Effects of a Central Point of Assessment with Digitally Assisted Triage in an Integrated Emergency Center.

these departments by low-urgency cases, they are increasingly becoming overcrowded, which has a negative effect on the care of critically ill and injured patients (1). Health policy measures are aimed at improving synchronization between emergency departments and primary care walk-in clinics in integrated emergency centers (IEC) (2). The key challenge of this coupling is the upstream triage of emergency patients at a central point of assessment (CPA). There are no concepts to date for a single-stage assessment procedure carried out by staff qualified in emergency medicine that also includes the allocation of patients to the appropriate sector. Methods In October 2023, an IEC service was implemented by integrating a primary care walk-in clinic from 8:00 am to 11:00 pm as well as an upstream CPA. Self-referring patients (SP) are assessed there by emergency department staff using a digital decision support system based on urgency (Emergency Severity Index [3]) and assigned to a treatment sector (primary care walk-in clinic or emergency department). Only once patients are in the respective treatment sector are they administratively admitted. The effect of the CPA on the emergency department was measured based on the percentage change in monthly patient numbers compared to the respective reference months of October to June in the previous years from 2013 to 2023. A comparison with national emergency department registry data was also carried out (4). In December 2023, a system was established to record secondary transfers from the primary care walk-in clinic to the emergency department and 30-day hospital mortality. All mean values are given as medians with a 95% confidence interval (CI). Outlier values were eliminated using the ROUT method (Q = 1%). Results Between October 2023 and June 2024, N = 48 835 patients were treated throughout the entire IEC; n = 33 258 (68.1%) of these were SP. The time to completion of the upstream assessment (door-to-triage time including waiting time) at the CPA was 5.01 minutes (95% confidence interval: [4.96; 5.06]). Of all SP, n = 12 265 (36.9%) were referred to the primary care walk-in clinic. Fewer patients presented to the CPA on weekdays (n = 141.0; [136.0; 148.0] compared to weekends (n = 191.5; [183.0; 211.0]; p < 0.0001). The percentage of SP referred to the primary care walk-in clinic was also lower on weekdays (24.9%; [22.3; 26.8] compared to weekends (38.9%; [36.4; 40.4]; p < 0.0001). From 2013 to 2023, the average percentage change in monthly patient numbers (October to June; n = 81) was + 4.0% (calculated as 104.0%; [101.8; 107.3]). In the 9 months following implementation of the IEC, the monthly change declined by 7.5% to 96.5% ([94.1; 101.4]; p = 0.0003) of the previous years value. This effect can be attributed to the decline in low-urgency patients (ESI 45; Figure 1). At the sites participating in the emergency department registry (4), the change compared to the previous year during the observation period was +5.6% (calculated as 105.6%; [100.6; 110.4]), and thus higher than at the study center (3.5%; calculated as 96.5%; p = 0.0106). There was also an increase in high-urgency cases within the emergency department (ESI 12; Figure 2). [ABSTRACT FROM AUTHOR]