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From intensive care to step-down units: Managing patients throughput in response to COVID-19.
Agnoletti, Vanni; Russo, Emanuele; Circelli, Alessandro; Benni, Marco; Bolondi, Giuliano; Martino, Costanza; Santonastaso, Domenico P; Brogi, Etrusca; PraticÒ, Beniamino; Coccolini, Federico; Fugazzola, Paola; Ansaloni, Luca; Gamberini, Emiliano.
  • Agnoletti V; Department of Anesthesia and Intensive Care, M Bufalini Hospital, Viale Ghirotti 285, 47521, Cesena, Italy.
  • Russo E; Department of Anesthesia and Intensive Care, M Bufalini Hospital, Viale Ghirotti 285, 47521, Cesena, Italy.
  • Circelli A; Department of Anesthesia and Intensive Care, M Bufalini Hospital, Viale Ghirotti 285, 47521, Cesena, Italy.
  • Benni M; Department of Anesthesia and Intensive Care, M Bufalini Hospital, Viale Ghirotti 285, 47521, Cesena, Italy.
  • Bolondi G; Department of Anesthesia and Intensive Care, M Bufalini Hospital, Viale Ghirotti 285, 47521, Cesena, Italy.
  • Martino C; Department of Anesthesia and Intensive Care, M Bufalini Hospital, Viale Ghirotti 285, 47521, Cesena, Italy.
  • Santonastaso DP; Department of Anesthesia and Intensive Care, M Bufalini Hospital, Viale Ghirotti 285, 47521, Cesena, Italy.
  • Brogi E; Department of Anesthesia and Intensive Care, University of Pisa, Via Piero Trivella, 56124, Pisa, Italy.
  • PraticÒ B; Department of Internal Medicine, M Bufalini Hospital, Viale Ghirotti 285, 47521, Cesena, Italy.
  • Coccolini F; Department of Surgery, University of Pisa, Via Piero Trivella, 56124, Pisa, Italy, and.
  • Fugazzola P; General, Emergency and Trauma Department, M Bufalini Hospital, Viale Ghirotti 285, 47521, Cesena, Italy.
  • Ansaloni L; General, Emergency and Trauma Department, M Bufalini Hospital, Viale Ghirotti 285, 47521, Cesena, Italy.
  • Gamberini E; Department of Anesthesia and Intensive Care, M Bufalini Hospital, Viale Ghirotti 285, 47521, Cesena, Italy.
Int J Qual Health Care ; 33(1)2021 Feb 20.
Article in English | MEDLINE | ID: covidwho-704209
Semantic information from SemMedBD (by NLM)
1. COVID-19 CAUSES Shock
Subject
COVID-19
Predicate
CAUSES
Object
Shock
2. COVID-19 PROCESS_OF Patients
Subject
COVID-19
Predicate
PROCESS_OF
Object
Patients
3. COVID-19 CAUSES Shock
Subject
COVID-19
Predicate
CAUSES
Object
Shock
4. COVID-19 PROCESS_OF Patients
Subject
COVID-19
Predicate
PROCESS_OF
Object
Patients
ABSTRACT
QUALITY PROBLEM OR ISSUE The on-going COVID-19 pandemic may cause the collapse of healthcare systems because of unprecedented hospitalization rates. INITIAL ASSESSMENT A total of 8.2 individuals per 1000 inhabitants have been diagnosed with COVID-19 in our province. The hospital predisposed 110 beds for COVID-19 patients on the day of the local peak, 90% of them were occupied and intensive care unit (ICU) faced unprecedented admission rates, fearing system collapse. CHOICE OF SOLUTION Instead of increasing the number of ICU beds, the creation of a step-down unit (SDU) close to the ICU was preferred the aim was to safely improve the transfer of patients and to relieve ICU from the risk of overload. IMPLEMENTATION A nine-bed SDU was created next to the ICU, led by intensivists and ICU nurses, with adequate personal protective equipment, monitoring systems and ventilators for respiratory support when needed. A second six-bed SDU was also created. EVALUATION Patients were clinically comparable to those of most reports from Western Countries now available in the literature. ICU never needed supernumerary beds, no patient died in the SDU, and there was no waiting time for ICU admission of critical patients. SDU has been affordable from human resources, safety and economic points of view. LESSONS LEARNED COVID-19 is like an enduring mass casualty incident. Solutions tailored on local epidemiology and available resources should be implemented to preserve the efficiency and adaptability of our institutions and provide the adequate sanitary response.
Subject(s)
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Critical Illness / COVID-19 / Intensive Care Units / Intermediate Care Facilities Type of study: Experimental Studies / Observational study / Prognostic study Limits: Humans Country/Region as subject: Europa Language: English Journal subject: Health Services Year: 2021 Document Type: Article Affiliation country: Intqhc

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Critical Illness / COVID-19 / Intensive Care Units / Intermediate Care Facilities Type of study: Experimental Studies / Observational study / Prognostic study Limits: Humans Country/Region as subject: Europa Language: English Journal subject: Health Services Year: 2021 Document Type: Article Affiliation country: Intqhc