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Implementation of a nurse-led alternate care site for the management of the surge of patients with COVID-19 in an Italian emergency department
  1. Matteo Paganini1,2,3,
  2. Michele Pizzato2,
  3. Eric Weinstein3,
  4. Elena Vecchiato2,
  5. Andrea Bitetti2,
  6. Caterina Compostella2,
  7. Caterina Onesto2,
  8. Andrea Favaro2
  1. 1 Department of Biomedical Sciences, Universita degli Studi di Padova, Padova, Italy
  2. 2 Emergency Department, San Bassiano Hospital, ULSS7 Pedemontana, Bassano del Grappa, Italy
  3. 3 Center for Research and Training in Disaster Medicine, Humanitarian Aid, and Global Health, Università degli Studi del Piemonte Orientale Amedeo Avogadro, Novara, Italy
  1. Correspondence to Dr Matteo Paganini, Department of Biomedical Sciences, Universita degli Studi di Padova, Padova, 35131, Italy; matteo.paganini{at}


Background To accommodate and separate the large numbers of patients going to hospital with COVID-19, many EDs had to create new pathways for patients. We describe the outcomes of patients treated in a nurse-led alternate care site (ACS) at our hospital.

Methods This was a retrospective study of outcomes of patients managed at the ACS of ‘San Bassiano’ Hospital ED, Bassano del Grappa, Italy between 9 March and 16 April 2020. Self-presenting patients aged 5 years and older, suspected of having COVID-19, were initially diverted to the ACS. Patients with a National Early Warning Score ≥5 or with a desaturation ≥4% after the walking test were sent back to the main ED COVID-19 path for further evaluation and medical attention and were not further followed up. In the ACS, patients received a CXR, blood samples and a nasopharyngeal swab to test for SARS-CoV-2, and were sent home. An emergency physician reviewed the results later and called the patient back 5–6 hours later with instructions to return for medical evaluation of abnormal findings, or to seek their general practitioner’s attention. Patients received a follow-up phone call 15 days later to learn of their course.

Results A total of 487 patients were fully managed in the ACS and discharged home. Of the 392 (80.5%) patients with no abnormalities after the workup and instructed to stay at home, 29 reattended the ED in the next 15 days, and 13 were admitted. Among the 95 patients asked to return and receive medical attention, 20 were admitted and of those discharged, 3 reattended the ED within 15 days. At 15 days, no patient was deceased or received invasive ventilation; one admitted patient received non-invasive ventilation.

Conclusions A nurse-led ACS diverted a substantial proportion of patients from main ED resources without associated negative clinical outcomes.

  • COVID-19
  • disaster planning
  • emergency nursing

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  • Handling editor Mary Dawood

  • Twitter @pagustein, @michelepiz

  • Contributors MPa, EW and AF conceived the study. MPa, MPi, EW and AF designed and conducted the study. MPa and AF supervised the conduct of the study. MPa, MPi, EV, AB, CC, CO and AF performed data collection. MPa provided statistical advice. MPa and MPi performed data analysis. MP and EW drafted the manuscript, and all authors contributed substantially to its revision and take responsibility for the paper as a whole.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.