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During the 1st wave of CoViD-19 pandemic there was a drastic reduction in total number of accesses, with more serious cases and a exorbitant increase in crowding, due to access block.
Objectives
evaluate population who went to ED for (1) mental disorders requesting a psychiatric visit and for (2) intossication and substance abuse, between the first and second wave of the coronavirus pandemic
Methods
We enrolled all patients who went at our ED from May 1 to October 20, 2020 and during the same period of 2019. We analized: vital parameters, age, sex, exit severity codes, hospitalization rate, Crowding input factors (number of access, waiting time, priority time to doc), Crowding throughput factors (LOS: Length Of ED Stay), Crowding output factors (percentage of access block; Total Access Block Time).
Results
The results are shown in table 1
Table 1
Mental-disorder
intossication/substance-abuse
May1-October 20,2020
May1- October 20,2019
May1-October 20,2020
May1- October 20, 2019
number of ED access
543
564
182
254
higher (yellow and red) priority time to doc (%)
28%
29%
50%
39%
worse exit severity codes (%)
10%
6%
16%
11%
rate of hospitalization (%)
26%
20%
16%
9%
average waiting times (min)
60
64
76
79
LOS lenght of stay (min)
369
326
629
506
access block (%)
3%
2%
5%
4%
Total Access Block Time: examination rooms (min)
11.538
8.384
8.059
8.889
Total Access Block Time: holding area (min)
8.382
3.963
182
254
Conclusions
We would like to thank all employees of the IRCCS Policlinico San Matteo Foundation for their extraordinary efforts during the pandemic.
The 2019 coronavirus epidemic (CoViD-19) in Italy originated in Lombardy, on February 21, 2020. Crowding has been defined as a worldwide problem and causes reduced quality of care. It is due and identified by three orders of factors: those at the access (input); those related to the patient’s process (throughput); and those at the exit from the ED (output).
Objectives
We evaluated all the population who went to ED for mental disorder. Due to the high level of care needed and the simultaneous exposure to risk factors, an excessive duration of ED process can be counterproductive.
Methods
We evaluated all patients accessing our ED for mental disorder from February 22 to May 1, 2020 and during the same period of the previous year.
Results
We enrolled 345 patients. The Crowding input factors are lower in the pandemic period: reduced attenders (142 vs 203) and reduced average waiting times (40 min vs 54 min). The Crowding throughput factors have instead worsened: LOS (length of stay) for both visit rooms (383 vs 271 min) and holding area (1735 min vs 797 min). The Crowding output factors also worsened: the percentage of access block is higher during the pandemic (100% vs 20%). The Total Access Block Time is significantly higher in the CoViD period for both the visit rooms (3.239 vs 649 min) and the holding area (590 vs 185 min).
Conclusions
The pandemic period presented a worsened crowding for these patients due to the Access Block.
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