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Speeding up the clinical pathways by accessing emergency departments

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Abstract

Inappropriate emergency admissions create overcrowding and may reduce the quality of emergency care. In Italy, overcrowding is further exacerbated by patients who use emergency admissions as a shortcut to avoid the general practitioner (GP) gateway. In this paper, we investigate access to emergency departments (EDs) by patients with non-severe medical conditions and their willingness to wait. Population data for ED accesses in Liguria (an Italian administrative region) in 2016 were used to estimate the number of strategic accesses and waiting time elasticities of low-severity patients. Our results show that the practice of using EDs to skip gatekeeping is a serious problem. The percentage of patients who engage in such practice vary from 8.7 to 9.9% of non-urgent patients; they generally prefer to access more specialized hospitals, especially during weekdays, when GPs are available, but hospitals run at full capacity. Strategic patients are usually much younger than average. From a policy point of view, our results show that long waits may discourage “genuine” patients rather than strategic ones. It is necessary to develop a system to improve access to patients mainly requiring specialist care, along with enhancing the management of diagnostic examinations through primary care.

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Notes

  1. According to the definition provided by the Italian Ministry of Health, a PS provides diagnostic assessments and all required interventions. Moreover, for the most complex cases, a PS provides all necessary interventions for the patient’s stabilization, and when required, it guarantees the patient’s transportation to another hospital that can provide specialized services. DEAs, in addition to the services provided by a PS, also provide observation, short hospitalization, and resuscitation, and diagnostic–therapeutic interventions of general medicine, general surgery, orthopedics and traumatology, and cardiology with intensive cardiological therapy unit. Furthermore, they include laboratory services and microbiological analysis, imaging diagnostics, and transfusions. DEAs also provide cardiac surgery, neurosurgery, neonatal intensive care, vascular surgery, and thoracic surgery.

  2. We focus on the middle days of the week (Tuesday, Wednesday, and Thursday) when accesses by tourists are less frequent.

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Acknowledgements

The authors would like to thank ALISA (Azienda Sanitaria Regione Liguria) for their invaluable cooperation in providing the data. We would also like to thank the two anonymous reviewers for thier comments, which greatly improved the paper. The usual disclaimer applies.

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Authors and Affiliations

  1. Department of Economics and Management, University of Brescia, Via San Faustino 74b, 25122, Brescia, Italy

    Rosella Levaggi

  2. DIEC - Department of Economics and Business Studies, University of Genoa, Via Vivaldi 5, 16126, Genoa, Italy

    Marcello Montefiori & Luca Persico

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  1. Rosella Levaggi
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  2. Marcello Montefiori
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  3. Luca Persico
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Correspondence to Marcello Montefiori.

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Levaggi, R., Montefiori, M. & Persico, L. Speeding up the clinical pathways by accessing emergency departments. Eur J Health Econ 21, 37–44 (2020). https://doi.org/10.1007/s10198-019-01107-5

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  • DOI: https://doi.org/10.1007/s10198-019-01107-5

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