An Innovative Organization Model to Face Risks Reduction Challenges in an Italian Cancer Center During the COVID-19 Pandemic: A Risk Reduction Estimation Study

Background: In this COVID-19 pandemic, onco-hematological patients are at higher risk of severe infection not only because of their immunosuppressive state caused by malignancy and treatments, but also due to recurrent hospital accesses.  Methods: At the Cancer Care and Research Institute of Romagna (IRST) (northeast Italy), following the pillars suggested by national authorities and scientific societies, we set up a model for reduction of risk of COVID-19 positive accesses through sequential actions on patients, caregivers and workers. In this paper, we give an estimate of reduction of risk of COVID-19 positive accesses in IRST for each action put in place. Five actions were implemented and measured: (1) all procedures judged as deferrable by physicians have been postponed, (2) a by-phone triage has been activated together with a (3) on-site triage to avoid accesses of suspected cases patients and caregivers. For workers (4) special leaves and (5) smartwork were encouraged.  Findings: In the period from Mar, 11 and Mar, 31 we estimated a total of 14.0 COVID-19 positive patients accesses. Actions on patients accesses gave an overall relative risk reduction (RRR) of 65.4%. As for caregivers, we estimated about 5 cases of COVID-19 positive accesses avoided with a 69.5% RRR. Measures on healthcare workers avoided 17 COVID-19 positive accesses (overall RRR of 58.0%).  Interpretation: The implemented actions of reduction of accesses and corresponding estimates of risk reduction can be an example of how to face this pandemia maintaining both continuity of care and safety for patients and staff in a context of frailty such as a cancer centre. Funding Statement: No external funding. Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: The Ethics Committee at IRST waived ethical approval for this intervention as it involved the prevention of disease in response to an immediate public health threat.