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AB1112 Does the Specialized Rheumatology Assessment Produce a Pull Effect in an Accident & Emergency Department?
  1. C.A. Guillen Astete,
  2. J. Bachiller-Corral,
  3. A.L. Boteanu
  4. on behalf of URMES
  1. Rheumatology Department, Ramon y Cajal University Hospital, Madrid, Spain

Abstract

Background Our A&E department counts with a specialized rheumatology unit in order to assess all rheumatology urgencies since October 2013. The Urgency clinic for Rheumatologic and Musculoskeletal conditions (URMES) is operative three days per week during business hours and. Although those urgencies do not include any complaint related to a traumatic process, they account for around 14% of all consultations. No other hospital in Madrid neither Spain counts with a unit of this kind. It is a concern that URMES activity could cause a pull effect into patients who are awaiting a scheduled specialized consultation and want to be attended sooner.

Objectives To determine if the URMES activity has generated a pull effect into the quantity of patients who claims for urgency assessment in our A&E department.

Methods We performed a systematic randomization of clinical records of patients who claimed for urgent healthcare in our A&E department and whose main complaint was related to a rheumatologic or musculoskeletal condition not related with a traumatic process. This randomization process selected 60 days per year equally distributed across the four seasons from 2009 to 2014. Main complains and volume of affluence was registered. Variables studied were demographic features, healthcare area (ours or other), origin of consultation (primary care physician or self initiative) and the volume of consultations generated by a single patient.

Results In the 300 days randomized, there were assessed 143192 patients. From them, 24507 consulted by a rheumatologic or musculoskeletal condition (16.8%). There were no significative differences into the volume of patients assessed from 2009 to 2014. Table 1 shows detailed information.

Conclusions The specialized rheumatology activity in our A&E environment does not seem to modify the gross amount of patient affluence to our department, however, it has been detected a significant increase of affluence of patients from other geographical healthcare areas and a higher proportion of patients who consults by self initiative in the very last two years. By the other hand, it seems that this increase is compensated by a reduction of the number of consultation per patient, maybe due to the high capacity to solve accurately this kind of pathology. It could be interpreted that both events together can have an impact in the long term, increasing the demand of the A&E department, however, we believe that URMES activity also reduces the demand of specialized scheduled consultation by performing –when is needed- and accurate derivation. This effect should the focus of further research to obtain a global acknowledge of the benefits of its implementation in terms of global hospital functioning rather than just A&E department.

Disclosure of Interest None declared

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