ABSTRACT National and international literature underlines that one of the main problems in the emergency room is the overcrowding of the structures. Many investigations have been carried out on the phenomenon and in particular on its causes. Among these, the literature identifies the use of the Emergency Unit by patients who are considered "non-urgent" and can be managed in a more appropriate manner in the area. OBJECTIVE: Analyze all users who have accessed the emergency room, extract those who have been triaged with a white and green code, categorizing them, comparing them with the literature and indicating the right alternative destination to entering the emergency room. Finally, possible solutions to the phenomenon of overcrowding were indicated. MATERIALS AND METHOD: A review of the literature (PubMed and ITJEM) was carried out on the description and analyzes of the causes of improper access in the ED; A 17-month retrospective prevalence study was performed by consulting the MCAU database of the Fermo hospital. The analysis was performed from 04/01/2022 to 08/31/2023. All the entrances relevant to the study (green and white codes) were cataloged into proper and improper accesses, for the latter an alternative to the PS in the area was provided. RESULTS: The major cause of overcrowding is given by the presence of minor codes (accesses to the emergency department in the absence of real urgent needs) as demonstrated in the literature and confirmed by the data collected for the Fermo ED: out of 47,614 accesses 26,757 are code green and white and of these 56.01% would have had to go elsewhere. CONCLUSIONS: the strengthening of staff in the ED departments, the use of clinics exclusively dedicated to minor codes, the use of See&Treat protocols, the payment of a ticket for improper access but above all an information and knowledge campaign on the services offered by the territory would contribute to a possible improvement in overcrowding. Keywords: Non-urgent patient, emergency room, prevalence study, overcrowding in the ED, improper access, white code. Keywords: Non-urgent patient, emergency department, cross sectional-study, overcrowding, low acuity, improper access.
ABSTRACT La letteratura nazionale ed internazionale sottolinea che uno tra i principali problemi in atto nel Pronto Soccorso sia il sovraffollamento (overcrowding) delle strutture. Molte sono le indagini eseguite sul fenomeno ed in particolare sulle sue cause. Tra queste la letteratura individua l’utilizzo della Unità di Emergenza da parte dei pazienti da considerarsi “non urgenti” gestibili in maniera più consona sul territorio. OBIETTIVO: Analizzare tutti gli utenti che hanno avuto accesso in Pronto Soccorso, estrarre quelli che sono stati triagiati con codice bianco e verde categorizzandoli, confrontandoli con la letteratura ed indicandone la giusta destinazione alternativa all’ingresso in PS. Infine, sono state indicate possibili soluzioni al fenomeno del sovraffollamento. MATERIALI E METODO: È stata eseguita una revisione della letteratura (PubMed ed ITJEM) sulla descrizione e le analisi delle cause di accesso improprio in PS; è stato eseguito uno studio retrospettivo di prevalenza di 17 mesi tramite consultazione del database del MCAU dell’ospedale di Fermo. L'analisi è stata eseguita dal 1/04/2022 al 31/08/2023. Tutti gli ingressi pertinenti allo studio (codici verdi e bianchi), sono stati catalogati in accessi propri e impropri, di quest’ultimi è stata fornita una alternativa al PS sul territorio. RISULTATI: La causa maggiore di sovraffollamento è data dalla presenza di codici minori (accessi nel dipartimento di emergenza in assenza di reali necessità di carattere urgente) come dimostrato in letteratura e confermato dai dati raccolti per il PS di Fermo: su 47.614 accessi 26.757 sono codice verdi e bianchi e di questi il 56,01 % si sarebbe dovuto recare altrove. CONCLUSIONI: il potenziamento del personale nei reparti di PS, l’uso di ambulatori esclusivamente dedicati a codici minori, l’utilizzo di protocolli See&Treat, il pagamento di un ticket sull’accesso improprio ma soprattutto una campagna informativa e conoscitiva sui servizi offerti dal territorio concorrerebbero ad un possibile miglioramento del sovraffollamento. Parole chiave: Paziente non urgente, pronto soccorso, studio di prevalenza, sovraffollamento in PS, accesso improprio, codice bianco. Keywords: Non urgent patient, emergency department, cross sectional-study, overcrowding, low acuty, imprope access.
Gli accessi impropri in Pronto Soccorso: analisi statistica e proposte d'intervento.
POLIMANTI, ELISA
2022/2023
Abstract
ABSTRACT National and international literature underlines that one of the main problems in the emergency room is the overcrowding of the structures. Many investigations have been carried out on the phenomenon and in particular on its causes. Among these, the literature identifies the use of the Emergency Unit by patients who are considered "non-urgent" and can be managed in a more appropriate manner in the area. OBJECTIVE: Analyze all users who have accessed the emergency room, extract those who have been triaged with a white and green code, categorizing them, comparing them with the literature and indicating the right alternative destination to entering the emergency room. Finally, possible solutions to the phenomenon of overcrowding were indicated. MATERIALS AND METHOD: A review of the literature (PubMed and ITJEM) was carried out on the description and analyzes of the causes of improper access in the ED; A 17-month retrospective prevalence study was performed by consulting the MCAU database of the Fermo hospital. The analysis was performed from 04/01/2022 to 08/31/2023. All the entrances relevant to the study (green and white codes) were cataloged into proper and improper accesses, for the latter an alternative to the PS in the area was provided. RESULTS: The major cause of overcrowding is given by the presence of minor codes (accesses to the emergency department in the absence of real urgent needs) as demonstrated in the literature and confirmed by the data collected for the Fermo ED: out of 47,614 accesses 26,757 are code green and white and of these 56.01% would have had to go elsewhere. CONCLUSIONS: the strengthening of staff in the ED departments, the use of clinics exclusively dedicated to minor codes, the use of See&Treat protocols, the payment of a ticket for improper access but above all an information and knowledge campaign on the services offered by the territory would contribute to a possible improvement in overcrowding. Keywords: Non-urgent patient, emergency room, prevalence study, overcrowding in the ED, improper access, white code. Keywords: Non-urgent patient, emergency department, cross sectional-study, overcrowding, low acuity, improper access.| File | Dimensione | Formato | |
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https://hdl.handle.net/20.500.12075/15782