Implementing a strategy to manage frequent emergency room visits in a district of Barcelona

• Published in: Gaceta sanitaria Vol. 38; p. 102428
• Main Authors: Giménez, Emmanuel, Abadías, María José, San-José, Antonio, Losada, Marta, Acezat, Jordi, Ibáñez, Jordi, Marte, Luis, Barrecheguren, Miriam, Méndez, Ana Belén, Aguayo-Álvarez, Marta, Arranz, María, Ramos, Rosa
• Format: Journal Article
• Language: Spanish
• Published: Spain 19.11.2024
• Subjects: Chronic complex patient; Health outcomes; Paciente crónico complejo; Coordinación asistencial; Listados automatizados; Automated lists; Multiple emergency department visit; Resultados en salud; Care coordination; Visitas frecuentes a urgencias
• ISSN: 1578-1283

Visits to hospital emergency departments by patients with multimorbidity, complex chronic conditions, and frailty are becoming an increasing challenge. A territorial strategy has been developed, based on automated preselection lists, a nurse case manager with specialized experience, and a multi-level territorial referral consensus. The feasibility of this approach has been demonstrated, with 368 alerts detected, 85% of which were well-selected. Age, frailty, home care percentage, Barthel index, and cognition were progressively aligned with levels of care/referral (primary, intermediate, and specialized) according to previously agreed criteria. In 2024, there is extensive structured technical information, an expanding role for advanced nursing, and well-established inter-level service resources. Therefore, through automated selection, a consensual territorial protocol of pathways and clinical profiles, and autonomous nursing assessments managing multi-frequent cases, it would be possible to achieve, in a proactive, simple, and scalable manner, an appropriate distribution of alerts across levels, consistent with the social and healthcare needs of the patients.