SUHCAT study, part 1: a map of the physical characteristics of hospital emergency services in Catalonia

Miró O, Escalada X, Gené E, Boqué C, Jiménez Fábrega FX, Netto C, Alonso G, Sánchez P , Sánchez M

Objective: To describe the physical characteristics of hospital emergency departments in Catalonia, Spain, with reference to other characteristics of the departments and the hospitals.

Methods: The heads of 79 of the 82 hospital emergency departments in Catalonia (96%) responded to a 353-item questionnaire and were personally interviewed. This study analyzes information from items referring to the departments facilities. Statistics were compiled for the entire dataset and for three levels of emergency department volume (high, medium, and low), for private and public hospital status, and for complexity of public hospitals (technologically well equipped, comprehensive general, other referral, or local).

Results: Half the departments had premises built or remodelled in the last 4 years; 59.5% had an observation area. Such areas were more often available in high-volume hospitals and public health service hospitals with a higher degree of complexity. A short-stay area was available in 35% of the emergency departments: 68% had staff physicians who were specialized in emergency medicine, 46% were staffed exclusively by emergency physicians, and 61% were under the emergency departments supervision. In 2011, these departments managed 3 949 885 emergencies (0.53 visits/inhabitant/y); 16% were handled in private hospitals. The median (25th-75th percentile) admission rate was 9% (6%-12%). Volume increased during the high tourist season for 34.2% of the departments; only 37.0% of them hired additional staff at these times and 18.5% increased the available space. Rates for mortality, discharge without care, and revisits within 72 hours were 0.05% (0.00-0.13), 1.1% (0.3-2.5), and 4.5% (3.5-5.6), respectively. All these rates were lower in lower-volume hospitals, private hospitals, and less complex public hospitals. Patient identification bracelets were used in 77.2% of the departments. An accompanying person was allowed at all times in the initial assessment area in 84.8% and in the observation area in 59.5%. Security personnel were not provided in 36.7% of the departments; this rate was higher in lower-volume hospitals, private hospitals, and less complex public hospitals. The departments had a median surface area of 364 (230-1200) m2, 13 (7-26) initial treatment rooms or spaces (2 for critical cases), and 8 (4-13) observation-area beds. A 50,7% of the respondents considered their facilities were inadequate (an opinion expressed

more often for public hospitals than for private ones), and 16,5% reported that the

quality of available spaces was unsatisfactory. The area designated for initial treatment could be increased at 11% (0%–50%) of the hospitals, but 0% (0%-5%) could increase the number of observation beds. The availability of complementary tests was related to type of emergency department and hospital. Conventional radiography could be performed in 44.3% of the departments and computed tomography in 13.7%. Although 49.4% had ultrasound machines, only 10% (0%-30%) of the emergency physicians knew how to use one. High-quality information systems were in place in 90% of the hospitals, although only 48.8% had digitized electrocardiography and 25.5% could prescribe electronically. Although 74.7% of the departments compiled time statistics, only 10% shared the information with users.

Conclusions: This study reveals the physical conditions of Catalan hospital emergency departments and identifies several ways they can be improved.

Alonso G, Boqué C, Escalada X, Gené E, Jiménez Fábrega FX, Miró O, Netto C, Sánchez M, Sánchez P