Emergency management of the COVID-19 pandemic in a Vascular Surgery
Department of a large metropolitan hospital in Milan, Italy.
Preparation, Escalation, De-escalation, Normal Activity
Abstract
During the first phase of COVID-19 pandemic in Italy, several strategies
have been taken to deal with the pandemic outbreak. The Regional
Authority of Lombardy remodeled the hospitalization system in order to
allocate appropriate resources to treat COVID-19 patients and to
identify “Hub/Spoke” hospitals for highly specialized medical
activities. The Hubs hospitals were required to guarantee full time
evaluation of all patients presenting with cardiovavascular diseases
with an independent pathway for patients with suspect or confirmed
COVID-19 infection. San Raffaele Hospital was identified as Hub for
cardiovascular emergencies and the Vascular Surgery Department was
remodeled to face this epidemic situation. Surgical treatment was
reserved only to symptomatic, urgent or emergent cases. Large areas of
the hospital were simultaneously reorganized to assist COVID-19
patients. During this period, 135 patients were referred to San Raffaele
Vascular Surgery Department. COVID-19 was diagnosed in 24 patients and,
among them, acute limb ischemia was the most common cause of admission.
At this time, the COVID-19 trend is in decline in Italy and the local
authorities reorganized the health care system in order to return to
normal activities avoiding new escalations of COVID-19 cases. Several
strategies have been taken to ensure the safety of the San Raffaele
hospital, and maintaining potentially suspected patients with COVID-19
separated from other patients. The aim of this paper is to report the
remodeling of the Vascular Surgery Department of San Raffaele Hospital
as regards the strategies of preparation, escalation, de-escalation and
return to normal activities during the COVID-19 pandemic.