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{ "pk": 14502, "title": "Impact of Coronavirus Disease 2019 Pandemic on Crowding: A Call to Action for Effective Solutions to “Access Block”", "subtitle": null, "abstract": "Introduction:\n Healthcare patterns change during disease outbreaks and pandemics. Identification of modified patterns is important for future preparedness and response. Emergency department (ED) crowding can occur because of the volume of patients waiting to be seen, which results in delays in patient assessment or treatment and impediments to leaving the ED once treatment is complete. Therefore, ED crowding has become a growing problem worldwide and represents a serious barrier to healthcare operations.\nMethods:\n This observational study was based on a retrospective review of the epidemiologic and clinical records of patients who presented to the Foundation IRCCS Policlinic San Matteo in Pavia, Italy, during the coronavirus disease 2019 (COVID-19) outbreak (February 21–May 1, 2020, pandemic group). The methods involved an estimation of the changes in epidemiologic and clinical data from the annual baseline data after the start of the COVID-19 pandemic.\nResults:\n We identified reduced ED visits (180 per day in the control period vs 96 per day in the pandemic period; P < 0.001) during the COVID-19 pandemic, irrespective of age and gender, especially for low-acuity conditions. However, patients who did present to the ED were more likely to be hemodynamically unstable, exhibit abnormal vital signs, and more frequently required high-intensity care and hospitalization. During the pandemic, ED crowding dramatically increased primarily because of an increased number of visits by patients with high-acuity conditions, changes in patient management that prolonged length of stay, and increased rates of boarding, which led to the inability of patients to gain access to appropriate hospital beds within a reasonable amount of time. During the pandemic, all crowding output indices increased, especially the rates of boarding (36% vs 57%; P < 0.001), “access block” (24% vs 47%; P < 0.001), mean boarding time (640 vs 1,150 minutes [min]; P 0.001), mean “access block” time (718 vs 1,223 min; P < 0.001), and “access block” total time (650,379 vs 1,359,172 min; P < 0.001).\nConclusion:\n Crowding in the ED during the COVID-19 pandemic was due to the inability to access hospital beds. Therefore, solutions to this lack of access are required to prevent a recurrence of crowding due to a new viral wave or epidemic.", "language": "en", "license": { "name": "Creative Commons Attribution 4.0", "short_name": "CC BY 4.0", "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.", "url": "https://creativecommons.org/licenses/by/4.0" }, "keywords": [ { "word": "Crowding, Coronavirus Disease, Pandemic, Emergency Department Access Block, Exit Block, Emergency Care Utilization" } ], "section": "Emergency Department Operations", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/4bc3418z", "frozenauthors": [ { "first_name": "Gabriele", "middle_name": "", "last_name": "Savioli", "name_suffix": "", "institution": "Fondazione IRCCS Policlinico San Matteo, Department of Emergency Medicine, Pavia, Italy; University of Pavia, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, Pavia, Italy", "department": "None" }, { "first_name": "Iride", "middle_name": "Francesca", "last_name": "Ceresa", "name_suffix": "", "institution": "Fondazione IRCCS Policlinico San Matteo, Department of Emergency Medicine, Pavia, Italy", "department": "None" }, { "first_name": "Roberta", "middle_name": "", "last_name": "Guarnone", "name_suffix": "", "institution": "Fondazione IRCCS Policlinico San Matteo, Department of Emergency Medicine, Pavia, Italy", "department": "None" }, { "first_name": "Alba", "middle_name": "", "last_name": "Muzzi", "name_suffix": "", "institution": "Fondazione IRCCS Policlinico San Matteo, Medical Direction, Pavia, Italy", "department": "None" }, { "first_name": "Viola", "middle_name": "", "last_name": "Novelli", "name_suffix": "", "institution": "Fondazione IRCCS Policlinico San Matteo, Medical Direction, Pavia, Italy", "department": "None" }, { "first_name": "Giovanni", "middle_name": "", "last_name": "Ricevuti", "name_suffix": "", "institution": "University of Pavia, Department of Drug Science, Pavia, Italy; Saint Camillus International University of Health Sciences, Department of Drug Science, Rome, Italy", "department": "None" }, { "first_name": "Giorgio", "middle_name": "Antonio", "last_name": "Iotti", "name_suffix": "", "institution": "Fondazione IRCCS Policlinico San Matteo, Intensive Care Unit, Pavia, Italy", "department": "None" }, { "first_name": "Maria", "middle_name": "Antonietta", "last_name": "Bressan", "name_suffix": "", "institution": "Fondazione IRCCS Policlinico San Matteo, Department of Emergency Medicine, Pavia, Italy", "department": "None" }, { "first_name": "Enrico", "middle_name": "", "last_name": "Oddone", "name_suffix": "", "institution": "University of Pavia, Department of Public Health, Experimental and Forensic Medicine, Pavia, Italy", "department": "None" } ], "date_submitted": "2020-08-25T15:15:54+05:30", "date_accepted": "2020-08-25T15:15:54+05:30", "date_published": "2021-06-29T23:03:27+05:30", "render_galley": null, "galleys": [ { "label": "", "type": "pdf", "path": "https://journalpub.escholarship.org/westjem/article/14502/galley/7419/download/" } ] }