Defining in an objective and simple way the complexity and the severity of an acute patient in the Emergency Medicine Unit: the Complexity-Severity Index (CSI)
Emergency Medicine; Complexity; Severity; Acute; Index.
- a number derived from the total number of co-morbidity ;
- one number linked to eventual intra-venous controlled speed therapy ;
- one number derived from actual blood/platelet/plasma transfusions ;
- actual condition of obliged bed rest in elderly or oncologic or not autonomous patients;
The sum of these 4 numbers must be reduced by the number of the days of staying of the patient in the Emergency Medicine Unit: the rationale of this fact, in the most part of cases, is that more days the patient is in the Emergency Medicine Unit, better is the diagnostic evaluation and the therapeutic course; moreover the time limit of the stay of a patient in the Emergency Medicine Unit (EMU) is no more 72 hours. In the period from June 2018 to February 2019 were collected 210 CSI, built by the above mentioned process.
The presentation of the same clinical case in the EMU was conducted in two ways: two different physicians during the new shift had the same patient; the first one received the case explaining it thoroughly by talking about all the clinical conditions in a subjective way; the second one had, also, the indication of the calculated CSI together with a brief classical explanation of the clinical scenario.
A satisfaction form was given to every physician in every new shift working in the EMU to collect the satisfaction derived by the use of the CSI.
The total time necessary to give-receive the clinical case was collected together with the time necessary to build the CSI at the admission and during every shift.
The flow-charts were built on the basis of diagnostic paths of current use into the Emergency Department of the Polyclinic of Foggia, initially setting a cut-off limit greater than or equal to 6 to describe a clinical case of greater severity and complexity; during the data collection, the number of 6 was considered adherent to what were the real management times of a critical patient from the point of view of the complexity of diagnosis and treatment. The data were collected by trainees graduated in medicine and surgery and by a student in medicine and surgery; the satisfaction questionnaires were administered by the first author to the doctors in the EMU, as well as the detection of all times.
Discussion - Conclusion
The use of CSI has proved useful, in our experience, to speed up the mechanism of delivery of medical records of patients admitted to emergency medicine, during the shift period, rationalizing the number of patients to be assigned to each doctor, based on the complexity of diagnosis and therapy; even if on the basis of a few cases considered in this study, the use of CSI could be a quick and easy application for all patients involved in an Emergency Medicine Unit, to improve the management of all patients left in the next work shift, making every clinical case with an absolute number from the point of view of clinical complexity and severity.
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