Risvolti aziendali e di sistema della regolamentazione degli accessi non urgenti nei Dipartimenti di Emergenza-Urgenza: l’esperienza dell’Azienda Ospedaliera "Spedali Civili" di Brescia

Journal title MECOSAN
Author/s Andrea Francesconi, Massimo Amato
Publishing Year 2015 Issue 2015/94
Language Italian Pages 17 P. 97-113 File size 20890 KB
DOI 10.3280/MESA2015-094006
DOI is like a bar code for intellectual property: to have more infomation click here

Below, you can see the article first page

If you want to buy this article in PDF format, you can do it, following the instructions to buy download credits

Article preview

FrancoAngeli is member of Publishers International Linking Association, Inc (PILA), a not-for-profit association which run the CrossRef service enabling links to and from online scholarly content.

The purpose of this study was to explore the magnitude of non-emergent Emergency Department (ED) visits by adults in one of the biggest hospital in north Italy, the "Spedali Civili" of Brescia Hospital. We performed a cross-sectional study aimed to investigate the whole population referring to ED with nonurgent conditions in 24-months time and to understand whether the organizational appropriateness has improved since Lombardy Region regulation IX/3379 entered into force. The data contained 45,087 non-emergent visits of the ED of three hospitals, nearly 37% of all accesses that are paradoxically decreasing in these years. All patients’ data have been provided by local ICT and the full number of improper visits supplies the exact dimension of the problem. Trend-lines and linear regression analysis have shown there is no improvement in appropriateness by this attempt of Lombardy Region on counteraction to this unresolved problem. At the end, we analyzed the phenomenon of the ED frequent users and calculated the costs of all non-urgent accesses to highlight the economic impact of this cohort of patients for the Regional Health Service.

Keywords: Emergency Department utilization, Organizational Appropriateness, economic impact, non-urgent visits

  1. Afilalo J., Marinovich A., Afilalo M., Colacone A., Leger R., Unger B., Giguere C. (2004). Nonurgent Emergency Department Patient Characteristics and Barriers to Primary Care. Academic Emergency Medicine, 11 (12): 1302-1310. DOI: 10.1111/j.1553-2712.2004.tb01918.x
  2. Bernstein S.L. (2006). Frequent Emergency Department Visitors: the End of Inappropriateness. Annals of Emergency Medicine, 48 (1): 18-20. DOI: 10.1016/j.annemergmed.2006.03.033
  3. Bianco A., Pileggi C., Angelillo I.F. (2003). Non-Urgent Visits to a Hospital Emergency Department in Italy. Public Health, 117 (4): 250-255. DOI: 10.1016/s0033-3506(03)00069-6
  4. Bissoni G., Moirano F. (2013). Editoriale. In AA.VV. I quaderni di Monitor. Assistenza h24 e riduzione degli accessi impropri in Pronto Soccorso: evidenze e indirizzi. 32(suppl 11). Age.na.s.
  5. Bloink J., Adler K.G. (2013). Transitional Care Management Services: New Codes, New Requirements. Family Practice Management, 20 (3): 12-17.
  6. Carret M.L., Fassa A.G., Kawachi I. (2007). Demand for emergency health service: factorsassociated with inappropriate use. BMC Health Services Research, 7: 131. DOI: 10.1186/1472-6963-7-131
  7. Carret M.L., Fassa A.C., Domingues M.R. (2009). Inappropriate use of emergency services: a systematic review of prevalence and associated factors. Cadernos de Salude Publica, 25 (1): 7-28. DOI: 10.1590/s0102/-311x200900010002
  8. Fiorentini G., Lippi Bruni M., Mammi I., Ugolini C. (2013). Aspetti metodologici per una stima della riduzione degli accessi impropri in Pronto soccorso. In AA.VV. I quaderni di Monitor. Assistenza h24 e riduzione degli accessi impropri in Pronto Soccorso: evidenze e indirizzi. 32 (suppl 11). Age.na.s.
  9. Francesconi A. (1993). Il coinvolgimento dei professionisti medici nei processi di controllo di gestione. Mecosan, 5 (2): 36-44.
  10. Ham C., York N., Sutch S., Shaw R. (2003). Hospital bed utilisation in the NHS, Kaiser Permanente, and the US Medicare programme: analysis of routine data. BMJ, 327 (7426): 1257. DOI: 10.10136/bmj.327.7426.1257.
  11. Honigman L.S., Wiler J.L., Rooks S., Ginde A.A. (2013). National Study of Non-urgent Emergency Department Visits and Associated Resource Utilization. Western Journal of Emergency Medicine, 14 (6): 609-616. DOI: 10.5811/westjem/2013.5.16112
  12. Huang J.A., Weng R.H., Lai C.S., Hu J.S. (2008). Exploring Medical Utilization Patterns of Emergency Department Users. Journal of the Formosans Medical Association, 107 (2): 119-128. DOI: 10.1016/s0929-6646(08)60125-4
  13. Hui D., Nooruddin Z., Didwaniya N., Dev R., De La Cruz M., Kim S.H., Kwon J.H., Hutchins R., Liem C., Bruera E. (2014). Concepts and Definitions for “Actively Dying”, “End of Life”, “Terminally Ill”, “Terminal Care”, and “Transition of Care”: A Systematic Review. Journal of Pain and Symptom Management, 47 (1): 77-89. DOI: 10.1016/j.jpainsymman.2013.02.021
  14. Kanter M.H. et al. (2013). Complete care at Kaiser Permanente: transforming chronic and preventive care. The Joint Commission Journal on Quality and Patient Safety, 39 (11): 484-494. ISSN: 1553.7250.
  15. LaCalle E.J., Rabin E.J., Genes N.G. (2013). High-Frequency Users of Emergency Department Care. Journal of Emergency Medicine, 44 (6): 1167-1173. DOI: 10.1016/j.jemermed.2012.11.042
  16. Lega F., Mengoni A. (2008). Why non-urgent patients choose emergency over primary care services? Empirical evidence and managerial implications. Health Policy, 88 (2-3): 326-338. DOI: 10.1016/j.healthpol.2008.04.005
  17. Liu T., Sayre M.R., Carleton S.C. (1999). Emergency Medical Care: Types, Trends, and Factors Related to Nonurgent Visits. Academic Emergency Medicine, 6 (11): 1147-1152. DOI: 10.1111/j.1553-2712.1999.tb.00118.x
  18. Liu S.W., Nagurney J.T., Chang Y., Parry B.A., Smulowitz P., Atlas S.J. (2013). Frequent ED users: are most visits for mental, alcohol, and drug-related complaints? American Journal of Emergency Medicine, 31(10): 1512-1515. DOI: 10.1016/j.ajem.2013,08.006
  19. Morganti K.G., Bauhoff S., Blanchard J.C., Mahshid A., Neema I., Smith A.C., Vesely J.V., Okeke E.N., Kellermann A.L. (2013). The Evolving Role of Emergency Departments in the United States. Santa Monica, CA, USA: RAND Corporation.

Andrea Francesconi, Massimo Amato, Risvolti aziendali e di sistema della regolamentazione degli accessi non urgenti nei Dipartimenti di Emergenza-Urgenza: l’esperienza dell’Azienda Ospedaliera "Spedali Civili" di Brescia in "MECOSAN" 94/2015, pp 97-113, DOI: 10.3280/MESA2015-094006