Until a few decades ago, the emergency room (ER) was the place of arrival and initial evaluation of severe patients. In the following years the ER has increasingly become the landmark of health organization has oriented people towards first aid, independently of the level of severity disease. In the late 1990s, healthcare costs became unsustainable, requiring all healthcare systems to drastically reduce hospital admissions. Various action strategies have therefore been developed, including activation of a specific sector within the Emergency Department called "brief intensive observation" (BIO).
The BIO is an operating unit in which patients evaluated in the ER are managed. These are patients whose direct discharge would be risky, but who have a high probability of safe discharge within 48-72 hours, the time required for completion of diagnostics, observation and therapy. In the absence of BIO, these patients would be discharged early, or hospitalized inappropriately. Among the most frequent morbid conditions are: chest pain, abdominal pain, headache, traumatism, supraventricular arrhythmias, transient global amnesia, low-risk transient ischemic attack, pneumonia, exacerbated COPD, head trauma and more.
In many countries, BIO has become one of the main strategies for managing patients with an intermediate level of severity disease. Health planning indicated the presence of a BIO bed for every 5,000-8,000 emergency accesses as optimal. The optimal outcome is to have a BIO discharge rate of 75-80%. The most important risk is to transform the BIO into a boarding space for patients awaiting hospitalization. Also thanks to the BIO, in the last 20 years the percentage of hospitalization from the ER in countries where the health service has a public prevalence has halved. Consequently, what could be the challenge and main objective for the BIO in the next 10 years?
(1) standardize the role and management of the operating unit in all hospitals in the health system, in order to avoid malpractice and inhomogeneity;
(2) create highly organized input, troughput and output paths within each hospital, so as to optimize resources and health performance.
By doing so, the BIO will be able to evolve into an Intensive Short Organization, with an improvement in emergency health organization.
- Emergency Unit
- Brief Intensive Observation
- Health System