Stroke integrated care pathway during COVID-19 pandemic
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COVID-19
Stroke integrated care pathway during COVID-19 pandemic Giovanni Frisullo 1,2
&
Antonio Giulio De Belvis 3,4 & Giacomo Della Marca 1,5 & Carmen Angioletti 4 & Paolo Calabresi 1,5
Received: 4 May 2020 / Accepted: 20 May 2020 # Fondazione Società Italiana di Neurologia 2020
Dear Editor, We read with a great interest the publication on “Acute stroke management pathway during Coronavirus-19 pandemic” [1] where Baracchini et al. shared their experience in the management of stroke patients in a COVID-19 Hospital. In particular, they underlined how pre-triage, a mobile CT unit for COVID-19 patients, and dedicated COVID-19 areas were effective measures to deal with the COVID-19 emergency. We would like to share our experience on the changes of integrated care pathway (ICP) focused on ischemic stroke patients. The Gemelli Hospital, a large university hospital in Rome, is one of the 4 hubs in the Stroke Network of Regione Lazio, serving for almost 2 million people, and is equipped with a specific ICP for the management of acute ischemic stroke that was implemented since 2013 [2]. Since March 2020, due to the outbreak of COVID-19 pandemic, the Gemelli University Hospital was identified as a COVID19 Hospital, therefore dedicated to the management of both COVID-19 and non-COVID-19 (n-COVID-19) patients. For this reason, a specific ICP, especially for time-dependent diseases, was needed in order to clearly separate the paths and the areas of COVID-19 from n-COVID patients. In particular, stroke ICP underwent several changes since the admission to the Emergency Department (ED) where all patients underwent
* Giovanni Frisullo [email protected] 1
Dipartimento Scienze dell’Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli IRCCS - UOC Neurologia, Largo A. Gemelli, 8, 00168 Rome, Italy
2
Institute of Neurology, Catholic University, Rome, Italy
3
Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
4
Section of Hygiene, Institute of Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
5
Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1, 00168 Rome, Italy
a two-step triage. In the first step, the pre-triage just outside the ED, the risk of COVID-19 infection, was evaluated. Based on the pre-triage, the patients were classified “COVID-19” or “suspected COVID-19” (s-COVID-19) if they presented one of the following: fever (T > 37.5 °C), respiratory symptoms (cough, short breath), interstitial involvement at chest X-ray if performed before admission, or if recent contact with confirmed or probable COVID-19 patients was reported [3]. The s-COVID-19 patient undergoes nasopharyngeal swabs, taken from the nasopharynx and from each nostril. Since the result of this test need at least three hours, in the meantime, the s-COVID-19 patient is managed within the COVID-19 path. Starting from this point, the pathway of the patient with acute ischemic stroke and suspected COVID is completely separated from the
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