ABSTRACT
Introduction. The Seasonal Continuity of Care (CAS) is a service of the Bergamo Health Protection Agency that provides medical and healthcare services, gua-ranteeing outpatient or home care to Italian and foreign tourists and seasonal workers during the months of July and August. The Covid-19 pandemic and the shortage of doctors made it impossible to provide the service in 2021 as in previous summer seasons. Aims. To activate a CAS service with the involvement of nurses. Methods. A "Hub -Spoke" network model was activated;nurses in the Spoke sites, with the patient in attendance, through teleconsul-tation by video call, made remote contact with a doctor in the Hub. Results. In the 3 Spoke CASs, from 2 to 22 August 2021, 274 services (of which 14.3% were telecon-sultations between the nurse at the Spoke CAS site and the doctor at the Hub site) and 162 repeat prescription re-quests were made. Teleconsultation was mainly performed for patients with acute pathology (71.8%), mainly for arth-ralgia and fever. In the majority of cases, it was sufficient to answer to the needs of the patient (87.2%);a small num-ber of cases were referred to a doctor's appointment (10.3%) or to Emergency Department (2.6%). Conclusions. Nurse triage reduced the time of medical visits, allowing more patients to be taken care of. The need for digital in-frastructure, training and integration with district servi-ces emerged.
ABSTRACT
Abstract: After SARS-CoV-2 vaccines development came at an unprecedented speed, ensuring safe and efficient mass immunization, vaccine delivery be-came the major public health mandate. Although mass-vaccination sites have been identified as essential to curb COVID-19, their organization and functioning is challenging. In this paper we present the planning, implementation and evalua-tion of a massive vaccination center in Lombardy - the largest Region in Italy and the most heavily hit by the pandemic. The massive hub of Novegro (Milan), managed by the Gruppo Ospedaliero San Donato, opened in April 2021. The Novegro mass-immunization model was developed building a la-yout based on the available scientific evidence, on comparative analysis with other existing models and on the experience of COVID-19 immunization delivery of Gruppo Ospedaliero San Donato. We propose a "vaccine islands" mass-immunization model, where 4 physicians and 2 nurses operate in each island, with up to 10 islands functioning at the same time, with the capacity of providing up to 6,000 vaccinations per day. During the first week of activity a total of 37,900 doses were administered (2,700/day), most of them with Pfizer vaccine (85.8%) and first doses (70.9%). The productivity was 10.5 vaccines/hour/vaccine station. Quality, efficiency and safety were boosted by ad-hoc personnel training, quality technical infrastructure and the presence of a shock room. Constant process monitoring allowed to identify and promptly tackle process pitfalls, including vaccine refusals (0.36%, below expectations) and post-vaccinations adverse reactions (0.4%). Our innovative "vaccine islands" mass-immunization model might be scaled-up or adapted to other settings. The Authors consider that sharing best practices in immunization delivery is fundamen-tal to achieve population health during health emergencies.