Enhancing patient safety in alternative emergency pathways: a comparative study of Italian and United Kingdom systems

Emergency departments (EDs) worldwide face increasing crowding, largely due to non-urgent patients. Various strategies have been proposed to redirect these patients to alternative care pathways, such as Urgent Care Centers (UCCs) in the United Kingdom and "Centri di Assistenza per le Urgenze" [Centers for Urgent Care] (CAUs) in Italy. However, the safety of these models remain uncertain. This study aims to compare the criteria of UCCs and CAUs to evaluate their impact on clinical outcomes. This retrospective, single-center study analyzed ED patients at Merano Hospital from January 1 to December 31, 2023. A sample of 1772 patients was independently assessed by two trained professionals using CAU and UCC criteria. The primary outcome was hospitalization following an ED visit, while secondary outcomes included 30-day and 6-month mortality. Sensitivity, specificity, positive and negative predictive values were calculated for both systems. The CAU system identified 833 patients (47.0%) as eligible for redirection, while the UCC system identified 937 patients (52.9%). The CAU model misclassified 4.1% of patients who subsequently required hospitalization, compared to 1.8% in the UCC system. Furthermore, patients redirected using CAU criteria had higher 30-day and 6-month mortality rates. The UCC model demonstrated higher sensitivity (81.5% vs. 3.7%) and greater specificity in predicting hospitalizations. The UCC system outperforms CAU in both patient safety and clinical effectiveness. Implementing evidence-based criteria for non-urgent patients is essential to alleviating ED overcrowding while maintaining patient safety. Future research should focus on refining selection algorithms to optimize care pathway effectiveness.