Assistence - A&E Department

The A&E Department’s clinical activity includes the initial assessment and stabilization of patients presenting with an acute or urgent condition, as well as determining their final destination once stabilized. The options may include: discharge to the patient’s home, hospital admission (conventional hospitalization, intermediate care units, or intensive care units), home hospitalization or stay in the A&E Department for a maximum of 24 hours.

Currently, to arrange a hospital admission, the A&E specialists must discuss the case with specialists from the relevant department, who, after assessing the case, can authorize the admission.

The A&E Department is spread out across two centres, which work in coordination to deal with a wide variety of urgent situations:

• The Villarroel Centre, a seven-storey building, has specific areas designed for particular clinical functions.
• The Plató Centre, currently undergoing improvement and expansion, focuses on the care of medical, surgical and orthopaedic patients with triage urgency levels 2 to 5, with a particular focus on frail patients.

Villarroel Centre: Care functions by floor

Ground Floor:

• Triage area: The initial assessment is carried out to determine the triage urgency level and allocate the necessary resources.
• Resuscitation area: Intended for patients with urgency level 1 critical conditions (medical, surgical or trauma-related), which pose a life-threatening risk.

1st Floor:

• A&E reception and admissions.
• Social work area.
• Waiting room for patients and relatives.

2nd Floor:

• Initial care area: For patients with triage urgency levels 3, 4 and 5 requiring a medical consultation.
• Recovery area: A space where patients can stay for up to 24 hours to assess their response to treatment, undergo further investigations, await assessment by a specialist, or the allocation of a hospital bed.

3rd Floor:

• Initial care area: For patients with potentially serious conditions (level 2), patients with non-traumatic chest pain, and patients with suspected poisoning.

4th Floor:

• Medical area: For ambulatory patients with urgency levels 3, 4 or 5.
• Trauma and orthopaedics area: For ambulatory and non-ambulatory patients requiring trauma consultation and with urgency levels 2 to 5. It has a plaster cast unit and a dedicated cubicle for patients requiring ENT consultation.

6th Floor:

• Initial assessment and follow-up area: For patients with psychiatric conditions.
• OBS6: Initial assessment and follow-up area: For surgical patients with triage urgency levels 3 to 5, with the option to stay for up to 24 hours. It also includes a gynaecology treatment cubicle for the care of victims of sexual assault.

Plató Centre: Care functions

The centre treats medical, surgical and trauma patients with triage urgency levels 2 to 5 in a single area for initial assessment and follow-up, with particular focus on frail patients with comorbidities.

The A&E Department has specific pathways for managing certain situations:

• Chest pain: First structured pathway of its kind in the country, located on the 3rd Floor, with the aim of carrying out a clinical and electrocardiographic assessment within the first 10 minutes of the patient’s arrival.
• Toxicology:  A benchmark in Catalonia for the care of poisoned patients, providing immediate assessment and initiating decontamination measures.
• Sexual assault: A multidisciplinary pathway for victims aged 16 and over.
• Frail patients: A pathway currently being developed to care for this specific sector of the population.

The A&E Department organizes patient care through a structured triage system, which aims to quickly and objectively classify the urgency of the reason for consultation and to prioritize care according to clinical risk.

It is important to note that patients are not seen on a first-come, first-served basis, but rather according to the level of urgency established during triage. This system ensures the patients with the most serious conditions receive immediate care, whilst less urgent cases can wait or be redirected to other emergency facilities outside the hospital, as appropriate.

The triage levels are defined as follows:

• Level 1: Patients with obvious life-threatening conditions or life-threatening emergencies requiring immediate care.
• Level 2: Emergency patients requiring rapid care and continuous central monitoring. Although they are not in imminent danger of death, their condition may worsen if they are not treated promptly.
• Level 3: Patients requiring urgent care, but without immediate danger to life. These are usually situations that can wait for a limited time, but which still require hospital intervention.
• Level 4:  Less urgent patients with low-complexity reasons for consultation who, in most cases, should be directed to other levels of care, such as Urgent Treatment Centres (CUAP).
• Level 5: Non-urgent patients with low-complexity reasons for consultation who, in most cases, should be directed to other levels of care such as primary care or Urgent Treatment Centres (CUAP).

The A&E Department actively collaborates with facilities such as the ambulance service (SEM), the Manso urgent treatment centres (CUAP), primary care centres (CAP) in the basic health area, the Hospital Sagrat Cor, and local intermediate care centres such as the Clínica Sant Antoni. It participates actively in the Urgent and Emergency Care Operational Committee (COUiE)) of the Barcelona Esquerra Integrated Health Area (AISBE).