Moving forward to create a more sustainable and efficient obstetrics and gynecology emergency services requires a change of stance: What to learn from COVID-19 pandemic

INTRODUCTION In Italy, emergency services are free of charge and to public perception they have the utopian power to offer an immediate response to health problems.This causes inadequate emergency visits that are not cost-effective and could be harmful for the patients themselves. Since Gynecologists and Obstetrics working in emergency department have the impression that the number of pregnant and gynecological women who present themselves without any urgent reasons is increasing, the purpose of this study was to assess the impact of the COVID-19 pandemic on emergency department consults across obstetrics-gynecology services at AOU Policlinico G.Martino in Messina. Design: Retrospective cohort study. METHODS This is the first and only study to determine the volume of patients presenting to OB-GYN Emergency Department (our centre is a tertiary center with a catchment area of 60,000 women and 1500 deliveries each year) from March to October 2020 (across all the different 'legislative' stages of the COVID-19 pandemic) and compared them with the same months in 2019 as a control period. The primary outcome was the number of access to Ob-Gyn ED in the two study periods. The co-primary endpoint was the overload daily rate in the two study periods. Patients were divided into two groups: gynecologic and pregnant. Secondary outcomes were the admission rate, the discharge rate, the abandonment rate, the reasons for and the number of access for each category in the two period and related to the restrictions. We conducted a population-based analysis using anonymized data. The only exclusion criteria was COVID-19 positive patients, as they could not gain access because of regional health services reorganization. Comparisons were analyzed with chi-square. RESULTS A total of 6033 women self-referred to our OB-GYN ED were enrolled. During COVID-19 period the total number of OB-GYN self-referrals was 2617 compared to 3416 accesses occur during 2019 (considering our catchment area, the difference was 1.49 % p < .0001) and the daily overload rate was 33.5% (COVID-19 pandemic ) vs 43.75 % (2019), with a difference all over the period of 10.2% (p < .0001). These differences were stronger during the 'lock down' periods of March, April and October 2020 (differences of daily overload rates respectively: 15.9 %;19.9%;9%, p < .0001). The hospitalization rate was significantly higher both for gynecologic and pregnant patients during the COVID-19 pandemic suggesting that women were going to hospital for more serious problems. CONCLUSIONS There was a significant reduction in OB-GYN ED accesses and the hospitalization rate was higher during the 'lock down period' only, while there were not any differences during the 'light lock down months' compared to the same time in 2019. It may be indirect proof of the probably inappropriate use of the OB-GYN ED. COVID Pandemic has been a stress test for our health care system highlighting our critical points. This underlines the urgent need to identify new healthcare algorithms to reduce the workload of the Emergency Departments and at the same time to create more efficient diagnostic and treatment paths in order to generate a more efficient, sustainable welfare system and get ready for a new crisis.