Chronic disease related emergency department presentations and potential for redirection to alternative acute care settings ("FOCUS" study): A nationwide flashmob study

BACKGROUND: Emergency Departments (EDs) face increasing pressure, driven in part by the complex needs of an ageing population. Many internal medicine ED visits may reflect complications of chronic conditions. Aiming to maintain the accessibility of acute care, evaluation whether such presentations can be managed in alternative settings is necessary.

METHODS: We conducted a prospective multicentre flashmob study in 28 Dutch hospitals over a 24-hour period (November 28th and 29th, 2024). All adult non-elective ED patients presenting for internal medicine were included. Primary outcomes were the proportion of visits related to chronic conditions and the potential for redirection to an alternative acute care facility. Data on patient characteristics, case complexity, and organisational factors were collected and analysed using descriptive and comparative statistics.

RESULTS: Among 203 included patients, 45.3% presented with an acute complication of a chronic condition. Of these patients, 39.4% were receiving chronic care from an internist. Nearly one-quarter (24.1%) of all ED visits were considered preventable. Additionally, 39.9% of patients could have been managed in alternative settings such as acute outpatient clinics or directly to acute admission units. Despite the presence of these alternative care facilities in most hospitals, the lack of structural organisation was reported in 58.0% as a barrier to redirecting patients.

CONCLUSION: A substantial proportion of internal medicine patients at the ED reflect an acute on chronic care need. While alternative care pathways exist, organisational barriers hinder their use. Improving access to structured outpatient acute care could possibly reduce ED use and improve the efficiency of acute internal medicine services.