José M García Santos1, Juana M Plasencia Martínez2, Pablo Fabuel Ortega3, Marina Lozano Ros2, María Carmen Sánchez Ayala4, Gloria Pérez Hernández2, Pedro Menchón Martínez5,6. 1. Radiology Department, University General Hospital Morales Meseguer, C/ Marqués de Los Vélez, s/n., 30008, Murcia, Spain. josem.garcia11@carm.es. 2. Radiology Department, University General Hospital Morales Meseguer, C/ Marqués de Los Vélez, s/n., 30008, Murcia, Spain. 3. Primary Care Health Center Vistabella-La Flota, 6th Health Area, Comunidad Autónoma de la Región de Murcia, Murcia, Spain. 4. Primary Care Health Center Molina-Jesús Marín, 6th Health Area, Comunidad Autónoma de la Región de Murcia, Murcia, Spain. 5. Neumology Section, University General Hospital Morales Meseguer, Murcia, Spain. 6. Medical Direction, 6th Health Area, Comunidad Autónoma de La Región de Murcia, University General Hospital Morales Meseguer, Murcia, Spain.
Abstract
BACKGROUND: Possible COVID-19 pneumonia patients (ppCOVID-19) generally overwhelmed emergency departments (EDs) during the first COVID-19 wave. Home-confinement and primary-care phone follow-up was the first-level regional policy for preventing EDs to collapse. But when X-rays were needed, the traditional outpatient workflow at the radiology department was inefficient and potential interpersonal infections were of concern. We aimed to assess the efficiency of a primary-care high-resolution radiology service (pcHRRS) for ppCOVID-19 in terms of time at hospital and decision's reliability. METHODS: We assessed 849 consecutive ppCOVID-19 patients, 418 through the pcHRRS (home-confined ppCOVID-19 with negative-group 1- and positive-group 2-X-rays) and 431 arriving with respiratory symptoms to the ED by themselves (group 3). The pcHRRS provided X-rays and oximetry in an only-one-patient agenda. Radiologists made next-step decisions (group 1: pneumonia negative, home-confinement follow-up; group 2: pneumonia positive, ED assessment) according to X-ray results. We used ANOVA and Bonferroni correction, Student T, Chi2 tests to analyse changes in the ED workload, time-to-decision differences between groups, potential delays in patients acceding through the ED, and pcHRRS performance for deciding admission. RESULTS: The pcHRRS halved ED respiratory patients (49.2%), allowed faster decisions (group 1 vs. home-discharged group 2 and group 3 patients: 0:41 ± 1:05 h; 3:36 ± 2:58 h; 3:50 ± 3:16 h; group 1 vs. all group 2 and group 3 patients: 0:41 ± 1:05 h; 5.25 ± 3.08; 5:36 ± 4:36 h; group 2 vs. group 3 admitted patients: 5:27 ± 3:08 h vs. 7:42 ± 5:02 h; all p < 0.001) and prompted admission (84/93, 90.3%) while maintaining time response for ED patients. CONCLUSIONS: Our pcHRRS may be a more efficient entry-door for ppCOVID-19 by decreasing ED patients and making expedited decisions while guaranteeing social distance.
BACKGROUND: Possible COVID-19 pneumoniapatients (ppCOVID-19) generally overwhelmed emergency departments (EDs) during the first COVID-19 wave. Home-confinement and primary-care phone follow-up was the first-level regional policy for preventing EDs to collapse. But when X-rays were needed, the traditional outpatient workflow at the radiology department was inefficient and potential interpersonal infections were of concern. We aimed to assess the efficiency of a primary-care high-resolution radiology service (pcHRRS) for ppCOVID-19 in terms of time at hospital and decision's reliability. METHODS: We assessed 849 consecutive ppCOVID-19patients, 418 through the pcHRRS (home-confined ppCOVID-19 with negative-group 1- and positive-group 2-X-rays) and 431 arriving with respiratory symptoms to the ED by themselves (group 3). The pcHRRS provided X-rays and oximetry in an only-one-patient agenda. Radiologists made next-step decisions (group 1: pneumonia negative, home-confinement follow-up; group 2: pneumonia positive, ED assessment) according to X-ray results. We used ANOVA and Bonferroni correction, Student T, Chi2 tests to analyse changes in the ED workload, time-to-decision differences between groups, potential delays in patients acceding through the ED, and pcHRRS performance for deciding admission. RESULTS: The pcHRRS halved ED respiratory patients (49.2%), allowed faster decisions (group 1 vs. home-discharged group 2 and group 3 patients: 0:41 ± 1:05 h; 3:36 ± 2:58 h; 3:50 ± 3:16 h; group 1 vs. all group 2 and group 3 patients: 0:41 ± 1:05 h; 5.25 ± 3.08; 5:36 ± 4:36 h; group 2 vs. group 3 admitted patients: 5:27 ± 3:08 h vs. 7:42 ± 5:02 h; all p < 0.001) and prompted admission (84/93, 90.3%) while maintaining time response for ED patients. CONCLUSIONS: Our pcHRRS may be a more efficient entry-door for ppCOVID-19 by decreasing ED patients and making expedited decisions while guaranteeing social distance.
Entities:
Keywords:
COVID-19; Coronavirus; Emergency medicine; Primary health care; Radiology
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