Speeding up the clinical pathways by accessing emergency departments

Area of Science:

• Health Services Research
• Public Health Policy
• Healthcare Management

Background:

• Emergency department (ED) overcrowding is a significant issue, often worsened by patients using EDs to bypass general practitioner (GP) gatekeeping.
• This practice is particularly prevalent in Italy, where non-severe conditions lead to inappropriate emergency admissions.

Purpose of the Study:

• To investigate emergency department access by patients with non-severe conditions in Liguria, Italy.
• To estimate the prevalence of strategic ED access and analyze the waiting time elasticity of low-severity patients.
• To inform policy interventions aimed at optimizing ED resource allocation and patient flow.

Main Methods:

• Analysis of population data for emergency department accesses in Liguria, Italy, for the year 2016.
• Estimation of strategic accesses and waiting time elasticities for low-severity patients.
• Comparison of demographic characteristics between strategic and non-strategic ED users.

Main Results:

• The percentage of non-urgent patients using EDs strategically (bypassing GPs) ranges from 8.7% to 9.9%.
• These strategic patients often prefer specialized hospitals, particularly during weekdays when GPs are available.
• Strategic patients tend to be significantly younger than the general ED population.

Conclusions:

• The practice of using EDs as a shortcut to avoid GP gatekeeping represents a substantial problem in healthcare access.
• Long waiting times in EDs may disproportionately discourage patients with genuine needs compared to strategic users.
• Policy recommendations include improving access to specialist care and enhancing diagnostic examination management within primary care settings.