Maria José De la Rosa, Andrea Duca, Lorenzo Querci, Francesca Cortellaro, Martina Calderaro, Paolo Pausilli, Annalisa Bodina, Andrea Albonico, Gabriele Perotti, Carlo Signorelli, Massimo Lombardo
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Furthermore, an inferential statistical analysis was performed to compare ED trends between 2019 and 2023.</p><p><strong>Results: </strong>During the analyzed period, there were 15,515,128 visits across all Lombardy EDs. ED visits dropped from 3,514,426 in 2019 to 2,380,005 in 2020, then rebounded to 3,464,756 in 2023. In 2019, triage code distribution was 9.9% white, 68.7% green, 19.0% yellow, and 1.9% red. During the pandemic, the proportion of white and green codes decreased. By 2023, these comprised 80.7% of the total. The percentage of admitted patients was 11.9% in 2019, rose to 16.2% in 2020, and returned to 11.4% in 2023. The median ED length of stay (EDLOS) for admitted patients in 2023 was 5.2 h (IQR [2.1-17.4]), compared to 3.8 h (IQR [1.6-8.6]) in 2019 (<i>p</i>-value < 0.01). The median EDLOS for discharged patients in 2023 was 2.7 h (IQR [1.4-4.9]), compared to 2.4 h (IQR [1.3-4.4]) in 2019 (<i>p</i>-value < 0.01). The rate of patients leaving before completing treatment was 5.0% in 2019 and peaked at 6.8% in 2023 (<i>p</i>-value < 0.01).</p><p><strong>Conclusions: </strong>In 2023, ED visits in Lombardy increased, compared to the pandemic period, but remained below 2019 levels. The proportion of high-acuity codes and hospital admissions was slightly lower than in 2019. However, ED crowding metrics worsened. The high levels of lower-acuity visits and the deterioration in crowding metrics highlight systemic challenges within the healthcare system.</p>","PeriodicalId":72944,"journal":{"name":"Epidemiolgia (Basel, Switzerland)","volume":"6 1","pages":""},"PeriodicalIF":0.0000,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11940893/pdf/","citationCount":"0","resultStr":"{\"title\":\"Does Calm Always Follow the Storm? 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This study examined ED visit volumes, patient acuity, hospital admission rates, emergency vehicle arrivals, and crowding metrics before, during, and after the pandemic.</p><p><strong>Methods: </strong>We conducted a retrospective descriptive study including data on all ED visits in the Lombardy Region of Italy from January 2019 to December 2023. Furthermore, an inferential statistical analysis was performed to compare ED trends between 2019 and 2023.</p><p><strong>Results: </strong>During the analyzed period, there were 15,515,128 visits across all Lombardy EDs. ED visits dropped from 3,514,426 in 2019 to 2,380,005 in 2020, then rebounded to 3,464,756 in 2023. In 2019, triage code distribution was 9.9% white, 68.7% green, 19.0% yellow, and 1.9% red. During the pandemic, the proportion of white and green codes decreased. By 2023, these comprised 80.7% of the total. The percentage of admitted patients was 11.9% in 2019, rose to 16.2% in 2020, and returned to 11.4% in 2023. The median ED length of stay (EDLOS) for admitted patients in 2023 was 5.2 h (IQR [2.1-17.4]), compared to 3.8 h (IQR [1.6-8.6]) in 2019 (<i>p</i>-value < 0.01). The median EDLOS for discharged patients in 2023 was 2.7 h (IQR [1.4-4.9]), compared to 2.4 h (IQR [1.3-4.4]) in 2019 (<i>p</i>-value < 0.01). The rate of patients leaving before completing treatment was 5.0% in 2019 and peaked at 6.8% in 2023 (<i>p</i>-value < 0.01).</p><p><strong>Conclusions: </strong>In 2023, ED visits in Lombardy increased, compared to the pandemic period, but remained below 2019 levels. The proportion of high-acuity codes and hospital admissions was slightly lower than in 2019. However, ED crowding metrics worsened. The high levels of lower-acuity visits and the deterioration in crowding metrics highlight systemic challenges within the healthcare system.</p>\",\"PeriodicalId\":72944,\"journal\":{\"name\":\"Epidemiolgia (Basel, Switzerland)\",\"volume\":\"6 1\",\"pages\":\"\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2025-03-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11940893/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Epidemiolgia (Basel, Switzerland)\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.3390/epidemiologia6010010\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Epidemiolgia (Basel, Switzerland)","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.3390/epidemiologia6010010","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
摘要
背景/目的：由于COVID-19大流行，急诊科（ED）拥挤已成为一个紧迫的全球问题。到目前为止，在大流行后的时期，欧洲还没有研究解决这一问题。本研究检查了在大流行之前、期间和之后的急诊科访问量、患者敏锐度、住院率、急诊车辆到达和拥挤指标。方法：我们进行了一项回顾性描述性研究，包括2019年1月至2023年12月意大利伦巴第地区所有急诊就诊的数据。此外，对2019年和2023年的ED趋势进行了推断统计分析。结果：在分析期间，伦巴第所有急诊科共有15,515,128人次就诊。ED访问量从2019年的3514426降至2020年的2380005，然后在2023年反弹至3446756。2019年，分类码的白色分布为9.9%，绿色分布为68.7%，黄色分布为19.0%，红色分布为1.9%。在大流行期间，白色和绿色代码的比例下降。到2023年，这一比例将达到80.7%。2019年住院患者比例为11.9%，2020年上升至16.2%，2023年回升至11.4%。2023年入院患者ED中位住院时间（EDLOS）为5.2 h (IQR[2.1-17.4])， 2019年为3.8 h (IQR [1.6-8.6]) （p值< 0.01）。2023年出院患者的中位EDLOS为2.7 h (IQR[1.4 ~ 4.9])， 2019年为2.4 h (IQR [1.3 ~ 4.4]) （p值< 0.01）。2019年患者未完成治疗就离开的比例为5.0%，2023年达到峰值6.8% （p值< 0.01）。结论：与大流行期间相比，伦巴第地区2023年急诊科就诊人数有所增加，但仍低于2019年的水平。高度码和住院比例略低于2019年。然而，急诊科拥挤度指标恶化了。高水平的低视力访问和拥挤指标的恶化突出了医疗保健系统内的系统性挑战。
Does Calm Always Follow the Storm? A Comprehensive Temporal Analysis of Emergency Department Visits in Northern Italy Before and After the COVID-19 Pandemic.
Background/objectives: Emergency department (ED) crowding has become a pressing global concern exacerbated by the COVID-19 pandemic. No studies have addressed this issue in Europe during the post-pandemic period so far. This study examined ED visit volumes, patient acuity, hospital admission rates, emergency vehicle arrivals, and crowding metrics before, during, and after the pandemic.
Methods: We conducted a retrospective descriptive study including data on all ED visits in the Lombardy Region of Italy from January 2019 to December 2023. Furthermore, an inferential statistical analysis was performed to compare ED trends between 2019 and 2023.
Results: During the analyzed period, there were 15,515,128 visits across all Lombardy EDs. ED visits dropped from 3,514,426 in 2019 to 2,380,005 in 2020, then rebounded to 3,464,756 in 2023. In 2019, triage code distribution was 9.9% white, 68.7% green, 19.0% yellow, and 1.9% red. During the pandemic, the proportion of white and green codes decreased. By 2023, these comprised 80.7% of the total. The percentage of admitted patients was 11.9% in 2019, rose to 16.2% in 2020, and returned to 11.4% in 2023. The median ED length of stay (EDLOS) for admitted patients in 2023 was 5.2 h (IQR [2.1-17.4]), compared to 3.8 h (IQR [1.6-8.6]) in 2019 (p-value < 0.01). The median EDLOS for discharged patients in 2023 was 2.7 h (IQR [1.4-4.9]), compared to 2.4 h (IQR [1.3-4.4]) in 2019 (p-value < 0.01). The rate of patients leaving before completing treatment was 5.0% in 2019 and peaked at 6.8% in 2023 (p-value < 0.01).
Conclusions: In 2023, ED visits in Lombardy increased, compared to the pandemic period, but remained below 2019 levels. The proportion of high-acuity codes and hospital admissions was slightly lower than in 2019. However, ED crowding metrics worsened. The high levels of lower-acuity visits and the deterioration in crowding metrics highlight systemic challenges within the healthcare system.
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