Revista Científica de la Sociedad Española de Medicina de Urgencias y Emergencias
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1er cuartil (5 de 32)
Emergency Medicine
Resumen
< ReturnQuality of hospital emergency department care for patients with COVID-19 during the first wave in 2020: the CALUR-COVID-19 study
JimĂ©nez S, MirĂł O, AlquĂ©zar-ArbĂ© A, Piñera P, Jacob J, Llorens P, GarcĂa-Lamberechts EJ, MartĂn-Sánchez FJ, González Del Castillo J, Burillo-Putze G
Servicio de Urgencias, Hospital ClĂnic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain. Servicio de Urgencias, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. Servicio de Urgencias, Hospital General Universitario Reina SofĂa, Murcia, Spain. Servicio de Urgencias, Hospital Universitario de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain. Servicio de Urgencias, Hospital General Universitario de Alicante, Universidad Miguel Hernández, Elche, Alicante, Instituto de InvestigaciĂłn Sanitaria y BiomĂ©dica de Alicante (ISABIAL), Spain. Servicio de Urgencias, Hospital ClĂnico San Carlos, IDISSC, Universidad Complutense, Madrid, Spain. Servicio de Urgencias, Hospital Universitario de Canarias, Tenerife, Spain.
Objectives. To define quality of care indicators and care process standards for treating patients with COVID-19 in hospital emergency departments (EDs), to determine the level of adherence to standards during the first wave in 2020, and to detect factors associated with different levels of adherence.
Methods. We selected care indicators and standards by applying the Delphi method. We then analyzed the level of adherence in the SIESTA cohort (registered by the Spanish Investigators in Emergency Situations Team). This cohort was comprised of patients with COVID-19 treated in 62 Spanish hospitals in March and April 2020. Adherence was compared according to pandemic-related ED caseload pressure, time periods during the wave (earlier and later), and age groups.
Results. Fourteen quality indicators were identified. Three were adhered to in less than 50% of the patients. Polymerase chain reaction testing for SARS-CoV-2 infection was the indicator most often disregarded, in 29% of patients when the caseload was high vs 40% at other times (P < .001) and in 30% of patients in the later period vs 37% in the earlier period (P = .04). Adherence to the following indicators was better in the later part of the wave: monitoring of oxygen saturation (100% vs 99%, P = .035), electrocardiogram monitoring in patients treated with hydroxychloroquine (87% vs 65%, P < .001), and avoiding of lopinavir/ritonavir treatment in patients with diarrhea (79% vs 53%, P < .001). No differences related to age groups were found.
Conclusions. Adherence to certain quality indicators deteriorated during ED treatment of patients with COVID-19 during the first wave of the pandemic. Pressure from high caseloads may have exacerbated this deterioration. A learning effect led to improvement. No differences related to patient age were detected.
Methods. We selected care indicators and standards by applying the Delphi method. We then analyzed the level of adherence in the SIESTA cohort (registered by the Spanish Investigators in Emergency Situations Team). This cohort was comprised of patients with COVID-19 treated in 62 Spanish hospitals in March and April 2020. Adherence was compared according to pandemic-related ED caseload pressure, time periods during the wave (earlier and later), and age groups.
Results. Fourteen quality indicators were identified. Three were adhered to in less than 50% of the patients. Polymerase chain reaction testing for SARS-CoV-2 infection was the indicator most often disregarded, in 29% of patients when the caseload was high vs 40% at other times (P < .001) and in 30% of patients in the later period vs 37% in the earlier period (P = .04). Adherence to the following indicators was better in the later part of the wave: monitoring of oxygen saturation (100% vs 99%, P = .035), electrocardiogram monitoring in patients treated with hydroxychloroquine (87% vs 65%, P < .001), and avoiding of lopinavir/ritonavir treatment in patients with diarrhea (79% vs 53%, P < .001). No differences related to age groups were found.
Conclusions. Adherence to certain quality indicators deteriorated during ED treatment of patients with COVID-19 during the first wave of the pandemic. Pressure from high caseloads may have exacerbated this deterioration. A learning effect led to improvement. No differences related to patient age were detected.
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