INTRODUCTION: Emergency Department overcrowding, driven by an increase in presentations with lower clinical priority codes, represents a significant challenge for healthcare systems, negatively impacting waiting times, quality of care, and resource efficiency. The "See and Treat" (SaT) organizational model, based on medical-nursing protocols for the management of predefined minor emergencies, emerges as a potential solution to optimize the management of this patient cohort. OBJECTIVES: This single-center retrospective study aims to characterize in detail the patient population that accessed the ED of San Benedetto del Tronto Hospital with lower clinical priority codes (White, Green, Light Blue) from 2020 to 2024. The primary objectives are to provide an epidemiological description (demographic distribution, frequency, and type of presenting complaints) of this cohort and to delineate typical care pathways, the utilization of diagnostic-therapeutic resources, and clinical outcomes, in order to assess the feasibility and potential impact of introducing an SaT model. MATERIALS AND METHODS: A retrospective analysis was conducted on data related to patient flow, priority codes (White, Green, Light Blue, Orange, Red, Black), average waiting and consultation times, discharge modalities, and specialist accesses. Data, extracted from the ED information systems, were processed using descriptive statistics and graphical visualizations to identify significant trends and correlations. RESULTS: An overall increase in ED access volume was observed during the study period, with a predominance of Green codes (approximately 40% with a constant increase over the years) and Light Blue codes (approximately 35% with a constant decrease over the years), indicative of minor or moderate urgency conditions. The implementation of Fast Track pathways showed an association with a different distribution of codes and an optimization of management times for specific pathologies. However, overall, a lengthening of waiting times was noted for some patient categories, especially for Light Blue and Green codes. The most frequent discharge modality was "Home" (14,000 in 2020 and 22,000 in 2024), but with significant temporal variations among priority codes. The obtained results highlight the prevalence of low-complexity clinical conditions and often brief and standardized care pathways. DISCUSSION: The findings of this study highlight the increasing pressure on the San Benedetto del Tronto Emergency Department, primarily caused by the rise in low-priority access codes. The effectiveness of Fast Track pathways in improving the management of certain specific pathologies suggests that a "See and Treat" model could offer a solution to optimize patient flows with minor urgencies, thereby reducing overall waiting times and enhancing service efficiency. Although the implementation of such organizational models has demonstrated improvements in the management of specific pathologies and a potential optimization of times, prolonged waiting times for some patient types and variability in discharges suggest a genuine need to develop targeted clinical-care interventions supported by protocols that ensure a smooth and safe transition. CONCLUSIONS: This retrospective study highlights the potential effectiveness of the "See and Treat" model and Fast Track pathways in addressing ED overcrowding caused by low-priority accesses. In this regard, it is hoped that future research will evaluate the long-term impact of advanced triage organizational strategies with Fast Track pathways and the See and Treat model, using patient satisfaction, quality of care, and efficiency within our National Health Service (SSN) as indicators. KEYWORDS: See and Treat, Overcrowding, Triage, Fast Track, Boarding, Emergency Department
INTRODUZIONE: Il sovraffollamento dei Pronto Soccorso (PS) a causa dell'aumento degli accessi con codici di priorità clinica minori rappresenta una sfida significativa per i sistemi sanitari, impattando negativamente sui tempi di attesa, sulla qualità dell'assistenza e sull'efficienza delle risorse. Il modello organizzativo "See and Treat" (SaT), basato su protocolli medico-infermieristici per la gestione di urgenze minori predefinite, emerge come una potenziale soluzione per ottimizzare la gestione di questa tipologia di pazienti. OBIETTIVI: Il presente studio retrospettivo monocentrico si propone di caratterizzare dettagliatamente la popolazione di pazienti che hanno acceduto al PS dell'Ospedale di San Benedetto del Tronto con codici di priorità clinica minori (bianco, verde, azzurro) nel periodo 2020-2024. Gli obiettivi primari sono: fornire una descrizione epidemiologica (distribuzione demografica, frequenza e tipologia dei motivi di consultazione) di questa coorte e delineare i percorsi assistenziali tipici, l'impiego di risorse diagnostico-terapeutiche e gli esiti clinici, al fine di valutare la fattibilità e il potenziale impatto dell'introduzione di un modello SaT. MATERIALI E METODI: È stata condotta un'analisi retrospettiva dei dati relativi a flussi di pazienti, codici di priorità (Bianco, Verde, Azzurro, Arancione, Rosso, Nero), tempi medi di attesa e visita medica, modalità di dimissione e accessi per specialistica. I dati, estratti dai sistemi informativi del PS, sono stati elaborati mediante statistiche descrittive e visualizzazioni grafiche per identificare trend e correlazioni significative. RISULTATI: Si è osservato un incremento del volume complessivo di accessi al PS nel periodo in studio, con una predominanza dei codici Verde (40% circa con un costante aumento negli anni) e Azzurro (35% circa con un costante decremento negli anni) indicativi di condizioni di urgenza minore o moderata. L'implementazione dei percorsi Fast Track ha mostrato un'associazione con una diversa distribuzione dei codici e un'ottimizzazione dei tempi di gestione per specifiche patologie. Tuttavia, in generale, si è evidenziato un allungamento dei tempi di attesa per alcune categorie di pazienti specialmente per i codici azzurri e verdi. Le modalità di dimissione più frequenti sono state il "Domicilio" (14.000 nel 2020 e 22.000 nel 2024), ma con variazioni temporali significative tra i codici di priorità. I risultati ottenuti evidenziano la prevalenza di condizioni cliniche a bassa complessità e percorsi assistenziali spesso brevi e standardizzati. DISCUSSIONE: I risultati di questo studio evidenziano la crescente pressione sul Pronto Soccorso di San Benedetto del Tronto, principalmente causata dall'aumento degli accessi per codici di bassa priorità. L'efficacia dei percorsi Fast Track nel migliorare la gestione di alcune patologie specifiche suggerisce che un modello "See and Treat" potrebbe offrire una soluzione per ottimizzare i flussi di pazienti con urgenze minori, riducendo i tempi di attesa complessivi e migliorando l'efficienza del servizio. CONCLUSIONI: Questo studio retrospettivo evidenzia la potenziale efficacia del modello "See and Treat" e dei percorsi Fast Track nell'affrontare il sovraffollamento dei Pronto Soccorso causato dagli accessi con codici di bassa priorità. A tal proposito, si auspica che ricerche future valutino l'impatto a lungo termine delle strategie organizzative di triage avanzato con percorso Fast Track e modello See and Treat che abbiano come indicatori la soddisfazione del paziente, la qualità assistenziale e l'efficienza sul nostro Servizio Sanitario Nazionale (SSN).
Il modello See and Treat (SaT): Uno Studio Retrospettivo nell'AST di Ascoli Piceno
DE ANGELIS, VERONICA
2024/2025
Abstract
INTRODUCTION: Emergency Department overcrowding, driven by an increase in presentations with lower clinical priority codes, represents a significant challenge for healthcare systems, negatively impacting waiting times, quality of care, and resource efficiency. The "See and Treat" (SaT) organizational model, based on medical-nursing protocols for the management of predefined minor emergencies, emerges as a potential solution to optimize the management of this patient cohort. OBJECTIVES: This single-center retrospective study aims to characterize in detail the patient population that accessed the ED of San Benedetto del Tronto Hospital with lower clinical priority codes (White, Green, Light Blue) from 2020 to 2024. The primary objectives are to provide an epidemiological description (demographic distribution, frequency, and type of presenting complaints) of this cohort and to delineate typical care pathways, the utilization of diagnostic-therapeutic resources, and clinical outcomes, in order to assess the feasibility and potential impact of introducing an SaT model. MATERIALS AND METHODS: A retrospective analysis was conducted on data related to patient flow, priority codes (White, Green, Light Blue, Orange, Red, Black), average waiting and consultation times, discharge modalities, and specialist accesses. Data, extracted from the ED information systems, were processed using descriptive statistics and graphical visualizations to identify significant trends and correlations. RESULTS: An overall increase in ED access volume was observed during the study period, with a predominance of Green codes (approximately 40% with a constant increase over the years) and Light Blue codes (approximately 35% with a constant decrease over the years), indicative of minor or moderate urgency conditions. The implementation of Fast Track pathways showed an association with a different distribution of codes and an optimization of management times for specific pathologies. However, overall, a lengthening of waiting times was noted for some patient categories, especially for Light Blue and Green codes. The most frequent discharge modality was "Home" (14,000 in 2020 and 22,000 in 2024), but with significant temporal variations among priority codes. The obtained results highlight the prevalence of low-complexity clinical conditions and often brief and standardized care pathways. DISCUSSION: The findings of this study highlight the increasing pressure on the San Benedetto del Tronto Emergency Department, primarily caused by the rise in low-priority access codes. The effectiveness of Fast Track pathways in improving the management of certain specific pathologies suggests that a "See and Treat" model could offer a solution to optimize patient flows with minor urgencies, thereby reducing overall waiting times and enhancing service efficiency. Although the implementation of such organizational models has demonstrated improvements in the management of specific pathologies and a potential optimization of times, prolonged waiting times for some patient types and variability in discharges suggest a genuine need to develop targeted clinical-care interventions supported by protocols that ensure a smooth and safe transition. CONCLUSIONS: This retrospective study highlights the potential effectiveness of the "See and Treat" model and Fast Track pathways in addressing ED overcrowding caused by low-priority accesses. In this regard, it is hoped that future research will evaluate the long-term impact of advanced triage organizational strategies with Fast Track pathways and the See and Treat model, using patient satisfaction, quality of care, and efficiency within our National Health Service (SSN) as indicators. KEYWORDS: See and Treat, Overcrowding, Triage, Fast Track, Boarding, Emergency Department| File | Dimensione | Formato | |
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https://hdl.handle.net/20.500.12075/22051