Thursday, March 28

The General Hospital Emergency Department treats a thousand covid patients in a high-resolution outpatient clinic


The General Emergency Service of the General University Hospital Dr. Balmis of Alicante It has a high-resolution monographic consultation aimed at patients with covid who, after passing through the Emergency Department, do not require hospital admission. It is a device that has been shown to be effective in offering a closer follow-up to patients with mild infection, without respiratory failure, with or without pneumonia, but with criteria of risk of complications or unfavorable evolution.

The device It was launched at a time of high demand for care, at the beginning of 2021, in close collaboration with the center’s covid team, led by the Internal Medicine, Pneumology and Infectious Diseases Unit (UEI) services.

And it is that the global health systems have faced enormous challenges during the pandemic. The decision of hospital emergency services about whether to admit or discharge a patient with covid is a key point in patient management, with implications for clinical outcomes and hospital capacity.

In this way, “we design and implement this outpatient care strategy of referral from the Emergency Department to a monographic face-to-face consultation, with the aim of guaranteeing adequate follow-up of positive patients with a stable clinical situation, offering them optimal quality of care and safety, which has allowed us to reduce unnecessary admissions and, thereby ensuring the sustainability of the health system”, remarks the head of the Emergency Service, Dr. Pere Llorens.

The patients are evaluated in person at the consultation by the medical team in the first 72 hours after the visit to the Emergency Department, “in which we carry out clinical monitoring, blood tests and chest X-ray or lung ultrasound. Depending on this clinical assessment, the patient can be discharged for follow-up in Primary Care, continue with this specialized follow-up or, if necessary, be admitted to the hospital”, remarks Dr. José Manuel Carratalá, an Emergency and Emergency Unit physician. Short Stay (UCE).

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During the sixth wave The aforementioned consultation has continued to be promoted, which is operational from Monday to Friday and “in which we attend to an average of between 10 and 16 patients a day, progressively including covid patients who have other risk factors. In total, to date, this face-to-face clinical evaluation has been offered to more than 1,000 patients”, explains Dr. Carratalá.

The covid team has evaluated this strategy and recently published a study that confirms the effectiveness of the high-resolution monographic consultation. This work, which has just been published in the Emergency journal of the Spanish Society of Emergency and Emergency Medicine (SEMES), spanned from January 7 to February 17, 2021, and included a cohort of 278 patients referred from the Emergency Service. of Emergencies to the mentioned consultation.

“The results show that approximately one 90% of patients included in the model they did not require hospital admission after discharge from the Emergency Department. Therefore, this device has made it possible to carry out an adequate clinical follow-up of patients, with an evolutionary control of the disease that allows hospitalization only in those patients who can benefit from it”, Dr. Llorens emphasizes.

Besides, the population to which the query has been addressed, middle-aged people, with low comorbidity and without respiratory insufficiency, represents a significant volume of covid patients who go to the Emergency Services and “accounts for a third of hospital admissions that occur in hospitals, which reinforces the importance of having with a device of these characteristics, which optimizes attention and income”, add the authors of the article.

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Another important element to take into account is that this strategy it has supposed, only in the period subject to the study, a potential saving of 2,559 euros per patient, which globally corresponds to a saving of 624,410 euros.

In a epidemiological scenario with a high incidence of infection like the current one, with a high care pressure in the Emergency Room and in the hospitalization ward, “decision-making in this group of patients has been facilitated by the availability of an early high-resolution face-to-face consultation”, indicate the same sources.

All of this has “important benefits for patients, since by not requiring hospital admission, complications derived from it are avoided; and for the hospital itself, since it helps preserve operational capacity during the pandemic, maintaining the quality of clinical care and patient safety”, concludes the head of the Emergency Service.


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