The Italian USL Toscana Centro model of a vascular hub responding to the COVID-19 emergency

Abstract

Background: Spreading of the COVID-19 pandemic in Italy forced health facilities to drastically change their organization to face the overwhelming number of infected patients needing hospitalization. The aim of this paper is to share with all the vascular community the protocol developed by the USL (Unità Sanitaria Locale) Toscana Centro for the reorganization of the Vascular Surgery Unit during the COVID-19 emergency, hoping to help other institutions to face the emergency during the hard weeks coming. Methods:The USL Toscana Centro is a public Italian health care institution including four districts (Empoli, Florence, Pistoia, Prato) with 13 different hospitals, serving more than 1,500,000 people in a 5000 km2 area. The USL adopted a protocol of reorganization of the Vascular Surgery Unit during the first difficult weeks of the epidemic, consisting in the creation of a Vascular Hub for urgent cases, with a profound reorganization of activities, wards, surgical operators, operating blocks, and intensive care unit (ICU) beds.Results: All 13 hospitals are now COVID-19 as the first days of April passed. The San Giovanni di Dio Hospital (Florence) has more than 80 COVID-19 patients in different settings (ICU, medical and surgical ward), which at the time of writing is almost one-third of the total hospital capacity (80/260 beds). It has been identified as the Surgical Hub for urgent vascular COVID-19 cases. Therefore, the elective surgical and office activities were reduced by 30% and 80%, respectively, and reserved to priority cases. A corner of the whole operating block, well separate from the remaining operating rooms, was rapidly converted into one operating room and six ICU beds dedicated to COVID patients. The COVID-19 surgical path now includes an emergency room for suspected COVID-19 patients directly connected to an elevator for the transfer of COVID patients in the COVID operating block and dedicated COVID-19 ward and ICU beds.Conclusions: Rapid modification of hospital settings, a certain "flexibility" of the medical personnel, a stepwise shutdown of vascular surgical and office activity, and the necessity of a strong leadership are mandatory to cope with the tsunami of the COVID-19 outbreak.

The impact of the SARS-CoV-2 pandemic on healthcare provision in Italy to non-COVID patients: a systematic review

“…50,51,55,56 For other medical conditions requiring surgery under particular circumstances, such as relapse of inflammatory bowel disease, dedicated hubs were identified. 94–57…”

Italy and COVID-19: the changing patient flow in an orthopedic trauma center emergency department

“…In Northern Italy, the overwhelming number of COVID-19 patients required a complete reorganization of the healthcare system [3,4]: wards were converted into COVID-19 care units, and deferrable surgeries and outpatient consultations were suspended. Some hospitals were designated hubs for specific urgent conditions [5], with the need to maximize resources and reduce patient crowding, reducing potential nosocomial COVID-19 spread.…”

A scoping review on the changes in vascular surgical practice during the early phases of the COVID-19 pandemic

“…A total of 19 articles had reported changes in the conduct of emergency and elective VS cases in respective institutions. 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 In summary, all articles reported continuation of emergency VS cases such as ruptured AAAs, and deferment of non-urgent elective VS cases such as revascularization for claudicants and varicose veins. There was some inter-institutional variation between the type of VS cases that proceeded or were deferred.…”