Effect of Lockdown in Surgical Emergency Accesses: Experience of a COVID-19 Hospital.

BACKGROUND/AIM: SARS-CoV-2 pandemic imposed extraordinary restriction measures and a complete reorganization of the Health System. The aim of the study was to evaluate the impact of COVID-19 on emergency surgical department accesses. PATIENTS AND METHODS: Patients admitted to surgical emergency departments was retrospectively recorded during the Lockdown (March 11, 2020-May 3, 2020) and compared with the same number of days in 2019 and immediately before Lockdown (January 16, 2020-March 10, 2020). Diagnoses, priority levels, modes of patient's transportation, waiting times and outcomes were analysed. RESULTS: During the lockdown phase, we ob-served a reduction in the access to emergency surgical departments of 84.45% and 79.78%, com-pared with the Pre-Lockdown2019 and Pre-Lockdown2020 groups, respectively. Patient's transportation, hospitalization and patients discharge with indications to an outpatient visit, waiting and total times exhibited a significant difference during the lockdown (p<0.005). CONCLUSION: We observed a reduction of surgical emergency accesses during the lockdown. Implementing the use of the regional systems and preventing overcrowding of emergency departments could be beneficial for reducing waiting times and improving the quality of treatments for patients.

[Integrated Procurement Model: A new approach to Tissue and Organ Procurement]. / Un modello integrato per l'identificazione dei potenziali donatori: un nuovo approccio nei trapianti di organi e tessuti.

INTRODUCTION: Literature has shown that the process of procurement of organs and tissues is fundamental in determining the number of donations. Starting from these assumptions, an integrated procurement model of organs and tissues has been designed and tested, where nurse specialists in organ donation coordinate the team and the entire process. AIM: To evaluate the effectiveness of the Integrated Procurement Models in terms of identifying potential donors and the number of donations. METHODS: A retrospective observational study was conducted before and after the introduction of the new procurement model in a large University Hospital in Rome. The data of potential donors identified, the number of donations made and the efficiency indicators of the donation process were compared. RESULTS: 692 potential donors were identified. The introduction of the integrated model increased the number of actual donors (from 31 to 51), brain death assessments (from 69 to 99), and the efficiency indicators of the donation process (from 0.25 to 0.29). From the comparison between the activities before and after the introduction of the integrated procurement model, statistically significant differences emerged regarding the number of donors and the amount of corneal tissue extracted. CONCLUSIONS: The adoption of the standardized Integrated Procurement Model would increase the number of potential donors and actual donations, thanks also to the key role assumed by the nurse specializing in organ donation as team and process coordinator.

[Reducing drug administration errors using "Do not disturb" tabards and signs]. / Ridurre gli errori da somministrazione dei farmaci attraverso una casacca segnaletica ed una cartellonistica di non disturbo.

INTRODUCTION: According to the report published by the Italian Ministry Health on sentinel events collected between 2005-2010, 873 events were reported, of which 4% (about 35) led to mortality, coma or serious functional disorders due to drug administration errors made by nurses. The link between interruptions and patient safety has been emphasized in the USA by the Institute of Medicine as a pivotal variable to improve the quality of nursing care. Airline companies have studied this problem since the 1960s, with a significant reduction of accidents. OBJECTIVE: This study emphasized that nurses who are never interrupted or distracted, by using 'Do not disturb' tabards and signs, reduce errors during the administration of drugs. METHODS: Quasi-experimental study on a convenience sample to explore the cause-effect relationship that reduces errors during drug administration by wearing a 'Do not disturb' tabard and signs. This study was conducted in 8 similar medicine and surgery units within 4 teaching hospitals in Rome. Of these 8 units, 4 were identified for the experimental group and 4 for the control group. Data were collected using the Medication Administration Distraction Observation Sheet tool. Data were analysed using SPSS 10.00 software. RESULTS: In the four hospitals that participated to the research were filled out 688 observational sheets, 356 (51,7%) for the control group and 332 (48,3%) for the experimental group. 132 were completed in the hospital 1, 143 in the hospital 2, 144 in the hospital 3 e 269 in the hospital 4. Analyzing the four hospitals, it emerged that in the experimental cohort some of the distractions calculated by the mean were lower compared with the control group (distractions by nurses and conversation). Yet, some distractions resulted greater in the experimental group respect to the control group (phone calls, other patients, external noise). At last, it did not emerge a significant difference in the distractions connected to variables such as: physicians, other personnel, visitors, and emergency situations. CONCLUSIONS: Distractions can lead to many errors throughout the drug administration phase. Wearing a high visibility vest while administering drugs proved to be very useful. However, this needs to be supported by effective teamwork, 'do not disturb' signs in all the workplace rooms, and by an education program that should not be limited only to those who administer drugs.