0.0001; Δ = -79.46%). Regarding the obstetric group, we saw an important decrease of visits in 2020 compared to 2019 (p < 0.0001; Δ = -40%). The prevalence of yellow codes was significantly higher in 2020 (Δ = +29.72%), while that of white (Δ = -61.58%) and green (Δ = -52.22%) codes was significantly lower (p ≤ 0.0001). Comparing the diagnoses at discharge, we could highlight significant reductions in 2020 for more than one diagnosis: bleeding (p ≤ 0.0001; Δ = -70.42%), pain (p ≤ 0.0001; Δ = -81.22%), urinary diseases (p = 0.004; Δ = -75.64%), and gastrointestinal diseases (p ≤ 0.0001; Δ = -87.50%). Conclusions: An evident change emerged in relation to the dynamics between the local obstetrical and gynecological population, and OGED resources. The COVID-19 lockdown greatly reduced the rate of admission to OGED without time-related obstetric and gynecological complications. The reduction of admissions suggests a more appropriate use of the ED by patients that may inspire future policies for the implementation of emergency services.
ABSTRACT
INTRODUCTION The main problems of Emergency Departments (ED) is overcrowding. The lockdown related to SARS-CoV2 pandemic imposed changes in the interaction of population with ED. This study evaluates the impact of lockdown on the activity of obstetrics and gynecology emergency department (OGED) in a teaching hospital, hub centre for COVID-19. METHODS This is a retrospective monocentric study, comparing all admissions to OGED during the lockdown period in 2020 (from March 09 to May 04) with the same period of 2019. The data were selected through the triage program 'PS NET' and collect anonymously. We analyzed frequency distributions of the variables separately for each woman, calculated mean and standard deviations for continue variables. Then we analyzed the association between factors and outcomes for the categorical variables (expressed as number and percentage of the total) by using Chi-square test (v2).The level of significance was set with p < .05. Statistical analysis was performed using SPSS Statistics V20.0. RESULTS The decrease of patients presenting to OGED was -50.96%, with a significant reduction for both Italian (Δ = -55.22%) and other nationalities (Δ = -41.77%) more significant for the first group (p=.006). The percentage of nonpregnant women was lower (p =< .0001;Δ = -79.46%). Regarding the obstetrical group we saw a reduction of -40%. We saw a decrease of the permanence times, mainly regarding stays that exceeded 120 min (Δ = -60.92%), in a similar way the range from 30 to 60 min (Δ = -58.49%). The prevalence of yellow codes was higher in 2020 (D=+29.72%), while it was lower for white (Δ = -61.58%) and green (Δ = -52.22%) codes (p =< .0001). Regarding the admission symptoms and signs the decrease was significant for Pain (Δ = -73.58%, p < .0001) and for gastrointestinal problems (Δ = -80.00%;p=.036). We observed a reduction for all the diagnosis at discharge with significant reductions for: bleeding (p =< .0001;Δ = -70.42%), pain (p =< .0001;Δ = -81.22%), urinary (p=.004;D= -75.64%) and gastrointestinal diseases (p =< .0001;Δ = -87.50%). Among obstetrical patients we found an increase of yellow codes (Δ = +51.6%;p=.005);70.9% was in the third trimester, with a decrease in the rate of accesses during the first trimester of Δ = -56.16% and of Δ = -66.01% during the second trimester of pregnancy(p < .0001). The rate of hospitalization rose from 21.9% to 34.9% (p < .0001). The percentage of patients admitted to OGED for contractions and then hospitalized rose (p < .0001;Δ = +360.7%). None of long term adverse outcomes showed significant changes despite the reduction in the number of accesses during lockdown. CONCLUSIONS An evident change emerged, describing the dynamics of the interactions between the local population and OGED. The COVID-19 lockdown reduced the rate of admission without adverse long term fetal or maternal outcomes. This reduction suggests a more appropriate use of the OGED that may inspire future policies for the implementation of emergency services. Implementing local health services to manage non-specific symptoms, more clear communication regarding how to manage pregnancy related symptoms during planned check ups, more expensive bills for accessing for non urgent reasons, could be useful for an appropriate use of OGED, resulting in less crowding, shorter waiting times and at ease staff during working hours.