Conclusion

The ED at the Scheper Hospital has recently been rebuild to better accommodate the treatment and diagnostic process of the patients. In total there is a capacity of 12 treatment rooms. Some treatment rooms have a dedicated function like for resuscitation, although this is not fixed when capacity is

needed. In the time period from the 1st _{of February 2017 till the 30}th _{of April 2017 a total of 3640 patient}

visited the ED. The average age of the patients was 50 years and male or female were equally divided. They were referred primarily by the GP. The second most common arrival was by ambulance. Policlinic patients, this means patients are in contact with the policlinic and then being transferred to the ED, come in as the third largest category. Reasons for this can be diverse, such as a worsening of the medical condition or for logistical reasons that swift consultation by a physicians is possible. Self-referral rate was low and does not seem contributing factor for crowding as stated in the literature review of chapter 2. The most consulted medical specialism was surgery. The majority of ED patients have a low triage code indicating no urgency. The specialisms with the highest percentage of a high triages codes, thus

suggesting urgency, are pulmonology, neurology and cardiology.

When looking at the admission another pattern if visible. Although surgical patient form the bulk of patients (n=1449) their admission rate is low, both numerical (n=313) as per percentage point (22%). In a way this is not strange. Minor injuries like cuts, stiches and small trauma are all done under the supervision of this specialism and do not call for admission. The internal medicine (n=553) patients form the greater number of admissions. In total 357 internal medicine patients needed admission making them the largest admitted medical specialism. This means 65% of the internal patients’ needs admission. An explanation of this might be that internal medicine patients generally need more treatment and are often fairly sick. Their condition is more worse than the surgery patients, hence the higher need for admission, both numerical and per percentage point. Also during the research period there was an influence epidemic in the Netherlands that lasted till the 13th _{of March 2017 (65), contributing the extra}

patients to internal medicine. This also applies on the medical specialisms geriatrics and pulmonology.

Figure 3.8 Admission per triage code

60% 71% 62% 28% _21% 16% _12% 40% 29% 38% 72% _79% 84% _88% 0% 20% 40% 60% 80% 100%

Red Oranje Yellow Green Blue White No Triage

n=3640

30 With the latter medical specialism pulmonology (n=346), patients with respiratory conditions like

pneumonia and COPD are extra vulnerable when they are infected with the influenza virus. Thus admission is often needed for further treatment resulting in 68% (n=236). For geriatrics patients (n=69) again the influenza virus, in combination with low resistance for this population, gives an explanation for the relative high admission percentage of 86%. Neurology (n=346) also has a high admission ratio of 79% (n=250), which can be explained by of the high impact that a cerebral vascular accident can have on patients. Literally every minute counts for these patients, resulting in a high triage code with ditto admission. The high urgency of urology (n=100) can be contributed to the inability of urinating, leading to a full bladder and significant physical complaints. Consequently 54% (n=54) are labeled as urgent. The relative high admission (n=86) of children (n=161) can also be explained due to the flu season where children are prone to viral or bacterial infections. Cardiology (n=69) forms a separated category. Because the hospital has a specialized Coronary Care Unit for the diagnosis and treatment of patients will acute coronary syndrome, all patients are reallocated directly to this ward without first entering the ED. Only when this unit has reached it maximum capacity an cannot admit any more patients, the ED takes over. Also patient with a cardiac arrest are treated in the resuscitation room of the ED together with

healthcare professionals from the ICU and CCU. Superfluously to say a condition of the highest urgency. For the cardiology patients that arrive by the ED, 58 % (n=40) need admission and 81% (n=56) is labeled to be urgent.

When looking at the overall admission ratio in relation to the triage code, of all admission (n=1443) the bulk of patients have a yellow (n=693) or green (n=462) triage code. In total 41% of the patients get admitted to a ward, the remaining patients (59%) leave the ED. It is noted that the higher the urgency code, the higher the admission rate. In other words the likelihood of admission correlates to the triage code that is given. We see that percentage of admission per triage codes, from orange (71%), to yellow (62%), green (28%), blue (21%) and white (16%), all have an downward trend. In other words the change of admission increases as the triage code, and thus the urgency, gets higher. A note can be placed when it comes to the red triage code. This code suggests, because it is the highest urgency, that almost all patient with the red triage need admission (60%), but because some of these patients died at the ED, admission was no longer an option.

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