Emergency department reorganisation to cope with COVID-19 outbreak in Milan university hospital: a time-sensitive challenge

Abstract

Background In March 2020 we faced a huge spread of the epidemic of SARS-CoV2 in northern Italy; the Emergency Departments (ED) and the Emergency Medical Services (EMS) were overwhelmed by patients requiring care. The hospitals were forced to reorganize their services, and the ED was the focal point of this challenge. As Emergency Department in a metropolitan area of the region most affected, we saw an increasing number of patients with COVID-19, and we made some structural and staff implementations according to the evolution of the epidemic. Methods We analysed in a narrative way the weaknesses and the point of strength of our response to COVID-19 first outbreak, focusing point by point on main challenges and minor details involved in our ED response to the pandemics. Results The main stems for our response to the pandemic were: use of clear and shared contingency plans, as long as preparedness to implement them; stockage of as much as useful material can be stocked; training of the personnel to be prepared for a fast response, trying to maintain divided pathway for COVID-19 and non-COVID-19 patients, well-done isolation is a key factor; preparedness to de-escalate as soon as needed. Conclusions We evaluated our experience and analysed the weakness and strength of our first response to share it with the rest of the scientific community and colleagues worldwide, hoping to facilitate others who will face the same challenge or similar challenges in the future. Shared experience is the best way to learn and to avoid making the same mistakes.

The impact of COVID-19 on cancer care in a tertiary hospital in Korea: possible collateral damage to emergency care

“…Providing adequate, acute care in the ED is critical for cancer patients, who may experience acute symptoms and signs resulting from the cancer itself or as complications of anticancer treatments [24,25]. During a pandemic, the ED is one of the most vulnerable hospital departments because of the increased volume of emergency visits and disruptions of the previous healthcare delivery system [26][27][28]. The regional ED is a particularly valuable resource [29,30], and in addition to cancer patients, those with serious medical problems rather than those with mild symptoms should visit the ED.…”

Who should receive treatment? Healthcare professionals’ perspectives surrounding the medical management of patients with COVID-19

“…The participants in this study experienced ethical dilemmas during the COVID-19 pandemic, particularly related to what was happening in certain parts of the world, such as Italy, where emergency rooms and ICUs were overwhelmed by COVID-19 patients. 28 Therefore, physicians and nurses had to decide to whom to provide urgent care and treatment. The ethical considerations related to this challenge, which have already been discussed for decades, are currently being faced in emergency rooms and intensive care units.…”

Convolutional Neural Network-Based Automatic Analysis of Chest Radiographs for the Detection of COVID-19 Pneumonia: A Prioritizing Tool in the Emergency Department, Phase I Study and Preliminary “Real Life” Results

“…The creation of a smart worklist that reduces the report turnaround time for critical patients using AI tools has been recently proposed in a paper by Baltruschat et al [28]. Here, we propose a specific model for COVID-19 suspicious CXRs; the authors believe that a specific COVID-19 CXR prioritizing tool might be of great value in order to promptly identify the infected cases and to reduce promiscuity in the waiting rooms of the emergency department [42].…”