Abstract
Amaç: Acil servis hizmetlerinin genellikle tıbben acil olmayan, acile başvurmadan kolaylıkla çözümlenebilecek problemlere bağlı olduğu görülmektedir. Hizmet kalitesi, hasta memnuniyeti ve çalışan memnuniyetini artırabilmek için acil servislerin etkin kullanılması gerekmektedir. Acil servis başvurularının yaklaşık %30’unu çocuk acil servisi karşılamaktadır. Tüm dünyayı etkisi altına alan Covid-19 pandemisi nedeniyle acil servislere başvuru sayısı azalmış ve tıbbi anlamda acil olmayan hasta sayıları oldukça düşmüştür. Pandemi sürecinde apandisit ön tanısı ile çocuk acil servisinde değerlendirilen hasta sayılarında anlamlı bir azalma olmamasına rağmen acil servisin etkin kullanımı sağlanabildiği için negatif laparotomi oranları azalmıştır.
Gereç ve Yöntem: Bu çalışmada 1 Mart 2019 – 1 Eylül 2019 tarihleri ile 1 Mart 2020-1 Eylül 2020 tarihleri arasında apandisit ön tanısı ile çocuk acilde değerlendirildikten sonra apendektomi yapılan olgular karşılaştırılmıştır. Retrospektif olarak dosyalar incelenmiş ve histopatolojik inceleme sonuçları altın standart olarak kabul edilmiştir.
Sonuç: Tıbbi aciliyeti olmayan hastaların pandemi sürecinde acil servislere başvurmaması sonucu acil servislerde hizmet kalitesi artmış, bunun sonucu olarak da negatif laparotomi oranları azalmıştır.Literatür incelendiği zaman apandisit ön tanısı ile opere edilen çocuklarda negatiflaparotomi oranı %8-30 olarak karşımıza çıkmaktadır. 2019 yılındaki 6 aylık süreçte bizim kliniğimizde negatif laparotomi oranı %11,2 bulunmuştur. 2020 yılında pandemi sürecindeki 6 aylık veriler incelendiğinde bu oranın %2,8’e gerilediği görülmektedir.
Tartışma: Covid-19 pandemisi sürecinde acil servise, tıbbi aciliyeti olmayan hastaların başvuru sayısı azaldığı için daha kaliteli ve bilimsel hizmet sunulabilmiştir. Acil servislere hangi durumlarda başvurulması gerektiği konusunda iyi bir eğitim verilirse acil servislerin yükü azalacaktır ve daha kaliteli hizmet sunulabilecektir.
References
- Pope D, Fernandes C, Bouthillette F, Etherington J. Frequentusers of the emergency department: A program to improve care and reduce visits. CMAJ 2000; 162: 1017-20.
- Brousseau DC, Mistry RD, Alessandrini EA. Methods of categorizing emergency department visit urgency: A survey of pediatric emergency medicine physicians. Pediatr Emerg Care 2006; 22: 635-9.
- Afi lalo M, Guttman A, Colacone A, Dankoff J, Tselios C, Beaudet M, et al. Emergency department use and misuse. J Emerg Med 1995; 13: 259-64.
- Baker DW, Stevens CD, Brook RH. Patients who leave a public hospital emergency department without being seen by a physician. Causes and consequences. JAMA1991;266:1085-90.
- Poortman P, Lohle PN, Schoemaker CM, Oostvogel HJ, Tepen HJ, Zwinterman VA, et al. Comparison of CT and sonography in the diagnosis of acute appendicitis: A blinded prospective study. AJR Am J Roentgenology 2003;181:1355-9.
- Axelrod DA, Sonnad SS, Hirschl RB. An economic evaluation of sonographic examination of children with suspected appendicitis. J Pediatr Surg 200;35:1236-41.
- Campell JPM, Gunn AA. Plain abdominal radiographs and acute abdominal pain. Br J Surg 1988;75: 554-86.
- Kniskern JH, Eskin EM, Fletcher HS. Increasing accuracy in the diagnosis of acute appendicitis with modern diagnostic techniques. Am Sur 1986;52:222-5.
- Halfon N, Newacheck PW, Wood DL, St Peter RF. Routine emergency department use for sick care by children in the United States. Pediatrics 1996; 98:28-34.
- Doobinin KA, Heidt-Davis PE, Gross TK, Isaacman DJ. Non urgent pediatric emergency department visits: Care-seeking behavior and parental knowledge of insurance. Pediatr Emerg Care 2003; 19:10-4.
- Boran P, Tokuç G, Çoban Büyükkalfa D, Taşkın B, Pişgin B. Çocuk acil servisine başvuran vakaların değerlendirilmesi. Çocuk Dergisi 2008; 8: 114-6.
- Kinnear N, Heijkoop B, Bramwell E, Frazetto A, Noll A, Patel P, et al. Communication and management of incidental pathology in 1,214 consecutive appendicectomies; a cohort study. Int J Surg 2019;72:185–91.
- Orthopoulos G, Santone E, Izzo F, Tirabassi M, Pérez-Caraballo AM, Corriveau N, et al. Increasing incidence of complicated appendicitis during COVID-19 pandemic. Am J Surg 2021;221:1056–60.
Abstract
Background/Aims: Emergency service referrals frequently depend on non-urgent problems which are easy to solve without emergency services. Emergency services should be used effectively to raise service quality, patient and personnel satisfaction. Approximately %30 of emergency service referrals are pediatric patients. Covid-19 pandemia affecting the whole world, caused a decrease in non-covid patient emergency service referral numbers, consequently medically non-emergent patient numbers decreased too. Although the number of patients with a prediagnosis of acute appendicitis did not decrease during the pandemic, negative laparotomy rates decreased due to the effective use of emergency services.
Material and Method: In this study we compared patients with prediagnosis of acute appendicitis and undergone appendectomy in our pediatric emergency service between 1 March-1 September 2019 and 1 March-1 September 2020. Patient records were evaluated retrospectively. Histopathological diagnoses were accepted as the gold standard.
Result: Decreasing referrals of medically non-emergent patients to emergency services during pandemic led to improvement in service quality, so negative laparotomy rates declined. Looking at the literature, negative laparatomy rates of pediatric patients with the pre-diagnosis of acute appendicitis are 8-30%. In the 6-month period in 2019 negative laparotomy rate of our clinic found as 11.2%. When we examine the 6-month data of 2020 during pandemic we noticed that this rate declined to 2.8%. There was also a statistically significant difference between 2019 and 2020 in terms of the length of stay in the hospital.
Conclusions: Because of the decrease in referral numbers of medically non-emergent patients to emergency services during pandemic, much more qualified and scientific service was provided. Community education considering emergency service referral indications could reduce workload density and enhance service quality of emergency services.
Keywords
Emergency Health Services Child Negative Laparotomy Qualified Health Care Covid-19 Pandemic. Acil Sağlık Hizmetleri Çocuk Negatif Laparotomi Kaliteli Sağlık Hizmeti Covid-19 Pandemisi
References
- Pope D, Fernandes C, Bouthillette F, Etherington J. Frequentusers of the emergency department: A program to improve care and reduce visits. CMAJ 2000; 162: 1017-20.
- Brousseau DC, Mistry RD, Alessandrini EA. Methods of categorizing emergency department visit urgency: A survey of pediatric emergency medicine physicians. Pediatr Emerg Care 2006; 22: 635-9.
- Afi lalo M, Guttman A, Colacone A, Dankoff J, Tselios C, Beaudet M, et al. Emergency department use and misuse. J Emerg Med 1995; 13: 259-64.
- Baker DW, Stevens CD, Brook RH. Patients who leave a public hospital emergency department without being seen by a physician. Causes and consequences. JAMA1991;266:1085-90.
- Poortman P, Lohle PN, Schoemaker CM, Oostvogel HJ, Tepen HJ, Zwinterman VA, et al. Comparison of CT and sonography in the diagnosis of acute appendicitis: A blinded prospective study. AJR Am J Roentgenology 2003;181:1355-9.
- Axelrod DA, Sonnad SS, Hirschl RB. An economic evaluation of sonographic examination of children with suspected appendicitis. J Pediatr Surg 200;35:1236-41.
- Campell JPM, Gunn AA. Plain abdominal radiographs and acute abdominal pain. Br J Surg 1988;75: 554-86.
- Kniskern JH, Eskin EM, Fletcher HS. Increasing accuracy in the diagnosis of acute appendicitis with modern diagnostic techniques. Am Sur 1986;52:222-5.
- Halfon N, Newacheck PW, Wood DL, St Peter RF. Routine emergency department use for sick care by children in the United States. Pediatrics 1996; 98:28-34.
- Doobinin KA, Heidt-Davis PE, Gross TK, Isaacman DJ. Non urgent pediatric emergency department visits: Care-seeking behavior and parental knowledge of insurance. Pediatr Emerg Care 2003; 19:10-4.
- Boran P, Tokuç G, Çoban Büyükkalfa D, Taşkın B, Pişgin B. Çocuk acil servisine başvuran vakaların değerlendirilmesi. Çocuk Dergisi 2008; 8: 114-6.
- Kinnear N, Heijkoop B, Bramwell E, Frazetto A, Noll A, Patel P, et al. Communication and management of incidental pathology in 1,214 consecutive appendicectomies; a cohort study. Int J Surg 2019;72:185–91.
- Orthopoulos G, Santone E, Izzo F, Tirabassi M, Pérez-Caraballo AM, Corriveau N, et al. Increasing incidence of complicated appendicitis during COVID-19 pandemic. Am J Surg 2021;221:1056–60.
Details
| Primary Language | English |
|---|---|
| Subjects | Clinical Sciences |
| Journal Section | Original Article |
| Authors | |
| Early Pub Date | June 30, 2023 |
| Publication Date | June 30, 2023 |
| Submission Date | November 28, 2022 |
| Published in Issue | Year 2023 Volume: 33 Issue: 3 |
Journal of General Medicine is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License (CC BY NC).