Pathways to the emergency department - a national, cross-sectional study in Sweden.

BACKGROUND: Swedish Emergency Departments (EDs) see 2.6 million visits annually. Sweden has a strong tradition of health care databases, but information on patients' pathways to the ED is not documented in any registry. The aim of this study was to provide a national overview of pathways, degree of medical acuteness according to triage, chief complaints, and hospital admission rates for adult patients (≥18 years) visiting Swedish EDs during 24 h. METHODS: A national cross-sectional study including all patients at 43 of Sweden's 72 EDs during 24 h on April 25th, 2018. Pathway to the ED, medical acuteness at triage, admission and basic demographics were registered by dedicated assessors present at every ED for the duration of the study. Descriptive data are reported. RESULTS: A total of 3875 adult patients (median age 59; range 18 to 107; 50% men) were included in the study. Complete data for pathway to the ED was reported for 3693 patients (98%). The most common pathway was self-referred walk-in (n = 1310; 34%), followed by ambulance (n = 920; 24%), referral from a general practitioner (n = 497; 1 3%), and telephone referral by the national medical helpline "1177" (n = 409; 10%). In patients 18 to 64 years, self-referred walk-in was most common, whereas transport by ambulance dominated in patients > 64 years. Of the 3365 patients who received a medical acuteness level at triage, 4% were classified as Red (Immediate), 18% as Orange (very urgent), 47% as Yellow (Urgent), 26% as Green (Standard), and 5% as Blue (Non-Urgent). Abdominal or chest pain were the most common chief complaints representing approximately 1/3 of all presentations. Overall, the admission rate was 27%. Arrival by ambulance was associated with the highest rate of admission (53%), whereas walk-in patients and telephone referrals were less often admitted. CONCLUSION: Self-referred walk-in was the overall most common pathway followed by ambulance. Patients arriving by ambulance were often elderly, critically ill and often admitted to in-patient care, whereas arrival by self-referred walk-in was more common in younger patients.

[Telephone referrals to the emergency department behind a large part of the visits. 4 out of 5 have health care contact prior to visits to the emergency department]. / Telefonhänvisning till akuten bakom en stor del av besöken - 4 av 5 har Sjukvårdskontakt före besök på akutmottagningen.

For unknown reasons, the number of visits to Swedish A&E Departments is on the increase. This study was designed to research whether patients had been in contact with the health service prior to their visit to the Örebro University Hospital A&E Department and if so, which part of the healthcare system. Our study revealed that 80% of patients had been in contact with the healthcare service prior to their visit, that referrals by telephone constituted a large proportion of visits and that the level of medical seriousness differed between the various methods of referral.

[Early team assessment relieves the emergency department]. / Tidig team-bedömning avlastar akutmottagningen.

A model for physician-led team triage was evaluated at the Emergency Department at the University hospital of Örebro, Sweden. Data from 1600 patients indicate that this work model reduces length of stay, time to physician assessment, emergency department occupancy, rate of admission and the proportion of patients in need of close monitoring. The project was conducted without any change in the number of physicians, nurses or staff nurses working in the Emergency Department.