Emergency department crowding: An assessment of the potential impact of the See-and-Treat protocol for patient flow management at an Italian hospital

Background: Crowding and patient flow management are among the most relevant issues for emergency departments (EDs). This results in delayed treatment, adverse outcomes and increased costs. For these reasons, nurse-independent treatment protocols were developed aimed at managing non-emergency patients outside EDs thus improving patient flow. Our objective was to assess the potential impact of the implementation of the "See-and-Treat" protocol on eligible patients and related healthcare costs at an Italian ED.

Methods: We selected all minor access codes from 2022 at the ED of Sassuolo Hospital in Northern Italy. We only included subjects discharged to home, while we excluded those who required specialized medical care or had received "Fast-Track" treatment. We identify a list of medical conditions to identify subjects eligible for inclusion in the See-and-Treat protocol and calculate the related healthcare costs.

Results: Of 40,906 individual ED admissions, 2,607 (6.4%) qualified for See-and-Treat management. Limb injuries and pain were the leading conditions at presentation. Through cost analysis, we found that implementation of the See-and-Treat protocol may result in savings over €100,000/year at Sassuolo Hospital, and over €7 million if projected to the entire Emilia-Romagna Region.

Conclusions: Despite some limitations affecting protocol implementation, especially availability of highly-specialized and specifically-trained nurses, the study provided a foundation for a more comprehensive understanding of the implementation of the See-and-Treat protocol as a possible valid model with a view to both human and economic healthcare resources.