key: cord-323334-ie7iklr4
authors: Tartari, F; Guglielmo, A; Fuligni, F; Pileri, A
title: Changes in emergency service access after spread of COVID19 across Italy
date: 2020-04-27
journal: J Eur Acad Dermatol Venereol
DOI: 10.1111/jdv.16553
sha: 
doc_id: 323334
cord_uid: ie7iklr4

The Italian National Health System is currently living through some catastrophic days, owing to the rapid spread of COVID‐19 across the country. At the time of writing, our Government has passed emergency laws (March 11, 2020), with a view to preventing widespread viral infection among the population, which may well lead to an increase in the number of people requiring intensive care unit (ICU) hospital treatment. Currently, most of the northern Italian regions are close to saturation point in terms of the number of available ICU inpatient beds.

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The Italian National Health System is currently living through some catastrophic days, owing to the rapid spread of COVID-19 across the country. At the time of writing, our Government has passed emergency laws (March 11, 2020) , with a view to preventing widespread viral infection among the population, which may well lead to an increase in the number of people requiring intensive care unit (ICU) hospital treatment. Currently, most of the northern Italian regions are close to saturation point in terms of the number of available ICU inpatient beds. Albeit dermatologic "true" emergencies are a small number, many patients access our emergency services (ES) for routine diseases in order to avoid having to wait any length of time for a scheduled dermatological examination. The aim of our study is to analyse any possible changes in access to our ES by examining two different weeks before and after COVID-19 emergency in Italy.

The first week in the pre-COVID-19 era was randomly selected, while the second was chosen during the actual COVID-19 emergency. We analysed a six-day workload because our Unit does not operate an ES on Sundays. Diseases such as burns, drug eruption, acute urticaria-angioedema, skin rash (including psoriasis and bullous autoimmune dermatitis) involving more than 10% of the body surface area, along with acute infection (bacterial or viral) were identified as real emergencies. The remaining pathologies were considered to be unjustified consultations. The week between October 21 and 26, 2019 was identified as the pre-COVID-19 (no closure of the outpatients' surgeries available in our Unit for holidays or meetings). The days between March 12 and 18, 2020 characterised the weekly activity of our emergency service during the COVID-19 era (days in the run-up to the Government decree law). In the pre-COVID-19 era, 106 patients accessed our emergency outpatients' room, whereas just 20 cases were examined after the emergency decree law. The number of unjustified accesses was 60 in pre-COVID era, 46 patients showed "true" emergencies. Acute bacterial/viral infections on a par with diffuse skin rashes (19 cases each) were the most common problems, while 8 patients accessed the ES for burns. After March 11, 2020, 19 patients referred to the ES. Five patients turned up for an unjustified consultation, while 14 showed a "true" problem (4 diffuse rashes, 7 acute infections and 3 burns). See Table 1 for all the patient details.

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The misuse of the emergency consultation facility is a bad habit and it has been estimated that at least half of the patients do not have a "true" emergency (range 49-82%) 1-6 , which is confirmed by our study (60 vs 5 unjustified accesses, before/after the COVID19 pandemic). However, emergencies still exist, even in the presence of a potentially life-threatening virus. Patients suffering from acute myocardial infarction will refer to the ES even in the COVID19 era and the same will occur in the case of dermatological emergencies. Drago et al 7 appropriately defined a "true emergency" in dermatology as a severe dermatosis that requires immediate medical attention and an observation period lasting at least 24 hours. A possible bias in our research may be due to the panic related to the COVID19 disease, which can explain the drop in the number of consultations (106 vs 19, for an 81% reduction). Our data clearly show a decrease in unjustified referrals (60 vs 4, for a 93% reduction, p-value for Fisher Exact Test 0.0032) highlighting the misuse of the ES at our Unit. To conclude, a solution for select patient access to ES could be to: 1) implement the number of scheduled examinations by recruiting more dermatologists; 2) have more outpatients accessing during the daytime, especially in afternoon (an infrequent event in Italy); 3) train general practitioners to recognize and diagnose the most commonly occurring dermatosis.

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Primary care and pattern of skin diseases in a Mediterranean island

Evaluation of emergency dermatological consultations in a tertiary care centre in North India

Global coronavirus pandemic (2019-nCOV): Implication for an Italian medium size dermatological clinic of a ii level hospital

Medical education and care in dermatology during the SARS-CoV2 pandemia: challenges and chances

Dermatological consultations in an observation unit of an emergency department in Italy

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This article is protected by copyright. All rights reserved Accepted Article
