Emergency Department Overcrowding: A Retrospective Spatial Analysis and the Geocoding of Accesses. A Pilot Study in Rome

Cristiano Pesaresi,Giuseppe Migliara,Davide Pavia,Corrado De Vito

doi:10.3390/ijgi9100579

Cristiano Pesaresi, Giuseppe Migliara + Show 2 more

Open Access

https://doi.org/10.3390/ijgi9100579

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Abstract

The overcrowding of first aid facilities creates considerable hardship and problems which have repercussions on patients’ wellbeing, the time needed for a diagnosis, and on the quality of the assistance. The basic objective of this contribution, based on the data collected by the Hospital Policlinico Umberto I in Rome (Lazio region, Italy), is to carry out a territorial screening of the municipality using GIS applications and spatial analyses aimed at reducing—in terms of triage—code white (inappropriate) attendances, after having identified the areas of greatest provenance of improperly used emergency room access. Working in a GIS environment and using functions for geocoding, we have tested an experimental model aimed at giving a close-up geographical-sanitary look at the situation: recognizing the territorial sectors in Rome which contribute to amplifying the Policlinico Umberto I emergency room overcrowding; leading up to an improvement of the situation; promoting greater awareness and knowledge of the services available on the territory, a closer relationship between patient and regular doctor (general practitioner, GP) or Local Healthcare Unit and a more efficient functioning of the emergency room. In particular, we have elaborated a “source” map from which derive all the others and it is a dot map on which all the codes white have been geolocalized on a satellite image through geocoding. We have produced three sets made up of three digital cartographic elaborations each, constructed on the census sections, the census areas and the sub-municipal areas, according to data aggregation, for absolute and relative values, and using different templates. Finally, following the same methodology and steps, we elaborated another dot map about all the codes red to provide another kind of information and input for social utility. In the near future, this system could be tested on a platform that spatially analyzes the emergency department (ED) accesses in near-real-time in order to facilitate the identification of critical territorial issues and intervene in a shorter time to regulate the influx of patients to the ED.

Highlights

Many studies have underlined the problems regarding overcrowding of first aid facilities and the pressure on emergency rooms which result in weak assistance and care services, since the inappropriate use of emergency rooms by patients with non-serious conditions has a negative impact on the human resources and technologies and on the response times of both the emergency department (ED) and the hospital [1], [2] (p. 29).high pressure creates unbalances, dysfunction, and difficulties in the possibility of emergency departments to rapidly guarantee a first accurate examination, followed by diagnostic images, laboratory tests, and consultation with a specialist [3] (p. 1), [4]
Working in a GIS environment and using functions for geocoding, we have tested an experimental model aimed at giving a close-up geographical-sanitary look at the situation: recognizing the territorial sectors in Rome which contribute to amplifying the Policlinico Umberto I emergency room overcrowding; leading up to an improvement of the situation; promoting greater awareness and knowledge of the services available on the territory, a closer relationship between patient and regular doctor or Local Healthcare Unit and a more efficient functioning of the emergency room
This system could be tested on a platform that spatially analyzes the emergency department (ED) accesses in near-real-time in order to facilitate the identification of critical territorial issues and intervene in a shorter time to regulate the influx of patients to the ED

Summary

Introduction

It has been evidenced that: “ED overcrowding could potentially affect anyone who suffers unexpected severe illness or injury requiring time-sensitive emergency treatment. Manifestations of ED overcrowding include: (1) “boarding” of patients in the ED; (2) increased risk of medical errors; (3) ambulance diversion; (4) threat to disaster preparedness; (5) eroding reliability of the emergency care system” [7] It has been affirmed that: “ED overcrowding has multiple effects, including placing the patient at risk for poor outcome, prolonged pain and suffering of some patients, long patient waits, patient dissatisfaction, ambulance diversions in some cities, decreased physician productivity, increased frustration among medical staff, and violence” [8] It has been affirmed that: “ED overcrowding has multiple effects, including placing the patient at risk for poor outcome, prolonged pain and suffering of some patients, long patient waits, patient dissatisfaction, ambulance diversions in some cities, decreased physician productivity, increased frustration among medical staff, and violence” [8] (p. 63)

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