SUHCAT study, part 2: a map of the functional characteristics of hospital emergency services in Catalonia

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

Objective: To describe the organization and functional characteristics of hospital emergency departments (ED) in Catalonia, Spain, as well as to describe the how these departments are staffed with physicians and nurses.

Methods: The heads of 79 of the 82 hospital EDs in Catalonia (96%) responded to questions

about the management structure of their department, their triage systems, relations with outof-hospital emergency medical services, volume, contractual arrangements with staff,

demographic characteristics of physicians and nurses on staff, and how their work is

organized. A theoretical estimate of the number of full-time staff positions for physicians and nurses in each department was based on the total number of contracted hours each year. Statistics were compiled for three levels of ED volume (high, medium, and low), for private and public hospital status, and for level of complexity of public hospitals (technologically well equipped, comprehensive general, other referral, or local).

Results: ED were organizationally separate in 69.6% of the hospitals, and 53.2% had their

own department head. Organization was based on care pathways in 68.4%; the pathways

usually followed a mixed model reflecting triage and specialty. A structured triage system was operating in 77.2% and was in use at all times in nearly all those departments; in 80.3%, nurses were in charge of triage. The Andorran Triage Model was the system most widely used. Triage levels 1 through 5 accounted for 0.7%, 5.5%, 28.2%, 47.9%, and 17.8% of the emergency patients, respectively. Physicians assignments were organized in shifts (preferably 12 hours) in 53.2% of the EDs or in a combination of shifts and on-call schedules (30.4%). A total of 4 894 264 physician hours and 3 836 579 nurse hours were contracted in 2012; that number would correspond to 2899 full-time staff positions for physicians and 2368 for nurses. Physicians contracted directly by the EDs covered 50.4% of the hours (73% of the contracted physicians had permanent contracts and 27% were on temporary or training contracts); 19.1% of the hours were covered by physicians from other departments and 30.6% were covered by residents. Most of the fully trained physicians were specialists in family and community medicine (24%) and internal medicine (16.6%); 11.3% had not done residency training in a specialty. The EDs were staffed by physicians from Spain (62.8%), from other European Union (EU) countries (2.1%), and from non-EU countries (17.7%). Many of these characteristics were significantly different according to hospital category.

Conclusions: In Catalonia differ in their organization and functional characteristics and in

staffing characteristics. These EDs generate full-time employment for over 5000 physicians

and nurses.

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