Humberto S Machado1, Catarina Nunes, António Marques, Isabel Almeida, António José Barros, Eurico Castro Alves, António Sousa Pereira, José Barros and Paulo Barbosa1
Background: Emergency department (ED) management relies on real-time information. Patient flow, length- of-stay (LOS), complaint related readmissions, and patients that leave without being seen (LWBS), are monitoring parameters. The objective of this study was to evaluate activity time trends regarding ED at Centro Hospitalar do Porto from 2007 to 2016.
Methods: Analysis of ED data warehouse (Alert® Emergency Room) was carried out. Manchester Triage System (MTS) is used, and the mentioned priorities (P1, P2, P3, P4 and P5) correspond to its terminology. Spearman correlation between variables was applied.
Results: Patient records from 1.256.900 ED visits were evaluated. ED demand increased 16%. Priority 2 increased by 50% (p<0.001). A decrease of priority 4 (p<0.001) was observed. Patients that visit ED for unrelated reasons (labeled white) decreased (p<0.001). Difference between patients’ medians at different day hours (p<0.001) was found. A steady peak influx between 10 h-11 h and 14 h-16 h was found and significant increase was observed during night/dawn hours (3-8 h). No differences were observed between weekdays affluence. A priority difference was observed in weekdays, with a Monday peak for P3 and P4 priorities (p<0.001). A decrease in all patients’ ages was observed till sixty years old (p<0.001); A raise was noticed after eighty years old (p<0.001). Nevertheless, the LWBS was kept under 2.5% LOS under 5 h 30 m, with a sustained time-to-first-medical-observation (TFMO) under 70 minutes. Complaint indexed to readmissions (CIR) remained constant.
Discussion: A constant LOS, TFMO, CIR, and small LWBS indicate a positive trend of ED clinical management. Population’s characteristics should be taken in to consideration to maintain these results.
Conclusions: ED affluence increased during the studied period, especially by the olde r and the sicker. Primary care increased availability did not influence ED demand. Real time data storage helped to maintain clinical management by evidence based decisions.