Implantación de una estrategia para gestionar la multifrecuentación de urgencias hospitalarias en una zona de Barcelona

Abstract

Visits to hospital emergency departments by patients with multimorbidity, complex chronic conditions, and frailty are becoming an increasing challenge. A territorial strategy has been developed, based on automated preselection lists, a nurse case manager with specialized experience, and a multi-level territorial referral consensus. The feasibility of this approach has been demonstrated, with 368 alerts detected, 85% of which were well-selected. Age, frailty, home care percentage, Barthel index, and cognition were progressively aligned with levels of care/referral (primary, intermediate, and specialized) according to previously agreed criteria. In 2024, there is extensive structured technical information, an expanding role for advanced nursing, and well-established inter-level service resources. Therefore, through automated selection, a consensual territorial protocol of pathways and clinical profiles, and autonomous nursing assessments managing multi-frequent cases, it would be possible to achieve, in a proactive, simple, and scalable manner, an appropriate distribution of alerts across levels, consistent with the social and healthcare needs of the patients.