Time Within the Acute Care Chain: How Long Have Medical Emergency Department Patients Spent

All adult ED patients in the province of Limburg will be included in a 72 hour time frame. Students were present at the EDs 24 hours to include all these patients. Patient data were gathered from medical records (including hospital file, referral letters and EMS notes) using a Case Report Form (CRF) and from a questionnaire filled out by the patient. Data were collected on demographic variables, including sex, age, highest level of education, living situation and the presence of roommates. Furthermore, information regarding the ACC and Time spent in the ACC (TACC) was collected.

The entire ACC was divided into four phases: the pre-referral phase, the referral phase, the ED phase and the post ED phase. In each phase several variables were collected.

Pre-referral phase The pre-referral phase started with the onset of complaints this disease period up to the referring contact. The following variables of this phase were collected: the symptom duration in days calculated from the day of onset of symptoms until ED visit, number of prior contacts with a healthcare provider and prescribed medication this disease period before ED visit. A prior contact with a healthcare provider was defined as a contact within this disease period, regarding the same complaint, and before the contact during which the patient was referred to the ED.

Referral phase The referral phase started with the moment of referral until arrival at the ED. The following variables of this phase were collected: time and date of referral contact, referring health care provider (GP, EMS, medical specialist, nursing home doctor, other or self-referral), prehospital triage urgency (EMS and GCP), and mode of transportation to the ED (own transport or by EMS). Prehospital triage urgency levels (for GPC and EMS) are determined using the Netherlands Triage Standard (NTS), which categorizes patients from U1 (life threatening, immediate action required) up to U5 (advice, a physical examination can wait until the next day) (16). If necessary, an ambulance is subsequently dispatched according to these urgency levels.

ED phase The ED phase started with arrival at the ED until hospital discharge, including 30-day follow-up. The following variables of this phase were collected at the ED: referred specialty (the specialty to which the patient has been referred), treating specialty (the specialty that eventually treated/discharged/admitted the patient), triage urgency level (MTS (17)), presenting symptoms, the number of patients with a presumptive prespecified complex condition, ED work up, and arrival and departure time in the ED to calculate the length of stay (LOS).