Strengthening Emergency Care Systems to Mitigate Public Health Challenges Arising from Influxes of Individuals with Different Socio-Cultural Backgrounds to a Level One Emergency Center in South East Europe.

Michèle Twomey,Gert Krummrey,Aristomenis K Exadaktylos,Ana Šijački,Tyson Welzel,Marko Ercegovac

doi:10.3390/ijerph15030501

Abstract

Emergency center visits are mostly unscheduled, undifferentiated, and unpredictable. A standardized triage process is an opportunity to obtain real-time data that paints a picture of the variation in acuity found in emergency centers. This is particularly pertinent as the influx of people seeking asylum or in transit mostly present with emergency care needs or first seek help at an emergency center. Triage not only reduces the risk of missing or losing a patient that may be deteriorating in the waiting room but also enables a time-critical response in the emergency care service provision. As part of a joint emergency care system strengthening and patient safety initiative, the Serbian Ministry of Health in collaboration with the Centre of Excellence in Emergency Medicine (CEEM) introduced a standardized triage process at the Clinical Centre of Serbia (CCS). This paper describes four crucial stages that were considered for the integration of a standardized triage process into acute care pathways.

Highlights

Introduction“Emergencies occur everywhere, and each day they consume resources regardless of whether there are systems capable of achieving good outcomes” [1]
A standardized triage process is an opportunity to obtain real-time data that paints a picture of the variation in acuity found in emergency centers
30 nurse technicians have been trained in the standardized triage process, and further training is planned to cover the rest of the staff at the Clinical Centre of Serbia (CCS)

Summary

Introduction

“Emergencies occur everywhere, and each day they consume resources regardless of whether there are systems capable of achieving good outcomes” [1]. To obtain a baseline snapshot, a core data team consisting of four nurses and two doctors was responsible for gathering information prospectively This allowed for the inclusion of relevant indicators relating to real-time tracking of acuity distribution of patients on or shortly after arrival, as well as value-adding information during their acute care pathway. All information available on demand and capacity was displayed visually This was essential to inform future decision-making regarding healthcare organization and to determine how to configure and standardize a triage process that is contextually appropriate for integration into the acute care pathways. Prospectively gathered data and annual statistics from InfoMedis during three discussion rounds after which a consensus was reached on the most prevalent clinical discriminators to be included This process informed the modifications of the triage tool for use within the local context

Contextually Configure and Standardize the Triage Process

Reorganize and Restructure Available Resources

Redesigning Care Pathways to Integrate Standardized Triage

Conclusions