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COMMUNITY CASE STUDY article
Front. Public Health
Sec. Public Health Policy
Volume 12 - 2024 |
doi: 10.3389/fpubh.2024.1444951
Addressing the overuse of hospital emergency departments in the Portuguese NHS: a new paradigm
Provisionally accepted
Francisco Goiana-da-Silva
1,2,3,4*
Soraia Costa
5
Filipa Malcata
6*
Juliana Sá
3,7*
Rafael Vasconcelos
8*
Miguel Cabral
6*
Raisa Guedes
6*
Inês Morais Vilaça
9
Lara Pinheiro-Guedes
10*
João Ferreira
11*
Nelson Pereira
10
José Gaspar-Pais
5*
Judite Neves
5*
Joaquim Monteiro Da Silva
5
Vera Pires
12*
Miguel Paiva
13*
Rui Guimarães
9*
Hutan Ashrafian
1,14
Rita Gonçalves Moreira
4
Fátima Fonseca
4*
Filomena Cardoso
4*
Jaime Alves
4*
Ara Darzi
1,14
Fernando Araújo
15,4*- 1 Centre for Health Policy, Institute of Global Health Innovation, Faculty of Medicine, Imperial College London, London, United Kingdom
- 2 NOVA Medical School, Faculty of Medical Sciences of Lisbon, New University of Lisbon, Lisbon, Portugal
- 3 University of Beira Interior, Covilhã, Castelo Branco, Portugal
- 4 National Health Service Executive Directorate, Ministry of Health, National Health Service (SNS), Porto, Portugal
- 5 Centro Hospitalar Póvoa de Varzim - Vila do Conde, Povoa de Varzim, Portugal
- 6 Centro Hospitalar Universitário de São João (CHUSJ), Porto, Portugal
- 7 Hospital de Santo António, Porto, Portugal
- 8 Leiria Hospital Center, Leiria, Leiria, Portugal
- 9 Centro Hospitalar de Vila Nova de Gaia, Vila Nova de Gaia, Portugal
- 10 Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
- 11 District Hospital of Santarém, Santarém, Portugal
- 12 Departamento de Saúde Familiar e Comunitária, ULS Póvoa de Varzim, Vila do Conde, Póvoa de Varzim, Portugal
- 13 Centro Hospitalar de Entre o Douro e Vouga E.P.E., Santa Maria da Feira, Aveiro, Portugal
- 14 Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, England, United Kingdom
- 15 University of Porto, Porto, Portugal
The escalating trend of non-urgent or inappropriate visits to Emergency Departments (ED) has led to significant concerns, including resource misallocation, compromised patient care, and an increased burden on healthcare workers. Portugal faces a notable challenge, reporting one of the highest per capita ED visit rates in 2011, with an annual average of approximately 6 million ED visits from 2013 to 2023. The "Call First, Save Lives" pilot project was launched, in 2023, by the Portuguese NHS Executive Board in response to this issue, leveraging the SNS 24 telephone triage system to manage healthcare provision more efficiently. This innovative initiative aimed to direct patients to the most appropriate care settings, alleviate pressures on ED, and optimize healthcare resources, marking a significant step toward improving health outcomes and service efficiency. The project introduced several strategic enhancements across hospital and primary care settings, including optimizations of the SNS 24 system and inter-institutional initiatives to promote teleconsultation and interoperability. Key improvements featured streamlined hospital follow-ups for chronic conditions, post-ED reassessment consultations, and a "reverse referral" system directing non-urgent ED cases to Primary Care Services (PCS). In PCS, the project expanded acute care consultations and introduced complementary health services to ease ED demands. Enhancements to SNS 24 included direct patient referrals, appointment scheduling, and the development of a teleconsultation system tailored for elderly care. The initiative also emphasized communication and education to improve health literacy and appropriate utilization of the National Health Service, supported by legal and regulatory framework development. Nonetheless, challenges such as the "reverse referral" process complexity, healthcare information systems integration, and procedural standardization need addressing, with future plans including satisfaction surveys and patient triage protocol refinements to improve service delivery and patient adherence.
Keywords: emergency department, Primary Health Care, Triage, Healthcare optimization, Care integration
Received: 06 Jun 2024; Accepted: 28 Nov 2024.
Copyright: © 2024 Goiana-da-Silva, Costa, Malcata, Sá, Vasconcelos, Cabral, Guedes, Morais Vilaça, Pinheiro-Guedes, Ferreira, Pereira, Gaspar-Pais, Neves, Monteiro Da Silva, Pires, Paiva, Guimarães, Ashrafian, Gonçalves Moreira, Fonseca, Cardoso, Alves, Darzi and Araújo. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Francisco Goiana-da-Silva, Centre for Health Policy, Institute of Global Health Innovation, Faculty of Medicine, Imperial College London, London, SW7 2NA, United Kingdom
Filipa Malcata, Centro Hospitalar Universitário de São João (CHUSJ), Porto, Portugal
Juliana Sá, Hospital de Santo António, Porto, Portugal
Rafael Vasconcelos, Leiria Hospital Center, Leiria, Leiria, Portugal
Miguel Cabral, Centro Hospitalar Universitário de São João (CHUSJ), Porto, Portugal
Raisa Guedes, Centro Hospitalar Universitário de São João (CHUSJ), Porto, Portugal
Lara Pinheiro-Guedes, Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
João Ferreira, District Hospital of Santarém, Santarém, 2005-177, Portugal
José Gaspar-Pais, Centro Hospitalar Póvoa de Varzim - Vila do Conde, Povoa de Varzim, Portugal
Judite Neves, Centro Hospitalar Póvoa de Varzim - Vila do Conde, Povoa de Varzim, Portugal
Vera Pires, Departamento de Saúde Familiar e Comunitária, ULS Póvoa de Varzim, Vila do Conde, Póvoa de Varzim, Portugal
Miguel Paiva, Centro Hospitalar de Entre o Douro e Vouga E.P.E., Santa Maria da Feira, 4520-211, Aveiro, Portugal
Rui Guimarães, Centro Hospitalar de Vila Nova de Gaia, Vila Nova de Gaia, 4400-129, Portugal
Fátima Fonseca, National Health Service Executive Directorate, Ministry of Health, National Health Service (SNS), Porto, Portugal
Filomena Cardoso, National Health Service Executive Directorate, Ministry of Health, National Health Service (SNS), Porto, Portugal
Jaime Alves, National Health Service Executive Directorate, Ministry of Health, National Health Service (SNS), Porto, Portugal
Fernando Araújo, National Health Service Executive Directorate, Ministry of Health, National Health Service (SNS), Porto, Portugal
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