The limitation of accessing hospital services due to COVID-19 pandemic: a pilot study of the telephone triage to re-organize the access to a Center for Sexual Health in North-West Italy.

ABSTRACT

BACKGROUND: The COVID-19 pandemic-related health crisis has imposed measures aimed at reducing the overcrowding of health facilities, by developing telemedicine and by forcing many STI clinics to book appointments by telephone. In this work we evaluate the performance of the nursing telephone triage system, introduced in the major STI center in Northwest Italy, for the adequacy of clinical pathways for of symptomatic STI patients. METHODS: From January to March 2021, all symptomatic patients wishing to access the CeMuSS center first underwent nurse-led telephone triage. Symptoms suggestive of STIs were further classified into four syndromic presentations cutaneous neoformations, genital and oral ulcers, ano-genital discharge, and finally other dermatological manifestations. All other clinical pictures were properly managed and eventually referred to other centres and not considered in the analysis. During the following medical examinations, the concordance between presumptive syndromic diagnosis and confirmed clinical diagnosis were recorded. Cohen's K-test was used to assess concordance. RESULTS: According to the Cohen's K-test a good concordance between telephone presumptive diagnoses and medical clinical assessment was found (73.79% with a k = 0.611), whereas only an scarcely acceptable concordance between expected and real waiting time was established (75.51%, k = 0.34). CONCLUSION: Concordance between nursing syndromic diagnosis and syndromic medically confirmed diagnosis is good from a clinical point of view but there is a limitation when considering a public health perspective. An optimal training of nurses may improve the method of telephone triage. For future ongoing emergencies, the implementation of telemedicine with accurate patient management systems is mandatory.