One fifth of emergency department visits are preventable, a European conference has heard.
A study presented at the Acute Cardiovascular Care 2016, in Lisbon, Portugal, yesterday, says that patients with preventable conditions are competing in hospitals with “real emergencies” such as stroke and myocardial infarction.
One of the report’s authors, Professor Martin Möckel, medical director of Emergency Medical Services at Charité – University Medicine Berlin, Germany, warned: “We face an increasing phenomenon of crowding in emergency departments.”
His comments follow the analysis of cardiovascular Ambulatory Care Sensitive Conditions (ACSCs) in 34,444 patients attending two departments in Berlin during one year.
In-hospital mortality and use of intensive care beds was examined in patients with cardiovascular ACSCs and the study stratified the results for inpatients and outpatients.
The researchers found that 21.9% of all patients admitted to hospital from the department had an ACSC. Of those, 52% had angina pectoris, congestive heart failure or hypertension. In patients directly discharged from the department, 20.5% had ACSCs, of which 35% were cardiovascular.
Professor Möckel said: “Half of the ACSCs were cardiovascular in those who were admitted for further inpatient care. In those who were treated as outpatients, the relative share of cardiovascular ACSCs was lower. This suggests that cardiovascular symptoms and diseases are taken seriously and patients are easily admitted to the hospital from the emergency department.”
In-hospital mortality for patients with any type of ASCS was 4.7%, but this fell to 2.3% for those with cardiovascular ACSCs. In-hospital mortality for cardiovascular ACSCs was 8.6% for congestive heart failure, 0.3% for angina pectoris and 0% for hypertension.
“Patients with chest pain are easily admitted but have a low risk of death due to the intensive structured treatment they receive in chest pain units, with swift access to monitoring units and intensive care,” said Professor Möckel.
“On the other hand, acute congestive heart failure is often a terminal condition with a high mortality and patients have little access to specialised care in the community.”
He said its analysis suggests that 20% of department visits are preventable and half of those are from cardiovascular disease.
“EDs are bursting at the seams and we could reduce crowding with more specialised and accessible outpatient care,” he added.
Patients treated in the department with no access to specialised chronic care in the community often return within a month with the same condition, the researchers say. This could be avoided by discharging patients from the department with a treatment plan, which includes an appointment to see a specialist.
“There is clearly a need to take some of the pressure off overstretched emergency departments,” continued Prof Möckel. “The next step in our research is to identify specific interventions that could improve care for patients with ACSCs and keep them out of hospital.”
Prevalence of cardiovascular ambulatory care sensitive conditions in the emergency department presented during the Rapid Fire Session, 16 October at Acute Cardiovascular Care 2016.
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