Brief intensive observation areas in the management of acute heart failure in elderly patients leading to high stabilisation rate and less admissions

Savioli, Gabriele; Ceresa, Iride Francesca; Novara, E.; Persiano, T.; Grulli, F.; Ricevuti, Giovanni; Bressan, Maria Antonietta; Oddone, Enrico

doi:10.36150/2499-6564-446

Cited by 6 publications

(5 citation statements)

References 45 publications

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“…The geriatric frequently required medium-high care intensity and higher triage codes. Therefore, our study is in line with the literature and underscores the finding that age itself does not cause crowding; however, age is a factor related to frailty in compromised patients [89][90][91][92]. The general fragility of geriatric patients increases crowding and wait times.…”

Section: Wait Timesupporting

confidence: 91%

Geriatric Population Triage: The Risk of Real-Life Over- and Under-Triage in an Overcrowded ED: 4- and 5-Level Triage Systems Compared: The CREONTE (Crowding and R E Organization National TriagE) Study

Savioli,

Ceresa,

Bressan

et al. 2024

JPM

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Elderly patients, when they present to the emergency department (ED) or are admitted to the hospital, are at higher risk of adverse outcomes such as higher mortality and longer hospital stays. This is mainly due to their age and their increased fragility. In order to minimize this already increased risk, adequate triage is of foremost importance for fragile geriatric (>75 years old) patients who present to the ED. The admissions of elderly patients from 1 January 2014 to 31 December 2020 were examined, taking into consideration the presence of two different triage systems, a 4-level (4LT) and a 5-level (5LT) triage system. This study analyzes the difference in wait times and under- (UT) and over-triage (OT) in geriatric and general populations with two different triage models. Another outcome of this study was the analysis of the impact of crowding and its variables on the triage system during the COVID-19 pandemic. A total of 423,257 ED presentations were included. An increase in admissions of geriatric, more fragile, and seriously ill individuals was observed, and a progressive increase in crowding was simultaneously detected. Geriatric patients, when presenting to the emergency department, are subject to the problems of UT and OT in both a 4LT system and a 5LT system. Several indicators and variables of crowding increased, with a net increase in throughput and output factors, notably the length of stay (LOS), exit block, boarding, and processing times. This in turn led to an increase in wait times and an increase in UT in the geriatric population. It has indeed been shown that an increase in crowding results in an increased risk of UT, and this is especially true for 4LT compared to 5LT systems. When observing the pandemic period, an increase in admissions of older and more serious patients was observed. However, in the pandemic period, a general reduction in waiting times was observed, as well as an increase in crowding indices and intrahospital mortality. This study demonstrates how introducing a 5LT system enables better flow and patient care in an ED. Avoiding UT of geriatric patients, however, remains a challenge in EDs.

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Section: Wait Timesupporting

confidence: 91%

Geriatric Population Triage: The Risk of Real-Life Over- and Under-Triage in an Overcrowded ED: 4- and 5-Level Triage Systems Compared: The CREONTE (Crowding and R E Organization National TriagE) Study

Savioli,

Ceresa,

Bressan

et al. 2024

JPM

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“…Boarding and exit blocks indicated longer wait times for low and medium-high-intensity care areas (Table 2; p < 0.001). We have chosen the crowding indices that are most reproducible with an automated data extraction [13,[75][76][77][78][79]. Boarding substantially reduced the risk of OT and slightly decreased the risk of UT in both care intensity areas, as shown in Table 5a.…”

Section: Crowdingmentioning

confidence: 99%

“…Collectively, these factors have changed the way ED physicians work, transforming their practice from "admit-to-care" to "care-to-admit" [13,[76][77][78][79]. This change is reflected in a gradual extension of LOS and process times.…”

Section: Overallmentioning

confidence: 99%

Five Level Triage vs. Four Level Triage in a Quaternary Emergency Department: National Analysis on Waiting Time, Validity, and Crowding—The CREONTE (Crowding and RE-Organization National TriagE) Study Group

Savioli

Ceresa²,

Bressan

et al. 2023

Medicina

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Background and Objectives: Triage systems help provide the right care at the right time for patients presenting to emergency departments (EDs). Triage systems are generally used to subdivide patients into three to five categories according to the system used, and their performance must be carefully monitored to ensure the best care for patients. Materials and Methods: We examined ED accesses in the context of 4-level (4LT) and 5-level triage systems (5LT), implemented from 1 January 2014 to 31 December 2020. This study assessed the effects of a 5LT on wait times and under-triage (UT) and over-triage (OT). We also examined how 5LT and 4LT systems reflected actual patient acuity by correlating triage codes with severity codes at discharge. Other outcomes included the impact of crowding indices and 5LT system function during the COVID-19 pandemic in the study populations. Results: We evaluated 423,257 ED presentations. Visits to the ED by more fragile and seriously ill individuals increased, with a progressive increase in crowding. The length of stay (LOS), exit block, boarding, and processing times increased, reflecting a net raise in throughput and output factors, with a consequent lengthening of wait times. The decreased UT trend was observed after implementing the 5LT system. Conversely, a slight rise in OT was reported, although this did not affect the medium-high-intensity care area. Conclusions: Introducing a 5LT improved ED performance and patient care.

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“…The risk factors for developing hypothermia, as well as heat diseases, include being part of a fragile population, such as the elderly, who are already a population at risk for worse outcomes in the emergency department for many diseases [90,[96][97][98], and who often present with pathologies that can be underestimated at triage [99,100].…”

Section: Laboratory Studiesmentioning

confidence: 99%

Hypothermia: Beyond the Narrative Review—The Point of View of Emergency Physicians and Medico-Legal Considerations

Savioli,

Ceresa,

Bavestrello Piccini

et al. 2023

JPM

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Hypothermia is a widespread condition all over the world, with a high risk of mortality in pre-hospital and in-hospital settings when it is not promptly and adequately treated. In this review, we aim to describe the main specificities of the diagnosis and treatment of hypothermia through consideration of the physiological changes that occur in hypothermic patients. Hypothermia can occur due to unfavorable environmental conditions as well as internal causes, such as pathological states that result in reduced heat production, increased heat loss or ineffectiveness of the thermal regulation system. The consequences of hypothermia affect several systems in the body—the cardiovascular system, the central and peripheral nervous systems, the respiratory system, the endocrine system and the gastrointestinal system—but also kidney function, electrolyte balance and coagulation. Once hypothermia is recognized, prompt treatment, focused on restoring body temperature and supporting vital functions, is fundamental in order to avert preventable death. It is important to also denote the fact that CPR has specificities related to the unique profile of hypothermic patients.

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Brief intensive observation areas in the management of acute heart failure in elderly patients leading to high stabilisation rate and less admissions

Abstract: How to cite this article: Savioli G, Ceresa IF, Novara E, et al. Brief intensive observation areas in the management of acute heart failure in elderly patients leading to high stabilisation rate and less admissions.

Cited by 6 publications

References 45 publications

Geriatric Population Triage: The Risk of Real-Life Over- and Under-Triage in an Overcrowded ED: 4- and 5-Level Triage Systems Compared: The CREONTE (Crowding and R E Organization National TriagE) Study

Geriatric Population Triage: The Risk of Real-Life Over- and Under-Triage in an Overcrowded ED: 4- and 5-Level Triage Systems Compared: The CREONTE (Crowding and R E Organization National TriagE) Study

Five Level Triage vs. Four Level Triage in a Quaternary Emergency Department: National Analysis on Waiting Time, Validity, and Crowding—The CREONTE (Crowding and RE-Organization National TriagE) Study Group

Hypothermia: Beyond the Narrative Review—The Point of View of Emergency Physicians and Medico-Legal Considerations

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