P351 “HOLDING AREA AND SHORT STAY HOSPITAL: A NEW MODEL OF ORGANIZATION

Abstract

Abstract In A.O. San Camillo–Forlanini, dedicated “Holding Areas” (HA) are active. They enable a rapid allocation of patients (pts), avoiding their long stay in the Emergency Department (ER) and therefore reducing the overcrowding. Moreover they allow the optimization of diagnosis and care, thanks to the direct management of specialists and reduce improper hospitalizations. Our HA is committed to receive (except on weekends) 3 pts/day destined to hospitalization in Cardiology. Here the patients are re–examined and quickly undergo to further specific tests, aiming at identifying those who can be addressed to alternative paths (Day Hospital/Day Service) and those who need to be hospitalized. For the latter, the HA allows to select the most appropriate diagnostic/therapeutic path according to the model of the intensity of care: critical area (ICU); ordinary hospitalization; short stay (SHS). In 2020 (with a total of 206 of Cardiology HA opening days, net of the lockdown and summer closure periods) 402 patients from the ER were admitted to cardiology HA. Among those, 20% (81 pts) was assigned to the SHS (availability of 2 beds/day, except for weekends) while another 4.3% (17 pts) was allocated to outpatient care. 52% of SHS pts had ischemic pathology (NSTE–ACS at low risk, CCS – Chronic Coronary Syndrome – with positive stress test, doubtful chest pain with multiple risk factors), 33% arrhythmic pathology (66% tachyarrhythmias, 34% bradyarrhythmias) and 12.6% heart failure (Killip class I–III). The HA reduced the average hospital stay (AHS): for SCA–NSTE, for example, from 5.1 days to 3.6 and the waiting time for diagnostic procedures (for example, for coronary angiography from 1.8 to 0.3 days). The opening of the SHS has further reduced the duration of the AHS: 1.5 nights for the CCS (the need for revascularization was not indicated in 68% of cases); 1 night for tachyarrhythmias (electrical cardioversion in 89% of cases); 3.75 nights for bradyarrhythmias (PMK implantation in 55% of patients). The overall average stay in SHS was very brief (2.5 nights) allowing a rapid turnover even with more difficult procedures. While criticalities persist (limited availability of SHS beds, “short” week opening), the results obtained confirm the need for dedicated and specialized HA in order to reduce improper hospitalizations, trim hospitalization times and broaden the appropriateness of care.