State of emergency medicine in Spain

The maturation of emergency medicine (EM) as a specialty has coincided with dramatic increases in emergency department (ED) visit rates, both in the United States and around the world. ED crowding has become a public health problem where periodic supply and demand mismatches in ED and hospital resources cause long waiting times and delays in critical treatments. ED crowding has been associated with several negative clinical outcomes, including higher complication rates and mortality. This article describes emergency care systems and the extent of crowding across 15 countries outside of the United States: Australia, Canada, Denmark, Finland, France, Germany, Hong Kong, India, Iran, Italy, The Netherlands, Saudi Arabia, Catalonia (Spain), Sweden, and the United Kingdom. The authors are local emergency care leaders with knowledge of emergency care in their particular countries. Where available, data are provided about visit patterns in each country; however, for many of these countries, no national data are available on ED visits rates or crowding. For most of the countries included, there is both objective evidence of increases in ED visit rates and ED crowding and also subjective assessments of trends toward higher crowding in the ED. ED crowding appears to be worsening in many countries despite the presence of universal health coverage. Scandinavian countries with robust systems to manage acute care outside the ED do not report crowding is a major problem. The main cause for crowding identified by many authors is the boarding of admitted patients, similar to the United States. Many hospitals in these countries have implemented operational interventions to mitigate crowding in the ED, and some countries have imposed strict limits on ED length of stay (LOS), while others have no clear

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“…Across Spain, there were 25 million ED visits in 2008 57 . Most EDs across Spain have a wide variety of technology, including ultrasound and CT.…”

Section: Catalonia (Spain)mentioning

confidence: 99%

International Perspectives on Emergency Department Crowding

Pines

Hilton

Weber

et al. 2011

Academic Emergency Medicine

509

360

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“…In the last decade, ED demand in Spain has risen by more than 4 percent annually, often surpassing the growth in ED capacity, and double the 2 percent population increase (82). The ED is often used as a time-saving alternative to specialist or diagnostic referrals and 30 percent of referrals are unnecessary (60,82).…”

Section: Revisiting the Portfolio Of Free Servicesmentioning

confidence: 99%

The Painful Effects of the Financial Crisis on Spanish Health Care

Bosch¹,

Moreno²,

López‐Soto³

2014

Int J Health Serv

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Spain has an advanced, integrated health care system that has achieved remarkable results, including substantially improved health outcomes, over a relatively short time. Measures introduced by central and regional governments to combat the financial crisis may be severely affecting the health sector, with proposed changes potentially threatening the principles of equity and social cohesion underlying the welfare state. This article examines recent developments in Spanish health care, focusing on the austerity measures introduced since 2010. In Spain, as in other countries, evaluation of health care changes is difficult due to the paucity of data and because the effects of measures often lag well behind their introduction, meaning the full effects of changes on access to care or health outcomes only become apparent years later. However, some effects are already clear. With exceptions, Spain has not used the crisis as an opportunity to increase efficiency and quality, rationalize and reorganize health services, increase productivity, and regain public trust. We argue that immediate health care cuts may not be the best long-term answer and suggest evidence-driven interventions that involve the portfolio of free services and the private sector, while ensuring that the most vulnerable are protected.

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“…The results predicted by simulation allow health care policymakers to improve modifiable factors contributing to the demand and performance of ED before reaching a critical point. Since most EDs in Spain has the same configuration and structure, and follow guidelines from the Spanish triage system (Sistema Español de Triage) [37], the results from this study can be generalized and used nationally to forecast future of all EDs in Spain [38] and [39]. Similarly, the method developed in this study can be used to asses and predict performance and quality of service of EDs in other countries provided that required data and information are available.…”

Section: Discussionmentioning

confidence: 97%

A Method for Projections of the Emergency Department Behaviour by Non-Communicable Diseases from 2019 to 2039

Shojaei

Rexachs

Epelde

et al. 2020

IEEE J. Biomed. Health Inform.

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In this paper, a new method for prediction of future performance and demand on emergency department (ED) in Spain is presented. Increased life expediency and population aging in Spain, along with their corresponding health conditions such as non-communicable diseases (NCDs), have been suggested to contribute to higher demands on ED. These lead to inferior performance of the department and cause longer ED length of stay (LoS). Prediction and quantification of behavior of ED is, however, challenging as ED is one of the most complex parts of hospitals. Using detailed computational approaches integrated with clinical data behavior of Spain's ED in future years was predicted. First, statistical models were developed to predict how the population and age distribution of patients with non-communicable diseases change in Spain in future years. Then, an agent-based modeling approach was used for simulation of the emergency department to predict impacts of the changes in population and age distribution of patients with NCDs on the performance of ED, reflected in ED LoS, between years 2019 and 2039. Results from different projection scenarios indicated that Spain would experience a continuous increase in total ED LoS from 5.7 million hours in 2019 to 6.2 million hours in 2039 if same human and physical resources, as well as same ED configuration, are used. The results from this study can provide health care provider with quantitative information on required staff and physical resources in the future and allow health care policymakers to improve modifiable factors contributing to the demand and performance of ED.

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State of emergency medicine in Spain

Cited by 15 publications

References 26 publications

International Perspectives on Emergency Department Crowding

International Perspectives on Emergency Department Crowding

The Painful Effects of the Financial Crisis on Spanish Health Care

A Method for Projections of the Emergency Department Behaviour by Non-Communicable Diseases from 2019 to 2039

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