Revista nº 815

Use of emergency department during COVID-19 pandemic | Lacorzana J, et al. 28 Actual Med.2022;107(815):27- 33 1. INTRODUCTION The sudden outbreak of coronavirus disease in December 2019 (COVID-19) has been a major issue to global health. To date, there are more than 132 million infected people and more than 2.8 million deaths reported worldwide, with the USA as the most affected country. Spain, with more than 3 million infected and 76.000 deaths, has been one of the most stressed countries in Europe. The Spanish National Health System (SNHS) was critically overwhelmed during the first wave of the pandemic in March, April, and May 2020 (1). WHO declared COVID-19 as a pandemic on March 12 th , 2020. Two days later, the Spanish government declared the “State of Alarm” and confined the population. After that, the de-escalation process happened in four phases with minimum differences between regions. Granada is a medium-sized city in the south of Spain, where two main hospitals cover a population of almost 900 000 inhabitants. In the city of Granada, the peak of the pandemic came a little later than in the rest of the neighboring cities. Most of the hospital departments have changed their protocols adapting to the new situation during the COVID-19 pandemic, using telemedicine (2–5) as one of the main ways for delivering medical care, while keeping the usual assistance to the emergency cases. Therefore, the Emergency Departments (EDs) have been opened as usual with minimal changes, consisting mainly of special protocols and differentiated circuits for patients with suspected COVID (6). There was also a general call by the government and health care authorities warning the population not to attend the hospital unless needed during the lockdown. The way that the COVID-19 Pandemic has affected the number of admissions, hospitalizations, hospitalization ratio, and classification by priorities in EDs is uncertain. Thus, we carried out a detailed analysis about the different pattern of use of the EDs in the only tertiary referral hospital in Granada, Spain (Virgen de las Nieves Hospital Complex) during the COVID-19 Pandemic, from February 1 st to July 31 st 2020, and compared to the same period in 2019. Possibly, a larger knowledge of these parameters would allow us to better manage a future COVID outbreak. 2. MATERIALS AND METHODS 2.1 Study Design This is a retrospective, observational and single- center study, carried out in the EDs of Virgen de las Nieves Hospital Complex (Granada, Spain), which covers a population of near 500000 inhabitants. The information was collected from the Electronic Medical Records of the three centers that form the complex: General Hospital (GH), Children’s Hospital (CH), and Neuro-Trauma Hospital (NTH). The period for data collection included from February 1 st to July 31 st (2019 and 2020,181 and 182 days respectively). 2.2 Description of collected variables The collected variables were the number of admissions, number of hospitalizations, and classification by priorities; no personal data from patients was collected. The following conceptsweredefined: 1)Hospitalizations: patients who needed to be hospitalized for inpatient care; 2) Admissions: patients attending the ED who did not need to be hospitalized and were discharged in ED for home care; 3) Hospitalization ratio: the division between the number of hospitalizations and admissions. Resultados: En el periodo analizado se produjeron 71236 atenciones en urgencias frente a 118382 en el mismo periodo de 2019, lo que supone una reducción global del 38,83%. Considerando las hospitalizaciones, hubo 6841 frente a 7648 (2020 y 2019, respectivamente) lo que da una reducción global del 10,55%. La distribución de las prioridades no mostró un patrón definido; mientras que los SU de CH y NTH mostraron cambios claros en su distribución, no se observaron cambios notables en el SU de GH. Conclusión: La pandemia de Covid-19 cambió drásticamente el patrón de derivación a urgencias en nuestro hospital terciario de referencia. Se constató una notable reducción de los pacientes atendidos en urgencias y las hospitalizaciones, junto con un pronunciado aumento de ratio de hospitalización que en algunos casos alcanzó casi el 50%. Esto podría explicarse por muchas razones, como el miedo al contagio y el bloqueo que presumiblemente provocó una disminución de los casos menos graves atendidos. Posiblemente, los efectos de COVID-19 pueden haber sido influenciados indirectamente por el sistema sanitario de cada país. La pandemia de COVID-19 constituye uno de los mayores retos de la medicina moderna, entender mejor estos cambios y el impacto que COVID-19 ha causado en el patrón de uso de los servicios de urgencias probablemente nos llevará a gestionar y utilizar mejor nuestros sistemas de salud pública en el futuro