The healthcare establishment which won this year’s first prize in the European Private Hospitalization Awards in this category is:
Acibadem City Clinic Tokuda University Hospital, Bulgaria
for The fundamental role of the Emergency Department of a University Multidisciplinary Hospital during a pandemic achievement
The present project is a dissertation of Parvoleta Krasteva Yakova – Krasteva, MD on the topic Place and role of the Emergency Room of a multidisciplinary hospital for active treatment in the implementation of a diagnostic and therapeutic algorithm in patients over 18 years of age infected with SARS-CoV-2 virus during a pandemic. Dr. Krasteva has been the head of the Emergency Room at Acibadem City Clinic Tokuda University Hospital since 2017. In her study, she presents in detail and specifics the activities of the Emergency Room (ER) in the ACC Tokuda University Hospital for the period from March 2020 to November 2021 and the action algorithms that have been created to ensure the management of patient flow and preservation of the overall activities of ACC Tokuda University Hospital in a pandemic. The thesis was publicly defended in December 2023. In December 2019, a newly emerged strain of virus from the family Coronaviridae, the causative agent of an unknown acute respiratory disease, was isolated in China’s Wuhan Province. The new etiological agent was named SARS-CoV-2. In February 2020, WHO renamed it COVID-19, and in March of that year, declared it a pandemic.
The avalanche-like spread of the coronavirus and the increasing number of infected patients in Bulgaria, and especially in the capital Sofia, necessitated a rapid restructuring of the hospital medical care, and in particular of the ER, as a structure of ACC Tokuda University Hospital, to identify the sick and separate them from the rest of the patients in the ER. The newly emerged pandemic posed the greatest challenge for the medical staff in the ER, due to the need for rapid adaptation to the ever-increasing flow of infected patients against the background of limited staff resources and available facilities. Key elements in the overall concept of working in a pandemic was maintaining continuity and safety of the working environment for health care workers and preventing the spread of infection. In the unprecedented crisis situation, emergency medics were faced with the challenges of recognizing and identifying risk factors for disease progression as the pandemic unfolded, with a view to making correct and rapid decisions about diagnostic and therapeutic management of each specific patient.
In the course of the pandemic in Bulgaria, the Ministry of Health and the Regional Health Inspectorate outlined a common framework of anti-epidemic measures to fight the infection, but each hospital adapted it to the specifics of its structure and resources. Despite the existence of a well-established standard in Emergency Medicine, those working in ЕRs do not know in detail the essence of triage, which is the basis of effective patient flow management, especially in pandemic settings. No common triage protocols have been developed, nor is there a single form in the ER in Bulgaria. In the course of virus spread, we studied factors predictive of severe course of infection and adapted strategies for diagnosis, treatment and prevention.
The aforementioned circumstances necessitated the creation of effective algorithms for diagnostic and therapeutic management at the first encounter with infected patients in the ER of a multiprofile hospital.
The general task of the hospital team and in part – the ER, was to maintain the continuity of the work of the hospital as a whole, by identifying early prognostic factors affecting the morbidity and survival of infected patients in the ER, developing an effective and rapid algorithm for the primary clinical assessment of patients in the ER and ensuring safe working conditions for hospital staff and patients.
After a detailed analysis of the structure of the ACC Tokuda University Hospital and the possibilities for restructuring in the emergency situation, analysis of the medical triage in patients over 18 years of age with manifestations of Acute Respiratory Diseases or non-specific complaints, we analyzed the risk factors for progression of COVID-19 as follows: Categorical variables – sex, comorbidities, transport to the ER, lung imaging; Quantitative variables – age, number of comorbidities, temperature, SpO2heart rate, number of days with symptoms, leukocyte values, lymphocyte values, CRP, LDH, ferritin, D-dimer.
Based on the analysis of these indicators, clinical protocols were developed for the behavior of ER teams in the face of an unprecedented pandemic.
The ER teams were trained and updated in regular training sessions, regarding initial patient assessment and retreatment, interpretation of history data, clinical indicators and imaging and laboratory results, and the latest data from global analyses (WHO, ECDC and other international institutions) on the course of the pandemic and infectious disease control options. In case of urgent need, emergency trainings were also conducted, including the provision of personal written information materials and verbal instructions from the Capital Regional Health Inspectorate, National Center of Infectious and Parasitic Diseases, Ministry of Health, WHO, ECDC and others, in collaboration with the infection control team operating on the hospital premises.
