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Minerva Cardioangiologica 2020 Dec 01

DOI: 10.23736/S0026-4725.20.05384-0

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

Caring for acute coronary syndrome and other time-sensitive medical emergencies during the coronavirus disease 2019 pandemic in Northern Italy: report from a hub centre

Luca CABRINI 1, 2, Walter AGENO 1, 3, Sergio BALBI 4, 5, Fabio BARUZZI 6, Elisa CANDELORO 7, Carlo CAPRA 2, Federico CARIMATI 7, Battistina CASTIGLIONI 8, Vinicio CONTI 1, 2, Roberto DE PONTI 1, 2, Dario FRANCHI 9, Giancarlo GINI 3, Andrea GIORGIANNI 6, Marianna SARTORELLI 10, Giovanni LANDONI 10, 11 , Davide LOCATELLI 1, 5, Lorenzo MAFFIOLI 12, Rita PRADELLA 1, 2, Paolo SEVERGNINI 1, 4, Matteo TOZZI 1, 2, Maurizio VERSINO 1, 7, Giuliano ZOCCHI 1, 2, Alberto ZOLI 9

1 Università degli Studi dell’Insubria, Varese, Italy; 2 Ospedale di Circolo e Fondazione Macchi, Varese, ASST-Settelaghi, Varese, Italy; 3 Emergency Department, Ospedale di Circolo e Fondazione Macchi, Varese, ASST-Settelaghi, Varese, Italy; 4 Department of of Biotechnology and Sciences of Life, Ospedale di Circolo e Fondazione Macchi, Varese, ASST-Settelaghi, Varese, Italy; 5 Department of Neurological Surgery, Ospedale di Circolo e Fondazione Macchi, Varese, ASST-Settelaghi, Varese, Italy; 6 Department of Neuroradiology, Ospedale di Circolo e Fondazione Macchi, Varese, ASST-Settelaghi, Varese, Italy; 7 Department of Neurology and Stroke Unit, Ospedale di Circolo e Fondazione Macchi, Varese, ASST-Settelaghi, Varese, Italy; 8 Department of Cardiology, Ospedale Luigi Galmarini, Tradate, ASST-Settelaghi, Varese, Italy; 9 A.R.E.U. [Lombardy EMS Regional Agency], Italy; 10 Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; 11 Faculty of Medicine, Vita Salute San Raffaele University, Milan, Italy; 12 Strategic Direction ASST-Settelaghi, Varese, Italy


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BACKGROUND: The Lombardy region, in Northern Italy, suffered a major outbreak of Coronavirus disease 2019 (COVID-19) at the end of February 2020. The health system was rapidly overwhelmed by the pandemic. It became evident that patients suffering from timesensitive medical emergencies like stroke, cerebral hemorrhage, trauma and acute myocardial infarction required timely, effective and safe pathways to be treated. The problem was addressed by a regional decree that created a hub-and-spoke system for time-sensitive medical emergencies.
METHODS: We report the re-organizational changes adopted at a hub hospital (despite having already destined to COVID-19 patients most resources), and the number of emergent procedures for medical emergencies on the first 30-day of activity. These data were compared with the hospital activity in the same period of the previous year.
RESULTS: Organizational changes were implemented in few hours. Dedicated pathways for non-COVID-19 patients affected by a medical emergency were set up in the emergency department, in the labs and in the operating theater. Ten intensive beds were implemented from a high-dependency unit; two operating rooms were reserved 24h/day to neurosurgical or trauma emergencies. The number of emergent procedures was not different from that of the previous year, no admission refusal, no treatment delay and no viral transmission to the treated patients were recorded. No viral transmission to health care workers was observed.
CONCLUSIONS: Re-organization of a hospital in order to adopt a hub-and-spoke model resulted feasible and allowed to face acute coronary syndrome and other time-sensitive medical emergencies timely and safely.


KEY WORDS: Acute coronary syndrome; Medical emergencies; COVID-19; Hub and Spoke; Health Policy; Critical Care

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