From symptom onset to ED departure: understanding the acute care chain for patients with undifferentiated complaints: a prospective observational study
Dublin Core
Title
From symptom onset to ED departure: understanding the acute care chain for patients with undifferentiated complaints: a prospective observational study
Subject
Acute care chain, Patient journey, Undifferentiated complaints
Description
Background For most acute conditions, the phase prior to emergency department (ED) arrival is largely unexplored.
However, this prehospital phase has proven an important part of the acute care chain (ACC) for specific time-sensitive
conditions, such as stroke and myocardial infarction. For patients with undifferentiated complaints, exploration of the
prehospital phase of the ACC may also offer a window of opportunity for improvement of care. This study aims to
explore the ACC of ED patients with undifferentiated complaints, with specific emphasis on time in ACC and patient
experience.
Methods This Dutch prospective observational study, included all adult (≥18 years) ED patients with undifferentiated
complaints over a 4-week period. We investigated the patients’ journey through the ACC, focusing on time in ACC
and patient experience. Additionally, a multivariable linear regression analysis was employed to identify factors
independently associated with time in ACC.
Results Among the 286 ED patients with undifferentiated complaints, the median symptom duration prior to ED visit
was 6 days (IQR 2–10), during which 58.6% of patients had contact with a healthcare provider before referral. General
Practitioners (GPs) referred 80.4% of the patients, with the predominant patient journey (51.7%) involving GP referral
followed by self-transportation to the ED. The median time in ACC was 5.5 (IQR 4.0-8.4) hours of which 40% was spent
before the ED visit. GP referral and referral to pulmonology were associated with a longer time in ACC, while referral
during evenings was associated with a shorter time in ACC. Patients scored both quality and duration of the provided
care an 8/10.
Conclusion Dutch ED patients with undifferentiated complaints consulted a healthcare provider in over half of the
cases before their ED visit. The median time in ACC is 5.5 h of which 40% is spent in the prehospital phase. Those
referred by a GP and to pulmonology had a longer, and those in the evening a shorter time in ACC. The acute care
However, this prehospital phase has proven an important part of the acute care chain (ACC) for specific time-sensitive
conditions, such as stroke and myocardial infarction. For patients with undifferentiated complaints, exploration of the
prehospital phase of the ACC may also offer a window of opportunity for improvement of care. This study aims to
explore the ACC of ED patients with undifferentiated complaints, with specific emphasis on time in ACC and patient
experience.
Methods This Dutch prospective observational study, included all adult (≥18 years) ED patients with undifferentiated
complaints over a 4-week period. We investigated the patients’ journey through the ACC, focusing on time in ACC
and patient experience. Additionally, a multivariable linear regression analysis was employed to identify factors
independently associated with time in ACC.
Results Among the 286 ED patients with undifferentiated complaints, the median symptom duration prior to ED visit
was 6 days (IQR 2–10), during which 58.6% of patients had contact with a healthcare provider before referral. General
Practitioners (GPs) referred 80.4% of the patients, with the predominant patient journey (51.7%) involving GP referral
followed by self-transportation to the ED. The median time in ACC was 5.5 (IQR 4.0-8.4) hours of which 40% was spent
before the ED visit. GP referral and referral to pulmonology were associated with a longer time in ACC, while referral
during evenings was associated with a shorter time in ACC. Patients scored both quality and duration of the provided
care an 8/10.
Conclusion Dutch ED patients with undifferentiated complaints consulted a healthcare provider in over half of the
cases before their ED visit. The median time in ACC is 5.5 h of which 40% is spent in the prehospital phase. Those
referred by a GP and to pulmonology had a longer, and those in the evening a shorter time in ACC. The acute care
Creator
Lieke Claassen1*, Laura Magdalena Ritter1
, Gideon Hubertus Petrus Latten1
, Noortje Zelis2
, Jochen Willo Lennert Cals3
and Patricia Maria Stassen4
, Gideon Hubertus Petrus Latten1
, Noortje Zelis2
, Jochen Willo Lennert Cals3
and Patricia Maria Stassen4
Source
https://doi.org/10.1186/s12245-024-00629-x
Date
2024
Contributor
Peri Irawan
Format
pdf
Language
english
Type
text
Files
Collection
Citation
Lieke Claassen1*, Laura Magdalena Ritter1
, Gideon Hubertus Petrus Latten1
, Noortje Zelis2
, Jochen Willo Lennert Cals3
and Patricia Maria Stassen4, “From symptom onset to ED departure: understanding the acute care chain for patients with undifferentiated complaints: a prospective observational study,” Repository Horizon University Indonesia, accessed April 11, 2026, https://repository.horizon.ac.id/items/show/12336.