Covid-19 pandemisinin acil servis başvurularına etkisi
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Date
2023
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T.C.Maltepe Üniversitesi
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info:eu-repo/semantics/openAccess
Abstract
Amaç: Son yıllarda hızlı nüfus artışı ve göçler sebebiyle acil servislerde aşırı hasta yoğunluğu gözlenmekte ve kaliteli hizmet sunumu aksamaktadır(1-3). Acil servisler kolay ulaşılabilen, poliklinik randevusu alamayan hastaların anında sağlık hizmeti alabildiği, laboratuvar hizmetlerinden kolayca yararlanabildiği, tetkik-tedavi işlemlerinin daha hızlı yapılabildiği alanlar olarak düşünüldüğünden, her geçen gün kalabalığı ve aynı zamanda kötüye kullanımı artan alanlardır. Son yıllarda Türkiye'de yapılan çalışmalarda acil servislere başvuran hastaların büyük bir kısmının acil patolojisi olmadığı ve bu nedenle gerçek acillere yeterli hizmetin verilemediği bildirilmiştir (4-6). Kılıçaslan ve arkadaşlarının (1) çalışmasında acil servise başvuran hastaların %47,4 'nün, Aydın ve arkadaşlarının (7) çalışmasında ise %62,3 acil olmayan hasta kategorisinde olduğu bildirilmiştir. Covid-19 pandemisi gibi salgınlarda acil servisler diğer zamanlardaki gibi kesintisiz hizmete devam etmektedirler. Hem COVID-19 şüpheli vakaların tespiti ve yönetimi hem de diğer tıbbi acillerin tanı ve tedavi sürecinin devam ettirilmesinde kritik bir öneme sahiptirler. Bu tür damlacık yoluyla bulaşların olduğu bir dönemde sadece gerçek acil hastaların acil servise başvurması beklenmektedir. Çalışma pandemi döneminde acil servis başvurularını değerlendirmek amacıyla yapılmıştır. Materyal-Metotlar: Çalışma, çok merkezli gözlemsel bir kohort çalışmasıdır. Gazi Üniversitesi Tıp Fakültesi Hastanesi ve Kastamonu Eğitim ve Araştırma Hastanesi'ne 1 Nisan 2019 ile 31 Mayıs 2019 (Covid-19 Pandemisinden önceki dönem) tarihleri arasında yapılan acil servis başvuruları ile 1 Nisan 2020 ile 31 Mayıs 2020(Covid-19 Pandemisinin ilk dönemleri) tarihleri arasındaki acil servis başvuruları karşılaştırıldı. Hastaların demografik verilerinin yanında, başvuru şikayetleri, ICD tanıları, yapılan tetkikler, konsültasyon durumu ve taburculuk durumları veri toplama formuna kaydedildi. Bulgular: Çalışmaya yaş ortalaması 40,9±19,6 yıl olan 22854 (%47,7) kadın ve 25034 (%52,3) erkek olmak üzere toplam 47888 hasta alındı. Çalışmaya dâhil edilen hastaların %30,1'i (14440) 2020 yılında pandemi döneminde acil servise başvururken, 2019 yılında %69,9'u (33448) pandemi öncesi dönemde başvurmuştur. Pandemi öncesi başvuran hastaların yaş ortalaması 39,8±19,8 iken, Pandemi döneminde yaş ortalaması döneminde başvuranların yaş ortalaması 43,5±18,9 idi (p<0,005). Pandemi öncesi dönemde acil servislerden daha fazla laboratuvar tetkiki istenirken, pandemi döneminde daha fazla radyolojik tetkik istendiği tespit edildi (p<0,05). Hastaların pandemi döneminde bir önceki yıla göre yaklaşık 7 kat daha fazla konsülte edildiği saptandı. Konsültasyon açısından dönemler arasında istatistiksel olarak anlamlı fark vardır (p<0,001). Hastaneye yatış açısından değerlendirildiğinde, hastaların %5,1'i pandemi öncesi dönemde, %9,7'si pandemi döneminde hastaneye yatırılmıştır (p<0,05). Sonuç: Pandemi döneminde, olasılıkla poliklinik veya aile hekimliği düzeyinde ele alınabilecek durumlar için daha hızlı ve daha kolay tedavi bekleyen hastaların gereksiz acil başvuruların azaldığı görülmektedir. Bu düşüşün en önemli nedeni basit bir müdahale ile çözülebilecek hastalık durumlarında acil servise başvurulmaması tercihi olabilir.
Aim: In recent years, due to rapid population growth and migration, over crowdedness has been observed in emergency services and quality service delivery has been disrupted (1-3). Since emergency services are thought to be areas that are easily accessible, where patients who cannot get an outpatient appointment can receive immediate health care, can easily use laboratory services, and where examination and treatment procedures can be performed faster, day by day they are getting more crowded and misused. In studies conducted in Turkey in recent years, it has been reported that most of the patients admitted to emergency services do not have an emergent condition, and therefore, adequate service cannot be provided to real emergencies (4-6). In the study of Kılıçaslan et al. (1), 47.4% of the patients admitted to the emergency department, and in the study of Aydın et al. (7) 62.3% were reported to be in the non-emergency patient category. In epidemics such as the Covid-19 pandemic, emergency services continue to provide uninterrupted service as in other times. They are of critical importance both in the detection and management of suspected cases of COVID-19 and in the continuation of the diagnosis and treatment of other medical emergencies. In a period of such droplet transmission, only patients with real emergency conditions are expected to apply to the emergency department. The study was conducted to evaluate emergency service applications during the pandemic period. Material-Methods: The study is a multicenter observational cohort study. Emergency department admissions made to Hospital of Gazi University Faculty of Medicine and Kastamonu Training and Research Hospital between April 1, 2019 and May 31, 2019 (pre-COVID-19 period).; and between April 1, 2020 and May 31, 2020 (the very first period of COVID-19) were compared. In addition to the demographic data of the patients, their initial complaints, ICD diagnoses, examinations, consultation status and discharge status were recorded in the data collection form. Results: A total of 47888 patients, 22854 (47.7%) female and 25034 (52.3%) male, with a mean age of 40.9±19.6 years were included in the study. While 30.1% (14440) of the patients included in the study admitted to the emergency department during the pandemic period in 2020, 69.9% (33448) of them admitted in the pre-pandemic period in 2019. The mean age of patients admitted before the pandemic was 39.8±19.8, while the mean age was 43.5±18.9 during the pandemic period (p<0,005). While more laboratory tests were requested from the emergency departments in the pre-pandemic period, more radiological examinations were requested during the pandemic period. Patients were consulted approximately 7 times more during the pandemic period than in the previous year. There is a statistically significant difference between the periods in terms of consultation (p< 0.001). When the patients were evaluated in terms of hospitalization, 5.1% of the patients were hospitalized in pre-pandemic period and 9.7% of them were hospitalized in the pandemic period (p<0.05). Conclusions: It is seen that unnecessary emergency admissions, possibly the number of patients who are expecting a faster and easier treatment for conditions that can be handled at the polyclinics or family medicine level, decreased during the pandemic period. The most important reason for this decrease may be the preference not to admit to the emergency department in cases of illness that can be handled with simple interventions.
Aim: In recent years, due to rapid population growth and migration, over crowdedness has been observed in emergency services and quality service delivery has been disrupted (1-3). Since emergency services are thought to be areas that are easily accessible, where patients who cannot get an outpatient appointment can receive immediate health care, can easily use laboratory services, and where examination and treatment procedures can be performed faster, day by day they are getting more crowded and misused. In studies conducted in Turkey in recent years, it has been reported that most of the patients admitted to emergency services do not have an emergent condition, and therefore, adequate service cannot be provided to real emergencies (4-6). In the study of Kılıçaslan et al. (1), 47.4% of the patients admitted to the emergency department, and in the study of Aydın et al. (7) 62.3% were reported to be in the non-emergency patient category. In epidemics such as the Covid-19 pandemic, emergency services continue to provide uninterrupted service as in other times. They are of critical importance both in the detection and management of suspected cases of COVID-19 and in the continuation of the diagnosis and treatment of other medical emergencies. In a period of such droplet transmission, only patients with real emergency conditions are expected to apply to the emergency department. The study was conducted to evaluate emergency service applications during the pandemic period. Material-Methods: The study is a multicenter observational cohort study. Emergency department admissions made to Hospital of Gazi University Faculty of Medicine and Kastamonu Training and Research Hospital between April 1, 2019 and May 31, 2019 (pre-COVID-19 period).; and between April 1, 2020 and May 31, 2020 (the very first period of COVID-19) were compared. In addition to the demographic data of the patients, their initial complaints, ICD diagnoses, examinations, consultation status and discharge status were recorded in the data collection form. Results: A total of 47888 patients, 22854 (47.7%) female and 25034 (52.3%) male, with a mean age of 40.9±19.6 years were included in the study. While 30.1% (14440) of the patients included in the study admitted to the emergency department during the pandemic period in 2020, 69.9% (33448) of them admitted in the pre-pandemic period in 2019. The mean age of patients admitted before the pandemic was 39.8±19.8, while the mean age was 43.5±18.9 during the pandemic period (p<0,005). While more laboratory tests were requested from the emergency departments in the pre-pandemic period, more radiological examinations were requested during the pandemic period. Patients were consulted approximately 7 times more during the pandemic period than in the previous year. There is a statistically significant difference between the periods in terms of consultation (p< 0.001). When the patients were evaluated in terms of hospitalization, 5.1% of the patients were hospitalized in pre-pandemic period and 9.7% of them were hospitalized in the pandemic period (p<0.05). Conclusions: It is seen that unnecessary emergency admissions, possibly the number of patients who are expecting a faster and easier treatment for conditions that can be handled at the polyclinics or family medicine level, decreased during the pandemic period. The most important reason for this decrease may be the preference not to admit to the emergency department in cases of illness that can be handled with simple interventions.
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Keywords
Acil servis, COVID-19, Pandemi, SARS-CoV-2, Emergency department
Journal or Series
EMOS III. Maltepe acil günleri sempozyumu / Acil toksikoloji günleri - Bildiriler / EMOS III. Emergency Medicine Online Symposium / Emergency Toxicology Days
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Citation
Üzer, B., Coşkun Yaş, S., Kutalmış, Z., Kukul Güven, F. M. ve Demircan, A. (2023). Covid-19 pandemisinin acil servis başvurularına etkisi, Akgün, Feride Sinem, (ed.). EMOS III. Maltepe acil günleri sempozyumu / Acil toksikoloji günleri - Bildiriler / EMOS III. Emergency Medicine Online Symposium / Emergency Toxicology Days; İstanbul: T.C.Maltepe Üniversitesi. s.25-35.
