Electronic file data analysis to improve health services and impact health policies. A pilot study

BACKGROUND: An important issue faced by Emergency Departments (ED) worldwide is “overcrowding”, whereby demand for health services exceeds available resources and may lead to increased morbidity and mortality. One cause of overcrowding is patients’ visits characterized as “avoidable” or “inappropriate”. Our study aims to estimate their prevalence in a Cardiology ED of a tertiary hospital. METHODS: This is a cross-sectional study, utilizing electronic files of patients attending a Cardiology ED during 2021. Using predefined criteria including tests, treatments, referral to/by other specialties/healthcare facilities and final admission, visits are categorized as either “inappropriate” or not. Our pilot results include all patients attending Cardiology ED on two separate days, one weekday and one weekend, in two different seasons, to account for respective variations. RESULTS: 55 patients (28 females) were studied with a mean age of 53.3 years, of whom 16 (29.1%) were transported by ambulance and 9 (16.4%) were finally admitted. Main analysis showed that 4/55 (7.3%) visits were “inappropriate”, however, in 13/51 (25.5%) of the “appropriate” visits, the sole criterion was D-dimers testing. A prespecified sensitivity analysis including them in the “inappropriate” group, increased the prevalence of “inappropriate” visits to 30.9% (17/55). CONCLUSIONS: Our results show that a considerable proportion of visits in a Cardiology ED may be “inappropriate”, and thus could be more suitable for primary care management. If confirmed by our full study results, this could trigger a health policy reform, aiming to increase the role of primary care thus reducing ED “overcrowding”. KEY MESSAGES: • To our knowledge, this is the first study evaluating “inappropriate” Emergency Department visits, focused solely on a Cardiology ED. • The considerable proportion of patients who could be managed in primary care, paves the way for novel healthcare policies to reform ED services in Greece.