Abstract
Portugal has significantly higher rates of hospital emergency service visits than other OECD countries, with studies indicating that approximately 30% of visits result from inappropriate use of NHS hospital emergency departments (ED). Therefore, reducing the inappropriate or avoidable use of NHS hospital emergency services is essential and represents a measure to enhance efficiency and improve the quality of healthcare delivery. In the interest of effectiveness, efficiency, quality of care, and resource optimization, EDVLHU has implemented the 'Call First, Save Lives' Project (CFSL) (Ordinance No. 71/2024, of February 27).
COMMUNICATION- EDVLHU launched a large-scale communication operations, both externally and internally with radio and local press campaign, outdoor advertising campaign (posters and displays in various municipalities), Community Engagement (Local Councils, Schools, Security Forces, Firefighters), digital campaign and release of videos featuring local influencers. Dedicated phones for NHS24 were installed at the 6 emergency service units and 3 attendants were placed at the ED entrance of the central hospital, along with 4 hostesses wearing T-shirts related to the project.
PHC - Creation of 200 daily slots, distributed across 30 PHC units, for specific scheduling for NHS24 and ED and also a new Complementary Care Service in Santa Maria de Lamas.
CHS - A hospital care structure was created for the direct referral of acute patients by PHC doctors, at the level of consultations, day hospital, and home hospitalization, with the development of referral protocols and dissemination through the Health Information System (HIS). Direct contact lines were also established between PHC doctors and Central Hospital Services (CHS), with dissemination via the HIS.
A monitoring system for the project was created, using a set of metrics to track the progress of the project’s results during daily/weekly follow-up meetings.
After eight months of implementing the Project, there has been positive progress in patient referrals, with 85% of cases now directed to the appropriate care location – reflecting increased adherence to using the NHS24 Line as the first point of contact. Significant decrease in ED visits (-34,370|-22.2%), substantially reducing hospital emergency overload and freeing up resources for more critical cases.
A drop of 36.7% in patients classified as low urgency/non-urgent (green/blue) according to the Manchester Triage Protocol, with a 6.7 percentage point decrease in their relative weight.
A 6.5% reduction in patients classified as urgent (yellow) under the Manchester Triage Protocol, yet with a significant 10.0 percentage point increase in their relative weight, confirming that the ED is being prioritized for more severe cases.
The “CFSL” Project has had a significantly positive impact on the functioning of the ED at EDVLHU reserving Hospital Emergency Services, as it should be, for the most severe cases. The Project’s operation has enabled more efficient patient direction, reserving ED resources for more critical cases, which results in greater efficiency and quality of care provided. There are some areas to improve like promoting closer collaboration between PHC and CHS, ongoing adjustment of available slots in PHC to optimize responsiveness to population needs and enhancing the project experience to maximize its benefits.