Analysis of the impact of the 2019 coronavirus epidemic (COVID-19) on the presentation and crowding of attenders for chest pain ATA lombarded

ABSTRACT

Introduction: Crowding has been defined as a global problem and causes a reduction in the quality of care and patient satisfaction. It is due to three orders of factors those of access (input);those referable to the patient's process (throughput);and those leaving the PS (output). The latter are held to be the main culprits of Crowding. Purpose: To evaluate the impact of the CoViD pandemic on the population who went to the emergency room for chest pain. Materials and Methods: We evaluated all patients who accessed our PS for chest pain from 22 February to 1 May 2020 and in the same period of the previous year Results and discussion: We enrolled 1611 patients. There is a severe reduction in the total number of accesses for chest pain 593 in the CoViD period and 1,018 in 2019. The vital parameters are comparable. Patients in the CoViD pandemic are most frequently accompanied by ambulance in 118 (68% vs 41%, the remaining half autonomous). The priority codes for the medical examination are no different. Patients in the CoViD pandemic have higher discharge severity codes (yellow and red) more frequently (24% vs 17%) and more frequently need hospitalization (25% vs 18%). Crowding input factors are lower in the pandemic period reduced attenders (593 vs 1.018) and reduced average waiting times (70min vs 94 min). The percentage of patients who exceeded the waiting time target set by priority code at the medical examination is also lower during the pandemic (35% vs 50%). Crowding throughput factors have worsened LOS (540 vs 430 min). Crowding output factors have also worsened the percentage of access blocks is higher during the pandemic (10% vs 6%). Total Access Block Time is significantly higher in the CoViD period both for the examination rooms (53,796 vs 41,451 min) and for the holding area (15,266 vs 8,419 min). The interpretation of the data must also take into account the increased finding of late heart attacks highlighted by the literature in the period of the epidemic and also published by a group of our Polyclinic. Conclusion: The epidemic has led to a reduction in accesses for chest pain, especially in self-reported ones. Patients had more frequent hospitalization needs and more severe exit codes. The period of the pandemic presented a worse crowding for these patients due to the Access Block.