Population Study of the Green and Blue Priorities in an Emergency Department

Abstract

Introduction: The management of the Emergency Department (ED) is complex and multifactorial, and with a growing influx of patients, it is burdened with hospital overcrowding, longer wait times, professional burnout, and lower quality of care. Approximately 43% of cases in Portugal are classified as low-priority emergencies.

Methods: This retrospective observational study was conducted in the ED of a district hospital in Portugal from October 2018 to May 2019. It included adults with green and blue priority in triage. Discharge destination and number of ED admissions were analysed, with associations examined in relation to age, mode of arrival, activation of the "via azul" (fast-track system), and access to primary healthcare services.

Results: We included 41 066 episodes, with the majority
being of green priority (99.9%). The majority of patients,
98.8%, were discharged to outpatient care. Frequent flyers
(≥ 4 admissions) made up 3.3% of the group and 0.3% were
high users (≥ 10 admissions). Analysis showed significant
associations of discharge destination with age, mode of arrival, and activation of the "via azul" (p <0.001). There was
also a significant association between number of admissions and age (p <0.001) and the number of admissions and access to primary healthcare services (p <0.001).

Conclusion: The study highlights the importance of different factors in the patient’s destination, showing a strong association between age and hospital admission. Furthermore, the mode of arrival to the ED and the activation of the "via azul" are also associated with the patient's discharge destination. However, further studies are needed to understand the systematic issues within the ED.