The effect of the COVID pandemic lockdown measures on surgical emergencies: experience and lessons learned from a Greek tertiary hospital

Abstract Background The COVID-19 pandemic caused a rise in healthcare demands leading to significant restructuring of hospital emergency departments worldwide. The aim of the present study is twofold: firstly, to discern any differences in regard to reason for surgical emergency department (SED) attendance and hospital admission during the pandemic and pre-pandemic eras in Greece, and secondly, to assess the impact of the lockdown measures implemented during the pandemic on SED patient attendance. Methods Since the beginning of the COVID-19 pandemic in Greece (1 March 2020) and up to 15 December 2020, the charts of all adult patients arriving at the SED of the third surgical department of the “Attikon” University Hospital (a tertiary referral center for surgical and COVID-19 cases) were retrospectively reviewed and broken down in four periods reflecting two nationwide lockdown (period A 1/3/2020 to 30/4/2020 and period D 16/10/2020 to 15/12/2020) and two interim (period B 1/5/2020 to 15/6/2020 and period C 15/9/2020 to 30/10/2020) periods. Demographic and clinical data were compared to those obtained from the same time periods of the year 2019. Results The total number of patients attending the SED decreased by 35.9% during the pandemic (from 2839 total patients in 2019 to 1819 in 2020). During the first lockdown, there was statistically significant reduction of motor vehicle accidents (p=0.04) and torso injuries (p=0.01). Contrarily, the rate of head injuries (p<0.001) and abdominal pain (p=0.04) were significantly increased. The same effect was observed regarding the rate of hospital admissions (p=0.002), although in terms of absolute numbers, admissions remained unchanged. During the second lockdown, there was a reduction in the number of perianal abscess cases (p=0.04) and hernia-related problems (p=0.001). An increase in the rate of fall injuries was also demonstrable (p=0.02). Overall, application of the lockdown led to a significant decrease in minor (p<0.001) and torso (p=0.001) injuries. Conclusion The burden of the new COVID-19 disease has left a noticeable imprint in the function of emergency departments worldwide. In Greece, SED attendance was significantly reduced during the pandemic, an effect that was even more pronounced during the lockdown implementation; nevertheless, the overall rate of hospital admissions remained the same, denoting that patient care was not altered.

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The Effect of the COVID Pandemic Lockdown Measures on Surgical Emergencies: Experience and Lessons Learned from A Greek Tertiary Hospital.

10.21203/rs.3.rs-165222/v1 ◽

2021 ◽

Author(s):

Emmanouil Pikoulis ◽

Nikolaos Koliakos ◽

Dimitrios Papaconstantinou ◽

Nikolaos Pararas ◽

Andreas Pikoulis ◽

...

Keyword(s):

Brain Injuries ◽

Hospital Admissions ◽

Motor Vehicle ◽

Admission Rate ◽

Lessons Learned ◽

University Hospital ◽

Long Term Effects ◽

Hospital Admission Rate ◽

Surgical Department ◽

Number Of Patients

Abstract Background: The COVID-19 pandemic caused a rise in healthcare demands and has necessitated a significant restructuring of hospital Emergency Departments.The present study aims to determine the pandemic lockdown's impact on the number of patients seeking assessment in the Surgical Emergency Department (SED) with General Surgery emergencies. Methods: Since the start of the Covid pandemic in Greece (1 March, 2020) and up to 15 December 2020, the charts of all patients arriving at the SED of the third surgical department of the “Attikon” University Hospital (a tertiary referral center for surgical and COVID-19 cases) were retrospectively reviewed and broken down in four periods reflecting two nationwide lockdown (period A; 1/3/2020 to 30/4/2020 and period D; 16/10/2020 to 15/12/2020) and two interim (period B; 1/5/2020 to 15/6/2020 and period C; 15/9/2020 to 30/10/2020) periods. Demographic and clinical data were compared to those obtained from the same time periods of the year 2019.Results:The total number of patients attending the SED decreased by 35.9% during the pandemic (from 2839 total patients in 2020 to 1819 in 2019). During the first lockdown, there was a statistically significant reduction of motor vehicle accidents (p=0.04) and torso injuries (p=0.01). A rise in the rate of traumatic brain injuries (p<0.001), abdominal pain (p=0.04) and hospital admissions (p=0.002) was also evident. During the second lockdown, there was a reduction in the number of perianal abscess cases (p=0.04) and hernia-related problems (p=0.001). An increase in the rate of fall injuries was also demonstrable (p=0.02).Conclusion: The burden of the new COVID-19 disease has left a noticeable imprint in the function of emergency departments worldwide. In Greece, implemented lockdown measures significantly impacted the SED attendance rates, the clinical characteristics of the attending patients and the overall hospital admission rate. The long-term effects on national health systems remain to be seen.

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Unpredictable Fall of Severe Emergent Cardiovascular Diseases Hospital Admissions During the COVID‐19 Pandemic: Experience of a Single Large Center in Northern Italy

Journal of the American Heart Association ◽

10.1161/jaha.120.017122 ◽

2020 ◽

Vol 9 (13) ◽

Cited By ~ 11

Author(s):

Mauro Toniolo ◽

Francesco Negri ◽

Marco Antonutti ◽

Marco Masè ◽

Domenico Facchin

Keyword(s):

Cardiovascular Diseases ◽

Acute Coronary Syndromes ◽

Hospital Admissions ◽

Early Recognition ◽

Time Frame ◽

Northern Italy ◽

University Hospital ◽

Tertiary Referral Center ◽

Coronary Syndromes ◽

The Impact

Background Northern Italy is one of the epicenters of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV 2) pandemic in Europe. The impact of the pandemic and the consequent lockdown on medical emergencies other than those SARS‐CoV 2 pandemic related is largely unknown. The aim of this study was to analyze the epidemiologic impact of coronavirus disease 2019 pandemic on hospital admission for severe emergent cardiovascular diseases ( SECD s) in a single Northern Italy large tertiary referral center. Methods and Results We quantified SECD s admissions to the Cardiology Division of Udine University Hospital between March 1, 2020 and March 31, 2020 and compared them with those of the same time frame during 2019. Compared with March 2019, we observed a significant reduction in all SECD s admissions: −30% for ST ‐segment–elevation acute coronary syndromes, −66% for non‐ ST ‐segment–elevation acute coronary syndromes and −50% for severe bradyarrhythmia. Conclusions A significant decrease in all SECD s admissions has been observed during the SARS‐CoV 2. pandemic and was unlikely caused by a reduction in the incidence of cardiovascular diseases. Fear of contagion may have contributed to the unpredictable drop of SECD s. Social education about early recognition of symptoms of life‐threatening cardiac conditions requiring appropriate care in a timely fashion may help to reduce this counterproductive phenomenon.

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Biomarkers-based personalized follow-up in chronic heart failure improves patient’s outcomes and reduces care associate cost

Health and Quality of Life Outcomes ◽

10.1186/s12955-021-01779-9 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Antonio Leon-Justel ◽

Jose I. Morgado Garcia-Polavieja ◽

Ana Isabel Alvarez-Rios ◽

Francisco Jose Caro Fernandez ◽

Pedro Agustin Pajaro Merino ◽

...

Keyword(s):

Heart Failure ◽

Hospital Admissions ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Secondary Outcome ◽

Ventricular Ejection Fraction ◽

Number Of Patients ◽

Ed Visits ◽

The Impact

Abstract Background Heart failure (HF) is a major and growing medical and economic problem, with high prevalence and incidence rates worldwide. Cardiac Biomarker is emerging as a novel tool for improving management of patients with HF with a reduced left ventricular ejection fraction (HFrEF). Methods This is a before and after interventional study, that assesses the impact of a personalized follow-up procedure for HF on patient’s outcomes and care associated cost, based on a clinical model of risk stratification and personalized management according to that risk. A total of 192 patients were enrolled and studied before the intervention and again after the intervention. The primary objective was the rate of readmissions, due to a HF. Secondary outcome compared the rate of ED visits and quality of life improvement assessed by the number of patients who had reduced NYHA score. A cost-analysis was also performed on these data. Results Admission rates significantly decreased by 19.8% after the intervention (from 30.2 to 10.4), the total hospital admissions were reduced by 32 (from 78 to 46) and the total length of stay was reduced by 7 days (from 15 to 9 days). The rate of ED visits was reduced by 44% (from 64 to 20). Thirty-one percent of patients had an improved functional class score after the intervention, whereas only 7.8% got worse. The overall cost saving associated with the intervention was € 72,769 per patient (from € 201,189 to € 128,420) and €139,717.65 for the whole group over 1 year. Conclusions A personalized follow-up of HF patients led to important outcome benefits and resulted in cost savings, mainly due to the reduction of patient hospitalization readmissions and a significant reduction of care-associated costs, suggesting that greater attention should be given to this high-risk cohort to minimize the risk of hospitalization readmissions.

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Impact of the COVID-19 pandemic and its related psychological effect on orthopedic surgeries conducted in different types of hospitals in Taiwan

Journal of Orthopaedic Surgery ◽

10.1177/2309499021996072 ◽

2021 ◽

Vol 29 (1) ◽

pp. 230949902199607 ◽

Cited By ~ 1

Author(s):

Chia-Lung Shih ◽

Peng-Ju Huang ◽

Hsuan-Ti Huang ◽

Chung-Hwan Chen ◽

Tien-Ching Lee ◽

...

Keyword(s):

Community Hospital ◽

University Hospital ◽

Total Knee Arthroplasties ◽

Peak Period ◽

Number Of Patients ◽

Total Knee ◽

Investigation Period ◽

Orthopedic Diseases ◽

The University ◽

The Impact

Aim: Taiwan’s response to the coronavirus disease 2019 (COVID-19) differed in that it successfully prevented the spread without having to shutdown or overburden medical services. Patients’ fear regarding the pandemic would be the only reason to reduce surgeries, so Taiwan could be the most suitable place for research on the influence of psychological factors. This study aimed to assess the impact of patients’ fear on orthopedic surgeries in Taiwan amid the peak period of the COVID-19 pandemic. Patients and Methods: The investigation period included the COVID-19 pandemic (March 2020 to April 2020) and the corresponding period in the previous year. The following data on patients with orthopedic diseases were collected: outpatient visits, hospital admission, and surgical modalities. Results: The COVID-19 pandemic led to a 22%–29% and 20%–26% reduction in outpatients, 22%–27% and 25%–37% reduction in admissions, and 26%–35% and 18%–34% reduction in surgeries, respectively, at both hospitals. The weekly mean number of patients was significantly smaller during the COVID-19 pandemic for all types of surgery and elective surgeries at the university hospital, and for all types of surgery, elective surgeries, and total knee arthroplasties at the community hospital. Further, patients visiting the community hospital during the pandemic were significantly younger, for all types of surgery, elective surgeries, and total knee arthroplasties. Conclusions: The reduction in orthopedic surgeries in Taiwan’s hospitals during COVID-19 could be attributed to patients’ fear. Even without restriction, the pandemic inevitably led to a reduction of about 20%–30% of the operation volume.

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Development of the Madrid Stroke Programme: Milestones and Changes in Stroke Trends and Mortality from 1997 to 2017

Neuroepidemiology ◽

10.1159/000514077 ◽

2021 ◽

pp. 1-6

Author(s):

Silvia Pastor ◽

Elena de Celis ◽

Itsaso Losantos García ◽

María Alonso de Leciñana ◽

Blanca Fuentes ◽

...

Keyword(s):

Hospital Mortality ◽

Hospital Admissions ◽

Temporal Trends ◽

Intravenous Thrombolysis ◽

Stroke Care ◽

Care Organization ◽

Stroke Units ◽

Health Region ◽

Number Of Patients ◽

The Impact

Introduction: Stroke is a serious health problem, given it is the second leading cause of death and a major cause of disability in the European Union. Our study aimed to assess the impact of stroke care organization measures (such as the development of stroke units, implementation of a regional stroke code, and treatment with intravenous thrombolysis and mechanical thrombectomy) implemented from 1997 to 2017 on hospital admissions due to stroke and mortality attributed to stroke in the Madrid health region. Methods: Epidemiological data were obtained from the National Statistics Institute public website. We collected data on the number of patients discharged with a diagnosis of stroke, in-hospital mortality due to stroke and the number of inhabitants in the Madrid health region each year. We calculated rates of discharges and mortality due to stroke and the number of inhabitants per SU bed, and we analysed temporal trends in in-hospital mortality due to stroke using the Daniels test in 2 separate time periods (before and after 2011). Figures representing annual changes in these data from 1997 to 2017 were elaborated, marking stroke care organizational measures in the year they were implemented to visualize their temporal relation with changes in stroke statistics. Results: Hospital discharges with a diagnosis of stroke have increased from 170.3/100,000 inhabitants in 1997 to 230.23/100,000 inhabitants in 2017. However, the in-hospital mortality rate due to stroke has decreased (from 33.3 to 15.2%). A statistically significant temporal trend towards a decrease in the mortality percentage and rate was found from 1997 to 2011. Conclusions: Our study illustrates how measures such as the development of stroke units, implementation of a regional stroke code and treatment with intravenous thrombolysis coincide in time with a reduction in in-hospital mortality due to stroke.

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Prospective Assessment of Helicobacter Pylori Infection and Gastric Pathologies in Sidi Bel Abbes region, Western Algeria

South Asian Journal of Experimental Biology ◽

10.38150/sajeb.7(5).p217-224 ◽

2018 ◽

Vol 7 (5) ◽

pp. 217-224

Author(s):

Zouaouia Chama ◽

Khedoudj Kanoun ◽

Fatima Zohra Elkadi ◽

Kara Turqui Douidi ◽

Noria Harir ◽

...

Keyword(s):

Gastric Cancer ◽

Helicobacter Pylori ◽

Histological Study ◽

Helicobacter Pylori Infection ◽

University Hospital ◽

Infection Prevalence ◽

Gastric Diseases ◽

Number Of Patients ◽

H Pylori ◽

The Impact

Helicobacter pylori infection concerns half of the world’s population, mainly in developing countries. It causes several gastrodudenal pathologies such as gastritis, ulcer and gastric adenocarcinoma. The aim of our study was to determine the prevalence of H.pylori infection and to assess the impact of different epidemiological factors as well as principal gastric diseases associ-ated to this infection. We underwent a prospective study during 18 months (month 2016-month 2017) which implicated 201 symptomatic patients for gastric fiboptic endoscopy at the level of Sidi Bel Abbes University hospital. We collected patients’ biopsies to perform a histological study and H. pylori culture. H. pylori identification was carried out based on bacteriological and biochemical analysis. The middle age of our population was (47.29 ±15.97ans) and the sex-ratio =0,8. The global prevalence of Helicobacter pylori infection is of 61.2% (123/201). This rate, after a statistic analysis, seems to be significantly related to age. It is particularly high especially for patients belonging to age range (20-30)-(51-60) years. The gender did not affect the infection prevalence that is more frequent in the gastritis case. We noticed also that HP infection prevalence was important in SBA the hospital. The range age (20-30)-(51-60) years had the highest prevalence of H. pylori and of gastritis which might be a risky ground of gastric cancer appearance. The ulcer pathology maximal rate concerned the group of 51 to 60 years. Above this age, this rate dropped whereas the number of patients suffering from gastric cancer, which presents an important rate in our study, increase for the group of 61-70 years.

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Evaluating alcohol intoxication management services: the EDARA mixed-methods study

Health Services and Delivery Research ◽

10.3310/hsdr08240 ◽

2020 ◽

Vol 8 (24) ◽

pp. 1-214 ◽

Cited By ~ 1

Author(s):

Simon C Moore ◽

Davina Allen ◽

Yvette Amos ◽

Joanne Blake ◽

Alan Brennan ◽

...

Keyword(s):

Emergency Department ◽

Emergency Departments ◽

Alcohol Intoxication ◽

Ethnographic Study ◽

Acute Alcohol Intoxication ◽

Front Line ◽

Night Time ◽

Number Of Patients ◽

The Impact ◽

Management Services

Background Front-line health-care services are under increased demand when acute alcohol intoxication is most common, which is in night-time environments. Cities have implemented alcohol intoxication management services to divert the intoxicated away from emergency care. Objectives To evaluate the effectiveness, cost-effectiveness and acceptability to patients and staff of alcohol intoxication management services and undertake an ethnographic study capturing front-line staff’s views on the impact of acute alcohol intoxication on their professional lives. Methods This was a controlled mixed-methods longitudinal observational study with an ethnographic evaluation in parallel. Six cities with alcohol intoxication management services were compared with six matched control cities to determine effects on key performance indicators (e.g. number of patients in the emergency department and ambulance response times). Surveys captured the impact of alcohol intoxication management services on the quality of care for patients in six alcohol intoxication management services, six emergency departments with local alcohol intoxication management services and six emergency departments without local alcohol intoxication management services. The ethnographic study considered front-line staff perceptions in two cities with alcohol intoxication management services and one city without alcohol intoxication management services. Results Alcohol intoxication management services typically operated in cities in which the incidence of acute alcohol intoxication was greatest. The per-session average number of attendances across all alcohol intoxication management services was low (mean 7.3, average minimum 2.8, average maximum 11.8) compared with the average number of emergency department attendances per alcohol intoxication management services session (mean 78.8), and the number of patients diverted away from emergency departments, per session, required for services to be considered cost-neutral was 8.7, falling to 3.5 when ambulance costs were included. Alcohol intoxication management services varied, from volunteer-led first aid to more clinically focused nurse practitioner services, with only the latter providing evidence for diversion from emergency departments. Qualitative and ethnographic data indicated that alcohol intoxication management services are acceptable to practitioners and patients and that they address unmet need. There was evidence that alcohol intoxication management services improve ambulance response times and reduce emergency department attendance. Effects are uncertain owing to the variation in service delivery. Limitations The evaluation focused on health service outcomes, yet evidence arose suggesting that alcohol intoxication management services provide broader societal benefits. There was no nationally agreed standard operating procedure for alcohol intoxication management services, undermining the evaluation. Routine health data outcomes exhibited considerable variance, undermining opportunities to provide an accurate appraisal of the heterogenous collection of alcohol intoxication management services. Conclusions Alcohol intoxication management services are varied, multipartner endeavours and would benefit from agreed national standards. Alcohol intoxication management services are popular with and benefit front-line staff and serve as a hub facilitating partnership working. They are popular with alcohol intoxication management services patients and capture previously unmet need in night-time environments. However, acute alcohol intoxication in emergency departments remains an issue and opportunities for diversion have not been entirely realised. The nurse-led model was the most expensive service evaluated but was also the most likely to divert patients away from emergency departments, suggesting that greater clinical involvement and alignment with emergency departments is necessary. Alcohol intoxication management services should be regarded as fledgling services that require further work to realise benefit. Future work Research could be undertaken to determine if a standardised model of alcohol intoxication management services, based on the nurse practitioner model, can be developed and implemented in different settings. Future evaluations should go beyond the health service and consider outcomes more generally, especially for the police. Future work on the management of acute alcohol intoxication in night-time environments could recognise the partnership between health-care, police and ambulance services and third-sector organisations in managing acute alcohol intoxication. Trial registration Current Controlled Trials ISRCTN63096364. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 24. See the NIHR Journals Library website for further project information.

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Energy-Based Devices Affect the Aesthetic Outcome of Cervical Thyroidectomy and Parathyroidectomy. A Retrospective Study

Surgical Technology Online ◽

10.52198/21.sti.39.gs1499 ◽

2021 ◽

Vol 39 ◽

Author(s):

Antonella Pino ◽

◽

Lorenzo Gasco ◽

Daqi Zhang ◽

Paolo Carcoforo ◽

...

Keyword(s):

Body Dysmorphic Disorder ◽

The Body ◽

University Hospital ◽

Aesthetic Outcome ◽

Aesthetic Result ◽

Scar Assessment ◽

Number Of Patients ◽

Group A ◽

Group B ◽

The Impact

Introduction: Thyroid and parathyroid diseases are very common. Most of these cases are in women and may be amenable to surgery. The patient’s perception that these are not life-threatening diseases leads them to expect an excellent aesthetic result, since the surgical incision area is clearly visible. Objective: To evaluate different scarring outcomes using three different energy-based devices (Harmonic Focus®, Johnson & Johnson, New Brunswick, NJ; Thunderbeat Open Fine Jaw®, Olympus Medical, Tokyo, Japan; LigaSure Small Jaw®, Medtronic, Dublin, Ireland) and to determine the impact of post-thyroidectomy/parathyroidectomy scars on the patient’s quality of life. Methods: One hundred female patients who underwent thyroidectomy or parathyroidectomy between September 2017 and September 2019 at the Endocrine and Minimally Invasive Surgery Department of Messina University Hospital were recruited. A retrospective analysis assessed the thickness of the cervical scar via ultrasound imaging, and the patient’s degree of satisfaction through the Patient and Observer Scar Assessment Scale (POSAS) and the Body Dysmorphic Disorder Questionnaire (BDDQ). Results: The patients were divided into three groups according to the energy-device used: group A (LigaSure SJ (n=38), group B (Harmonic F, n=32) and group C (Thunderbeat OFJ, n=30). The three groups were homogeneous with respect to number of patients, age and surgical procedures. The best aesthetic result, which correlated with the lowest scar thickness, was observed in group A; these patients were more satisfied than those in the other two groups. Moreover, correlations between scar thickness and quantitative variables (such as age or BMI) were not found in any of the groups. Conclusions: Based on the data collected and our experience, the LigaSure Small Jaw® (Medtronic) seems to offer the best aesthetic outcome in patients who undergo transverse cervicotomy for thyroid and parathyroid diseases. However, further prospective studies involving a greater number of cases are needed.

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Breaking the bottle neck to enhance pediatrics renal transplantation at Soba university hospital: Role of a non-governmental organization

Healthcare in Low-resource Settings ◽

10.4081/hls.2019.7930 ◽

2019 ◽

Vol 7 (1) ◽

Author(s):

Ihab B. Abdalrahman ◽

Shaima N. Elgenaid ◽

Rashid Ellidir ◽

Asma Nizar Mohammed Osman Abdallah ◽

Safa Ahmed Hassan Hamid ◽

...

Keyword(s):

Renal Transplant ◽

Quality Care ◽

Healthcare Delivery ◽

University Hospital ◽

Healthcare Delivery System ◽

Governmental Organization ◽

Low Resource ◽

Number Of Patients ◽

Stage Renal Disease ◽

The Impact

High cost and limited resources of pediatrics renal transplant in low-resource countries limits the number of transplants. However, the collaboration between government and community sector provided high quality care for these patients. Here we highlight the impact of a non-governmental organization in facilitating pediatrics renal transplant. Data was collected from files of all pediatric patients withend stage renal disease who received renal transplant between January 2010 and December 2017 at Soba University Hospital (77 patients). The 8-year period was divided into 16 intervals of 6 months each. The number of patients who received renal transplant ranged from 1 to 12 patients in each interval. There was a rise in 2017 when 21 (28.7%) patients received kidney transplant. In the last 6 months in 2017 there was a significant reduction in duration of hospital stay compared to the rest of the period; it dropped from 16.36 to 9.92 days (P=0.003). Partnership between governmental and non-governmental sectors is a good strategy in low resource area to bridge some of the gaps of healthcare delivery system.

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Quick diagnostic unit integrated in an emergency department setting reduces medical admissions – an observational study

Journal of Hospital Administration ◽

10.5430/jha.v3n3p17 ◽

2013 ◽

Vol 3 (3) ◽

pp. 17 ◽

Cited By ~ 1

Author(s):

Dan Brun Petersen ◽

Thomas Andersen Schmidt

Keyword(s):

Internal Medicine ◽

Emergency Department ◽

General Medicine ◽

University Hospital ◽

First Year ◽

Special Focus ◽

Diagnostic Study ◽

Diagnostic Unit ◽

Number Of Patients ◽

The Impact

Background: Hospitals in countries with public health systems have recently adopted organizational changes to improve efficiency and resource allocation, and reducing inappropriate hospitalizations has been established as an important goal, as well as avoiding or buffering overcrowding in Emergency Departments (EDs). Aims: Our goal was to describe the impact of a Quick Diagnostic Unit established on January 1, 2012, integrated in an ED setting in a Danish public university hospital following its function for the first year. Design: Observational, descriptive and comparative study. Methods: Our sample comprised the total number of patients being admitted and discharged from the Department of Internal Medicine in 2011 and 2012, with special focus on the General Medicine Ward. Results: Compared with 2011 the establishment of the Quick Diagnostic Unit integrated in the Emergency Department resulted in the admittance and discharge of fewer patients (40%; p < .0001) to the hospital’s General Medicine Ward and 11.6% (p < .0001) fewer patients in the whole Department of Internal Medicine. Conclusions: A Quick Diagnostic Unit integrated in an ED setting represents a useful and fast track model for the diagnostic study and treatment of patients with simple internal medicine ailments, and also serves as a buffer for overcrowding of the ED.

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