In Varese, one inhabitant out of two visits Casualty

In 2015, nearly 390,000 people visited the Casualty Departments in Varese Province.

This is what has been found by a study carried out by the health protection agency, ATS Insubria, who analysed data relating to the work of hospitals in the Valle Olona and Sette Laghi health districts, and at the Mater Domini.

The hospital that saw the largest number of cases was that of Busto Arsizio, with 62,919 visits (a daily average of 172 cases). In second place, there was the hospital of Varese, with 61,010 visits (an average of 167), followed by Gallarate, with 52,614 (average, 144), Saronno with 48,005 (average, 132) and Tradate, with 46,057 (average, 126). The hospitals that had the fewest visits to the Casualty Departments were in Somma Lombardo, with 10,601 (average, 29), and in Angera, with 17,465 (48 per day). The paediatric and obstetric departments in the Del Ponte Hospital had 22,713 visits (63 per day).

THE TYPICAL VISITOR

The typical visitors to Casualty are Italian (91.2% of cases), over 65, and female, although they vary with age: males make more visits in the first years of life and during adolescence, then, around the age of 40, and in the older age ranges; for females, there is a peak in the first few years of life (as there is for males), during the age of fertility, and after the age of 70. After the age of 80, the number of visits to Casualty drops for both sexes.

THE CASUALTY DEPARTMENT OF REFERENCE

The choice of Casualty Department confirmed the tendency of people to go to their local hospital, and this also true for smaller hospitals: the highest rate of visits was to Tradate, with 412.3 users per 1000 inhabitants, followed by Luino, with 411.7/1000. The rate was also high in Busto, where it was 413 per 1000 inhabitants. The town of Varese had among the lowest rates, with 336.6/1000.

TYPES OF EMERGENCY

The statistical study carried out by ATS Insubria confirms that the Casualty Department remains a general point of reference: 74% of visits were code green (the highest percentage was in the Sette Laghi district), 14% were code yellow, and 12%, code white (higher values were found in the Lariana district). Only 1.0% were code red.

In detail

In 2015, the percentages of cases recorded by the Sette Laghi Health Authority were: 0.4%, code red, 12%, code yellow, 77.9%, code green, and 9.5%, code white.

The percentages of cases recorded by the Valle Olona Healthy Authority were: 0.8%, code red, 12.5%, code yellow, 75.6%, code green, and 11.1%, code white.

PERCENTAGE OF ADMISSIONS FROM CASUALTY

Of the 388,444 visits to Casualty, only 12.6% required admission to a ward, and 75.1% were discharged.

The percentage of admissions ranged from 4.5% (Somma Lombardo) to 19.7% (Del Ponte); in 3 of the biggest hospitals (Macchi, Busto Arsizio and Sant’Anna), the admission percentages were 17.5%, 12.1% and 15.8%, respectively.

The general picture of the Insubria area (Varese and Como) was of 417,262 home discharges, 75%; of 69,900 admissions, 12.6%; of 4798 transfers to another hospital; of 936 deaths in Casualty, and of 136 people who were dead on arrival.

The number of people who left before being examined was 15,094 (2.7%), the number of those who left before tests was 7393 (1.3%), and the number of discharges to outpatient facilities was 37,241.

In the Valle Olona area, the hospitals that discharged most were those of Somma Lombardo (93%), and Mater Domini (88%); and in the Sette Laghi Area, it was the hospital in Luino (89%).

HOW MANY FREE BEDS  PER DAY WERE NECESSARY FOR ADMISSIONS FROM CASUALTY

The main reason for there being stretchers was the lack of beds on hospital wards. In order to proceed with an admission, a bed had to become free on the ward. This procedure did not always manage to reduce the “lines”, especially at particularly difficult times.

In order to have the right turn over, the number of admissions from Casualty in a year must be taken into consideration. The average number of beds depends on the size and characteristics of the hospital, and on the stream of Casualty requests; on average, 192 free beds were required every day (range: 60-350), with a minimum of 1 (Somma Lombardo, range: 0-7) and a maximum of 31 (Sant’Anna, range: 12-47).

In each hospital, the ranges reported for the daily need of beds for emergency admissions could be used in special overcrowding plans.

The Sette Laghi Health Authority

The Del Ponte Hospital, 4465 admissions, 12 free beds per day, with a range of 4-22.

Varese Hospital, 10,685 admissions, with 29 beds required per day, and a range of 14-46.

Tradate Hospital, 3843 admissions, with 11 free beds per day, and a range of 2-23.

Cittiglio Hospital, 2691 admissions, with 7 free beds, and a range of 0-16.

Luino Hospital, 1258 admissions, with 3 free beds, and a range of 0-9.

Valle Olona Health Authority

Busto Arsizio Hospital, 7622 admissions, with 21 free beds, and a range of 8-36.

Gallarate Hospital, 6907 admissions, with 19 free beds, and a range of 6-33.

Saronno Hospital, 6621 admissions, with 18 beds, and range of 6-32

Somma Lombardo Hospital, 477 admissions, with 1 free bed, and a range of 0-7

Angera Hospital, 2245 admissions, with 6 free beds, and a range of 1-14.

The Casualty Departments that most transferred patients because of a lack of beds were: in the Sette Laghi district, the Del Ponte mother-child centre (27.4%) and Tradate (15.5%); in the Valle Olona district, the Busto Arsizio Hospital (18.9%).

The figures show that the Casualty Departments in the hospitals of Busto Arsizio, Varese, Tradate, Gallarate and Saronno were clearly busy: often the level of overcrowding that triggered corrective management actions was reached.

From this survey, the Territorial Health Agency has taken some organisational items to work on, to improve Casualty responses:

The distribution, in terms of age and sex, indicates that there should be dedicated reception procedures (including in-patient outcomes) for groups with a higher number of requests, such as children, women of childbearing age and the elderly: for the latter, in particular, there are about ¼ more requests for the Casualty Department than among the non-elderly population. Suitable procedures can also be identified for the foreign population, who accounted for about 9% of visits.

Looking at the classification based on urgency, 1% of cases were in a very critical condition, with an immediate danger to life (about 5000 people per year), and about 12% were accounted for by white code cases, that is, where the visit to Casualty was unnecessary. According to an estimate by the Italian Society of Emergency Medicine, about 1/5 of Casualty visits were superfluous: this could lead to diverting about 110,000 visits per year in the ATS territory, to specific outpatient departments for code white cases, near the Casualty Department, or to easily accessible local facilities.

About 13% of the visits to Casualty ended with admission, with variability, from hospital to hospital, of 5-20%. Proportionally, the Del Ponte and F. Macchi Hospitals in Varese admitted more (Sette Laghi Health Authority).

The particular demand for admissions should be considered in periods of overcrowding, with ad hoc plans that make resolution easy.

By contrast, some hospitals (Somma Lombardo, C. C. M. Domini, Luino) have a higher proportion of home discharges, using the Casualty Department above all as an outpatient