Abstract
Background: This project aims to optimize patient flow at the General Emergency Unit (UGP) of the São José Local Health Unit (ULS São José) by referring patients triaged as non-urgent (blue) or less urgent (green) to appropriate primary healthcare (PHC) units. The objective is to manage emergency demand more efficiently by utilizing the capacity of integrated primary health services, including ACES Lisboa Central and the Sacavém Health Center.
Approach: Patients triaged as non-urgent (blue) or less urgent (green) under the Manchester Triage System at the UGP are considered for referral to primary healthcare units if they meet established criteria, such as being registered with ULS São José primary healthcare, having autonomy and mobility, and requiring general medical care rather than specialized care. The referral system provides for scheduling consultations at the primary care level within 24 hours.
A digital platform is used to verify appointment availability. If the patient accepts the referral, an appointment is booked. During peak demand periods, adjustments are made to increase the available appointments based on demand patterns at the UGP. These measures aim to improve access to the appropriate levels of care, alleviate pressure on emergency services, and enhance continuity of care for patients.
Results: From June 17th to October 31st, 2024, a total of 979 patients were referred from the UGP to the primary healthcare units of ULS São José. During peak demand periods, up to 50 referral slots were made available daily. Data collected show consistent use of the referral system, with 82% of refererred patients successfully scheduled and followed up in primary care, thereby reducing their need to revisit the emergency department.
The study shows that, up to 50% of the non-attending patients, rejected the appointment in PHC and returns to the UGP and 25% reported missing their primary healthcare appointment because they no longer needed it.
Additionally, the referral process improved efficiency, allowing the emergency department to focus on more critical cases. The average waiting time for non-urgent (blue) or less urgent (green) patients at the UGP decreased, and there was a reduction in the number of patients requiring readmission within 72 hours.
Implications: The referral of non-urgent (blue) or less urgent (green) patients from the UGP to primary healthcare services demonstrated positive impacts on patient flow, waiting times, and overall efficiency in emergency care management. It provided a feasible model to alleviate the burden on emergency units while ensuring patients continued to receive timely care. Moving forward, the plan includes further integration of digital tools and expanded referral capacity, particularly during times of high seasonal demand, to maintain service quality and patient satisfaction.