See and treat nella gestione dei codici minori in pronto soccorso: indagine retrospettiva e prospettive di sistema

Abstract. The increase in emergency department(Ed) accesses, combined with the shortage of medical and nursing staff, makes it necessary to reflect on the appropriateness of assigning professional resources to the different complexities. Among the solutions present in the literature, the See and treat (Set), introduced in Tuscany in 2007, emerges as a model to improve the use of professionals in minor codes. A retrospective analysis was carried out to analyze Ed accesses in a Tuscan local health authority in the year 2019; through the ICD-9-CM coding, patients suitable for the Set model were then identified. On the basis of the result obtained, the personnel requirements, calculated in full time equivalent (Fte), were determined first as a whole and subsequently by separating the eligible activity from the Set path. In 2019, the requests for accesses to the Ed were 42,745; more than 60,000 cases were defined as eligible for the Set protocols; of these, half were wounds or minor ophthalmic, ear, nose, throat and limb injuries. Seteligible activity absorbs 13.8 Fte per year; transferring this activity to Set-trained nurses, therefore, has the potential to reduce the need for physicians by 10-11 units. By aggregating the data at regional level, it is possible to estimate the Set-eligible activity at 63.8 Fte per year (56 physicians). The good results that have emerged in the literature regarding efficacy, user satisfaction and waiting and process times can support the extension of the Set model. Furthermore, its impact on personnel requirements can improve the appropriateness of the care provided by the various professionals even in more complex pathways, without reducing safety but, on the contrary, increasing the overall performance of the structures. Keywords. Appropriateness, emergency department,minor emergencies, task shifting, emergency medicine