Revista nº 815

Use of emergency department during COVID-19 pandemic | Lacorzana J, et al. 32 Actual Med.2022;107(815):27- 33 These results made us consider several ideas. 1) The coming of COVID-19 seems a good opportunity to understand the flow of patients to the EDs in Spain, which is probably comparable to other countries with similar health systems. It is tempting trying to get quick and easy conclusions looking at these numbers, but understanding all the reasons behind this drastic reduction in the number of patients admitted to the EDs is much more challenging. Thus, we could expect some changes in the flow of patients to the ED due to this new situation. 2) The fear of contagion might be responsible for a decrease in the number of less severe cases (priority 4 and 5) and children; this may be the main factor to consider. 3) The lockdown itself could cause fewer cases due to road- traffic, work, and sports accidents. Nevertheless, severe emergencies due to strokes, heart attacks, acute abdomen, etc., should have maintained their numbers in general, even some increment in the cases related to cardiovascular events might be expected due to the sedentariness imposed to the population during the lockdown. Furthermore, COVID-19 cases would cause an increase in the numbers affecting both the ED’s admissions and the hospitalizations. These theories are supported by other authors (13,14,18,19) . The COVID-19 pandemic has been an inspiration for many authors to analyze the flux of patients in the EDs (11,13,14,17–20). However, it is very difficult to analyze and compared their results due to their differences (short follow-up periods, different period of time, countries health care system or different type of hospital). In order to address these limitations, the current study shows a longer follow- up period, EDs of complete hospital complex (GH, CH and NTH) and a higher number of patients than other research works based on the same health system (BHCS) (13,14). The main limitations of our study were its retrospective nature and its analysis limited to BHCS. Thus, we cannot make conclusions about effect of COVID on global health care system. Nonetheless, this focus on BHCS is a strength at the same time since allow us understand better what happened in others countries with the same health care system. 5. CONCLUSION The COVID-19 constitutes one of the greatest challenges in modern medicine, with still unknown consequences, including its impact on the patterns and flow of patients in primary and hospital care. Understanding better these changes and the impact that COVID-19 has caused, will probably lead us to manage and use better our public health systems in the future. ACKNOWLEDGEMENTS The authors would like to thank all the health care workers in the analyzed hospitals for their work and efforts. CONFLICT OF INTERESTS The authors of this article declare that they have no conflict of interest with respect to what is stated in this work. BIBLIOGRAPHIC REFERENCES 1. COVID-19 Map - Johns Hopkins Coronavirus Resource Center [Internet]. [cited 2021 Apr 7]. Available from: ht- tps://coronavirus.jhu.edu/map.html 2. Moazzami B, Razavi-Khorasani N, Dooghaie Moghadam A, Farokhi E, Rezaei N. COVID-19 and telemedicine: Imme- diate action required for maintaining healthcare providers well-being. J Clin Virol. 2020 May 1;126. DOI: 10.1016/j. jcv.2020.104345 3. Ohannessian R, Duong TA, Odone A. Global Telemedicine Im- plementation and Integration Within Health Systems to Fight the COVID-19 Pandemic: A Call to Action. JMIR Public Heal Surveill. 2020 Apr 2;6(2):e18810. DOI: 10.2196/18810 4. Bokolo Anthony Jnr. Use of Telemedicine and Virtual Care for Remote Treatment in Response to COVID-19 Pandemic. J Med Syst. 2020 Jul 1;44(7). DOI: 10.1007/s10916-020- 01596-5 5. Contreras CM, Metzger GA, Beane JD, Dedhia PH, Ejaz A, Pawlik TM. Telemedicine: Patient-Provider Clinical Enga- gement During the COVID-19 Pandemic and Beyond. Vol. 24, Journal of Gastrointestinal Surgery. Springer; 2020. p. 1692–7. DOI: 10.1007/s11605-020-04623-5 6. Leibner ES, Stokes S, Ahmad D, Legome E. Emergency depart- ment COVID management policies: one institution’s experien- ce and lessons learned. Emerg Med Pract. 2020 May 4;22(5):1. 7. Storm-Versloot MN, Ubbink DT, Kappelhof J, Luitse JSK. Comparison of an Informally Structured Triage System, the Emergency Severity Index, and the Manchester Triage System to Distinguish Patient Priority in the Emergency De- partment. Acad Emerg Med. 2011 Aug 1;18(8):822–9. DOI: 10.1111/j.1553-2712.2011.01122.x 8. Azeredo TRM, Guedes HM, Rebelo de Almeida RA, Chian- ca TCM, Martins JCA. Efficacy of the manchester tria- ge system: A systematic review. Vol. 23, International Emergency Nursing. Elsevier Ltd; 2015. p. 47–52. DOI: 10.1016/j.ienj.2014.06.001