key: cord-0771959-spzr4q7s authors: Alquézar-Arbé, Aitor; Piñera, Pascual; Jacob, Javier; González del Castillo, Juan; Miró, Òscar title: ENCOVUR-3 study: Spanish emergency departments’ participation in hospital decision-making committees during the first peak of the coronavirus disease 2019 pandemic date: 2021-06-30 journal: Eur J Emerg Med DOI: 10.1097/mej.0000000000000794 sha: 23aa5dd929125da3ac59593fb62d80a71f560eff doc_id: 771959 cord_uid: spzr4q7s nan At the time of writing the present letter, the WHO has reported more than 60 million confirmed cases of coronavirus disease 2019 (COVID- 19) , including 1 426 101 deaths [1] . This has been the most important challenge to every National Health System in modern times worldwide, and, in this context, hospital work routines, including those of the emergency departments, had to be quickly adapted with unprecedented organizational and structural changes [2] [3] [4] . The European Union shares a universal public healthcare system, but the strategies are ruled at a country level, including during the management of the COVID-19 pandemic [5] [6] [7] [8] . In Spain, the first wave of COVID-19 was during March-April 2020, and it is estimated that around 5% of the population became infected during this period [9] . It should be noted that unlike most European countries, in Spain, there is still no emergency medicine specialty [10, 11] . In order to face this huge challenge, crisis executive committees (CEC) were created in practically every hospital in Europe. Nonetheless, there are no data about the participation of emergency departments in these CECs. On the other hand, it is unknown if the role of emergency departments was different according to the size of the hospital or the local extension of COVID-19. Bearing in mind this knowledge gap, the present study was performed with the main objective of describing the participation of heads of Spanish emergency departments in the decision-making processes carried out by CECs during the first wave of the COVID-19 pandemic. Secondarily, it also analyzed if there were differences in the participation of heads of emergency departments depending on hospital size and the local incidence of the pandemic. The ENCOVUR study consisted of a cross-sectional survey assessing the organizational impact of the COVID-19 pandemic on emergency departments. The survey was addressed to the head of every public Spanish emergency department attending adult patients, 24 h a day, during March-April, 2020. The source of centers was the 2019 National Catalogue of Hospitals [12] that identified 283 emergency departments fulfilling the inclusion criteria. The survey methodology has been previously published [13] . In summary, it was developed by the steering committee of the SIESTA (Spanish Investigators on Emergency Situations TeAm) network [14] during three successive teleconferences and consisted of 35 questions structured in 4 different sections. The ENCOVUR-3 study reported the results of the section investigating the participation of heads of emergency departments in the institutional decision-making process of the CEC. The questions were related to (1) the level of participation in hospital CECs; (2) the level of participation in the protocols and algorithms for the management of patients with COVID-19; (3) the overall satisfaction with their involvement in the CECs during the first COVID-19 surge. All responses were categorized as low, medium or high. In order to analyze the effect of hospital size on hospital emergency department participation, the hospitals were divided according to having ≤500 or >500 beds. To evaluate the influence of the local impact of the COVID-19 pandemic, hospitals were classified according to a provincial seroprevalence of SARS-CoV-2 ≤3% or >3% at the beginning of May 2020 determined in a previous study [5] . Qualitative variables were expressed as absolute values and percentages, and comparisons were conducted with the chi-square test for linear trends. Statistical differences were considered with a P value <0.05. All the statistical analyses were performed using the SPSS Statistics V26 (IBM, Armonk, New York, USA). Given the characteristics of the study, approval by a Clinical Research Ethics Committee was not necessary. A total of 246 of the 283 Spanish emergency departments (87%) participated in the study: 181 hospitals had ≤500 beds (73.5%) and 101 hospitals (41%) were in geographic areas with low seroprevalence of SARS-CoV-2 infection. Two hundred twenty-six emergency department heads (91.8%) reported high participation in the hospital CEC and 205 (83.3%) participated in the elaboration of the COVID-19 protocols of their respective centers. Overall, 202 emergency department heads (82.1%) reported a high level of satisfaction with their participation in the CEC, while the level of satisfaction was medium in 27 (11.4%) and low in 16 (6.5%). When comparing these results according to the size of the hospital and the local impact of the COVID-19 during the first wave of the pandemic, no differences were observed in responses to any of the survey questions (Fig. 1) . The ENCOVUR-3 study evaluates the participation of heads of emergency departments in hospital CECs in charge of decision making during the first wave of the COVID-19 pandemic of 2020 in Spain. The study has two main findings. First, the participation of heads of Spanish emergency departments in hospital CECs and in the development of protocols for COVID-19 patient management was significantly high. Overall satisfaction with their involvement was high among 8 out of 10 emergency department heads; these results are not surprising, since emergency departments had a central position in patient hospital reception (receiving close to 100% of cases) and played a key role in the initial management and final disposition of the patients (i.e., hospitalization or discharge) [6, 7, 15] . Therefore, involvement in the CEC should be, as in fact, it was, the general rule. Second, there were no significant differences in emergency department head involvement in CEC decision-making according to hospital size or burden generated by COVID-19 patients. The ENCOVUR-3 study has some limitations. First, the results are based solely on the opinion of persons in charge of the emergency departments. This option was chosen because the survey referred mostly to issues managed by heads of emergency departments. Second, full recruitment of the entire population was not achieved; however, participation was close to 90% and can, therefore, be considered as highly representative. Lastly, external validation of the results is needed by investigations carried out in European countries other than Spain. In conclusion, the participation of emergency department heads in hospital decision-making committees was high during the first peak of the COVID-19 pandemic, regardless of the size of the hospital or the local impact of the pandemic. provided insight for the final version. J.G.C. is the guarantor of the article, taking responsibility for the integrity of the work as a whole, from inception to publication. There are no conflicts of interest. Hospital Universitario Doctor Peset Aleixandre de Valencia: María Luisa López Grima Hospital Marina Baixa de Villajoyosa de Alicante: Rosa María Hernández Sánchez Hospital Lluis Alcanys de Xativa: Carles Pérez García Dunia Bel Verge Josep Maria Mòdol Deltell Josep Tost Hospital del Mar (Barcelona): Alfons Aguirre Tejedo Hospital Universitari de Girona Dr Lluís Llauger García Enrique Martín Mojarro Carmen del Arco Galán Verónica Prieto Cabezas Available at: https:// covid19.who.int/?gclid=EAIaIQobChMI9sDNu--k7QIVFxkGAB0V-wB5EAAYASAAEgIZTvD_BwE COVID-19: one threat, one world, one response (magical thinking) COVID-19: change is urgent European Society For Emergency Medicine position paper on emergency medical systems' response to COVID-19 COVID-19 in French and Spanish emergency departments: we're not so very different from each other The challenge of emergency medicine facing the COVID-19 outbreak How emergency departments prepare for virus disease outbreaks like COVID-19 Emergency medicine: we can be heroes, just for a few days ENE-COVID Study Group. Prevalence of SARS-CoV-2 in Spain (ENE-COVID): a nationwide, population-based seroepidemiological study Still with neither a specialization nor a spokesperson Emergency medicine -a specialty that absolutely must have its place in medical education Catálogo Nacional de Hospitales Impact of the COVID-19 pandemic on hospital emergency departments: results of a survey of departments in 2020 -the Spanish ENCOVUR study Collaboration among Spanish emergency departments to promote research: on the creation of the SIESTA (Spanish Investigators in Emergency Situations TeAm) network and the coordination of the UMC-19 (Unusual Manifestations of COVID-19) macroproject Emergency services and the fight against the SARS-CoV-2 pandemic All authors discussed the idea and design of study and provided patients. Data analysis and first draft writing was done by J.G.C. and O.M. All authors read this draft and