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. 2024 Apr 15;17(1):55.
doi: 10.1186/s12245-024-00629-x.

From symptom onset to ED departure: understanding the acute care chain for patients with undifferentiated complaints: a prospective observational study

Lieke Claassen  1 , Laura Magdalena Ritter  2 , Gideon Hubertus Petrus Latten  2 , Noortje Zelis  3 , Jochen Willo Lennert Cals  4 , Patricia Maria Stassen  5
Affiliations

From symptom onset to ED departure: understanding the acute care chain for patients with undifferentiated complaints: a prospective observational study

Lieke Claassen et al. Int J Emerg Med. .

Abstract

Background: For most acute conditions, the phase prior to emergency department (ED) arrival is largely unexplored. However, this prehospital phase has proven an important part of the acute care chain (ACC) for specific time-sensitive conditions, such as stroke and myocardial infarction. For patients with undifferentiated complaints, exploration of the prehospital phase of the ACC may also offer a window of opportunity for improvement of care. This study aims to explore the ACC of ED patients with undifferentiated complaints, with specific emphasis on time in ACC and patient experience.

Methods: This Dutch prospective observational study, included all adult (≥ 18 years) ED patients with undifferentiated complaints over a 4-week period. We investigated the patients' journey through the ACC, focusing on time in ACC and patient experience. Additionally, a multivariable linear regression analysis was employed to identify factors independently associated with time in ACC.

Results: Among the 286 ED patients with undifferentiated complaints, the median symptom duration prior to ED visit was 6 days (IQR 2-10), during which 58.6% of patients had contact with a healthcare provider before referral. General Practitioners (GPs) referred 80.4% of the patients, with the predominant patient journey (51.7%) involving GP referral followed by self-transportation to the ED. The median time in ACC was 5.5 (IQR 4.0-8.4) hours of which 40% was spent before the ED visit. GP referral and referral to pulmonology were associated with a longer time in ACC, while referral during evenings was associated with a shorter time in ACC. Patients scored both quality and duration of the provided care an 8/10.

Conclusion: Dutch ED patients with undifferentiated complaints consulted a healthcare provider in over half of the cases before their ED visit. The median time in ACC is 5.5 h of which 40% is spent in the prehospital phase. Those referred by a GP and to pulmonology had a longer, and those in the evening a shorter time in ACC. The acute care journey starts hours before patients arrive at the ED and 6 days of complaints precede this journey. This timeframe could serve as a window of opportunity to optimise care.

Keywords: Acute care chain; Patient journey; Undifferentiated complaints.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Visualisation of the acute care chain Abbreviations: T0 - start of the ACC; GP - general practitioner, GPC - General Practitioner Cooperative, EMS -emergency medical services *In case of self-referral and no previous contact with a healthcare provider, the time of registration for the ED was considered to be T0
Fig. 2
Fig. 2
Flowchart of study population Abbreviations: ED – Emergency Department
Fig. 3
Fig. 3
Patient journey of adult ED patients with undifferentiated complaints and the time spent in ACC. Abbreviations: GP – general practitioner, GPC – General Practitioner Cooperative, EMS – emergency medical services, med – median, IQR – interquartile range, min – minutes
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