Impacto organizativo de la pandemia COVID-19 de 2020 en los servicios de urgencias hospitalarios españoles: resultados del estudio ENCOVUR

Objective To estimate the impact of the coronavirus disease 2019 (COVID-19) pandemic on the organization of Spanish hospital emergency departments (EDs) To explore differences between Spanish autonomous communities or according to hospital size and disease incidence in the area Methods Survey of the heads of 283 EDs in hospitals belonging to or affiliated with Spain's public health service Respondents evaluated the pandemic's impact on organization, resources, and staff absence from work in March and April 2020 Assessments were for 15-day periods Results were analyzed overall and by autonomous community, hospital size, and local population incidence rates Results A total of 246 (87%) responses were received The majority of the EDs organized a triage system, first aid, and observation wards;areas specifically for patients suspected of having COVID-19 were newly set apart The nursing staff was increased in 83% of the EDs (with no subgroup differences), and 59% increased the number of physicians (especially in large hospitals and locations where the COVID-19 incidence was high) Diagnostic tests for the severe acute respiratory syndrome coronavirus 2 were the resource the EDs missed most: 55% reported that tests were scarce often or very often Other resources reported to be scarce were FPP2 and FPP3 masks (38% of the EDs), waterproof protective gowns (34%), and space (32%) More than 5% of the physicians, nurses, or other emergency staff were on sick leave 20%, 19%, and 16% of the time These deficiencies were greatest during the last half of March, except for tests, which were most scarce in the first 15 days Large hospital EDs less often reported that diagnostic tests were unavailable In areas where the COVID-19 incidence was higher, the EDs reported higher rates of staff on sick leave Resource scarcity differed markedly by autonomous community and was not always associated with the incidence of COVID-19 in the population Conclusions The COVID-19 pandemic led to organizational changes in EDs Certain resources became scarce, and marked differences between autonomous communities were detected Objetivo Estimar el impacto del brote pandemico de COVID-19 en diversos aspectos organizativos de los servicios de urgencias hospitalarios (SUH) espanoles e investigar si difirio en funcion de la comunidad autonoma, tamano del hospital e incidencia local de la pandemia Metodo Encuesta a los responsables de los 283 SUH espanoles de uso publico, quienes valoraron el impacto de la pandemia en aspectos organizativos, disponibilidad de recursos, y bajas del personal durante marzo-abril de 2020, diferenciando dicho impacto por quincenas Los resultados se analizaron en conjunto, por comunidad autonoma, segun tamano del hospital y segun incidencia local de la pandemia Resultados Se recibieron 246 encuestas (87% de los SUH espanoles) La mayoria de SUH reorganizaron el triaje, primera asistencia y observacion y habilito nuevos espacios especificos para pacientes con sospecha de COVID-19 Un 83% aumento dotacion enfermera (sin diferencias entre grupos) y un 59% la dotacion de medicos (mas frecuente en hospitales grandes y zonas de alta incidencia) El recurso que mas escaseo fue el test diagnostico de SARS-CoV-2 (55% del tiempo insuficiente con cierta o mucha frecuencia), seguido de mascarillas FPP2-FPP3 (38%), batas impermeables (34%) y espacio asistencial (32%) Hubo mas del 5% de medicos/enfermeria/otro personal de baja el 20%/19%/16% del tiempo Estos deficits fueron maximos la segunda quincena de marzo, excepto para los test diagnosticos (primera quincena de marzo) Los SUH de grandes centros tuvieron menos escasez de tests diagnosticos, y los de zonas de alta incidencia pandemica mas profesionales de baja Existieron marcadas diferencias en todas estos deficits entre comunidades autonomas, no siempre concordantes con el grado de afectacion pandemica en cada comunidad Conclusiones La pandemia COVID-19 genero cambios estructurales en los SUH, que sufrieron una escasez considerable en ciertos recursos, con diferencias marcadas entre comunidades autonomas