Between the firstand secondwave of the 2019 coronavirus pandemic (COVID-19): Presentation and crowding of attenders for neurological disorders. experience of lombardy ED

ABSTRACT

Background: During the first wave of the CoViD-19 pandemic, we witnessed a drastic reduction in the total number of accesses, in the face of more serious cases and a exorbitant increase in crowding, especially linked to the access block. It is due by three orders of factors those at the access (input);those related to the patient's process (throughput);and those at the exit from the PS (output). The latter are considered the main responsible for Crowding. Purpose: Evaluated the population who went to ED for neurological disorders between the first and second wave of the pandemic. Materials and Methods: We evaluated all the patients who were accessing our emergency room for neurological disorders from May 1 to October 20, 2020 and during the same period of the previous year. Results and discussion: We have enrolled 3297 patients. There was a light reduction in the total number of accesses for acute neurological disorders 1589 in the CoViD period and 1708 in the previous year. The vital parameters, age and sex were overlapping without statistically significant differences. The higher code (yellow and red) of priority to doc and the exit severity codes were stackable (59% vs 50% and 34% vs 30% respectively) and also the need of hospitalization (42% vs 38%). Crowding input factors are slightly lower, in a not statistically significant way, in the pandemic period number of patients (1589 vs 1708) and average waiting times (80min vs 85 min) accesses. The percentage of patients who exceeded the waiting time target by code of priority to the medical visit was also overlapping (21% vs 22%). Crowding throughput factors worsened LOS (593 vs 487min). Crowding output factors also worsened the percentage of access block is higher during the pandemic (14% vs 9%). The Total Access Block Time is significantly higher in the CoViD period both for the examination rooms (116.373 vs 65.027 min) and for the holding area (64.640 vs 41.959 min). Conclusion: In the period between the two pandemic peaks we had a slight reduction in ED accesses for acute neurological disorders. Patients were found to have comparable severity, need for hospitalization, and need for high-intensity care. The pandemic period however, it has changed the way the whole hospital works for the necessary execution of swabs on entry and exit. In the period between the two waves the exit block phenomenon persisted, albeit relieved, and the process time was longer with a consequent workload on EDs.