Impact of a high-resolution primary care emergency center over emergency department demand
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Departamento de Epidemiología y Estudios en Salud, Universidad de los Andes, Chile
Clínica Universidad de los Andes, Chile
Publication date: 2023-04-27
Popul. Med. 2023;5(Supplement):A877
Background: Emergency Departments (ED) overcrowding is a worldwide problem causing poorer inpatient outcomes and the inability of staff to adhere to protocols. EDs are, for many people the access gate to health system. In Chile, for a population around 17 million, they had over twenty million visits in 2019, compared with 17 million in primary care. The demand is growing up every year increasing crowding EDs. Since 2015, it has been implemented High Resolution Primary Care Emergency Center (HRPCEC) near to main Hospitals trying to control demand, the first one was Miraflores HRPCEC. But its impact has not been analyzed yet. Objective: To analyze the impact of implementation of Miraflores HRPCEC over Dr. Hernan Henriquez Aravena (DHHA) Hospital ED visits. Methods: We analyze visits by triage categorization, wait time and admission rate, from DHHA Hospital ED since 2012 to 2018 and visits to Miraflores HRPCEC from 2015 to 2018 with R Core Team (2022) software. We compare the period before and after 2015. To trend analysis, we used least squares regression lines, modeling the estimation error using an ARMA model. To compare the number of visits by triage, we use a Poisson model regression. Results: Demand to DHHA Hospital ED is growing until 2014. Since 2015, there is a decrease in visit trend in 37% (p<0.05). At the same time, Miraflores HRPCEC visits double. All visits by triage categorization decrease since 2015, but it is especially significant in C4 and C5 (37% and 65%). Wait times for C1, C2 and C3 fall in 90%, 71% and 55% respectively. Hospitalization rates stay stable for all triage categories. Conclusions: The implementation of HRPCEC impact directly on DHHA Hospital ED visits. Reducing demand of non-urgent triage categorization patients and improving wait time of those who need urgent care.
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