Reducing Emergency Room’s overcrowding

Abstract Introduction The ageing of the population and the consequent increase in the epidemiology of chronic diseases pose numerous challenges at both hospital and territorial levels. In this context, one phenomenon that deserves particular attention is the frequent use of emergency services by ‘frail’ people. The aim of our study was to identify the most frequent users of the University Hospital’s Emergency Room (ER) of Siena, based on their care at territorial level. Materials and methods A retrospective study was carried out on the data of accesses to the ER of the University Hospital’s of Siena from June to September 2023. Patients were stratified according to the number of admissions, excluding those with only one admission during the study period. After identifying those with four or more accesses, the USL-TSE management system ‘Astercloud’ was used to check whether they were in integrated home care (ADI) or planned home care (ADP). Descriptive analysis was performed using STATA software. Results During the study period, 2347 patients were admitted to the ER, 78.95% had two admissions, 14.96% had three, 4.26% had four, 1.24% had five, 0.34% had six, 0.13% had seven, 0.09% had eight and, finally, 0.04% had eleven admissions. 93.1% of the sample had fewer than four admissions (2,204 patients), while 6.1% had four or more admissions (143 patients). Of the 143 patients studied, 16.1% were in home care, 13.3% in ADI and 2.8% in ADP. 36.8% of patients in ADI died within 4 months of the last admission during the period studied. Conclusions Our results suggest that the identification of people at risk of frequent use of the ER seems essential. Equally important is the existence of effective coordination and cooperation between hospitals and the community, with special attention to certain categories of patients. All of this is aimed to achieve overall appropriateness and therapeutic effectiveness, thus avoiding inappropriate admissions to the ER. Key messages • Significance of identifying individuals prone to frequent use of emergency services to underscore the need for proactive management strategies to address their healthcare needs. • Coordination and cooperation between hospital facilities and community-based services to enhance appropriateness of care and reduce inappropriate Emergency Room admissions.