Abstract
To analyse structural and non-structural modifications of acute stroke care pathways undertaken at healthcare institutions across the regions of Italy due to the coronavirus disease 2019 (COVID-19) pandemic. Research on National decrees specific for the pandemic was carried out. The stroke pathways of four Italian regions from North to South, such as Lombardy, Veneto, Lazio and Campania, were analysed before and after the pandemic outbreak. On 29 February 2020, the Italian Minister of Health issued national guidelines on how to address the COVID-19 emergency. Stroke management was affected and required changes, basically resulting in the need to prioritise the ongoing COVID-19 emergency. In the most affected regions, the closure of departments and hospitals led to a complete reorganisation of previously functioning stroke networks. With the closure of several Stroke Units and Stroke Centres, the transportation time to hospital lengthened significantly, especially for the outlying populations. The COVID-19 pandemic outbreak has been spreading rapidly in Italy and placing an overwhelming burden on healthcare systems. In response to this, political and healthcare decision-makers worked together to develop and implement efforts to sustain the national healthcare system while fighting the pandemic. Stroke care pathways changed during the pandemic and different organisational models were applied in the most affected regions. Stroke treatment pathways will need to be redesigned so to guarantee that severe and acute disease patients do not lose their rights to the access and delivery of care during the COVID-19 pandemics.
Highlights
Background and purposesIntroductionAfter the first Italian case was diagnosed on 20 February 2020 at the Codogno Hospital (Lodi, Lombardy, Italy), on 29 February 2020, the Italian Minister of Health issued national guidelines on how to address the COVID-19 emergency.[1]
The management pathways for acute conditions needed to adapt immediately to the novel realities associated with COVID-19
The management path of acute stroke in Italy has reached a level of organisation, capillary diffusion and efficiency that, in most regions, the number of intravenous thrombolysis (IVT) is greater than 10% of hospitalisations for acute ischemic stroke
Summary
After the first Italian case was diagnosed on 20 February 2020 at the Codogno Hospital (Lodi, Lombardy, Italy), on 29 February 2020, the Italian Minister of Health issued national guidelines on how to address the COVID-19 emergency.[1] This led to a profound restructuring of the Italian hospital system; a greater number of hospital beds were dedicated to COVID-19 patients. The system is strongly decentralised, with 19 regions and 2 autonomous provinces that are given significant autonomy in their managing of the services, while the central government is still responsible for the overall system structure and guidelines on services that should be provided (i.e. minimum assistance levels).[3] Of the 21,551 deceased, at least 130 physicians[10] and more than 25 nurses have died because of the COVID-19 infections including those who have voluntarily returned to work to overcome shortages
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