Prevalence of Ambulatory Care Sensitive Conditions, their urgency and need for treatment in the emergency department. A single-center cross-sectional study

Abstract

Abstract Background and Importance The early differentiation between patients who require urgent care and those who could receive adequate care through ambulatory services remains a challenge in managing patient volumes in emergency departments (ED). Different approaches pursue to characterize patient populations that could safely divert to the ambulatory care sector. However, this characterization remains challenging as the urgency upon presentation in an ED is assessed based on immediately available characteristics of the patients - rather than on subsequent diagnoses. This work employs a core set of Ambulatory Care Sensitive Conditions (core-ACSCs) to describe conditions that do not require inpatient care if treated and monitored adequately in the ambulatory care sector. It subsequently analyzes corresponding triage levels at presentation to determine whether core-ACSCs contribute to the high patient volumes in an ED. Settings and Participants Single center cross-sectional analysis of administrative data of a tertiary care emergency department in 2019. Outcome measures and analysis The proportion of core-ACSCs among all presentations was assessed. Triage levels were binarily classified as ‘urgent’ and ‘non-urgent’, and the distribution of core-ACSCs in both categories was studied. Additionally, the patients presenting with core-ACSCs requiring inpatient care were assessed based on adjusted residuals and the proportion being discharged home was investigated. Main results This study analyzed 43.382 cases, 10.79% (n=4683) of which fell under the definition of core- ACSCs categories. 65,2% of all core-ACSCs were urgent and received inpatient care in 62,8% of the urgent cases. 34,8% of the core-ACSCs were attributed to low urgency and were discharged home in 92,4% of the cases. The two core-ACSCs that mainly contributed to non-urgent cases discharged home after the presentation were “back pain” and “soft tissue disorders”. Discussion Core-ACSCs contribute relevantly to the overall ED patient volume but cannot be considered the primary drivers of such. However, once patients presented to the ED with what was later confirmed to be a core-ACSC, they required urgent care in 65,2%. This finding highlights the importance of effective ambulatory care to avoid emergency presentations. Additionally, the core-ACSC categories of “back pain” and “soft tissue disorders” were most often found to be non-urgent and were discharged home after initial treatment. Although further research is required, these core-ACSCs could be considered potentially avoidable ED presentations. Trial registration The study was registered in the German trials register (DRKS-ID: DRKS00029751) on 2022-07-22.