“We haven’t solved the issue of wait times just yet, but one thing is certain: our wait times are not the same as those at other emergency departments. Our patients undergo risk assessment and receive constant attention from the service, ensuring their safety,” José Manuel Almeida, Director of the General Emergency Service at Santo André Hospital, told Lusa.

About three weeks ago, the patient intake process at the Leiria Region Local Health Unit’s emergency department changed with the creation of the Nursing Initial Observation Station (PPOE).

Clinical protocols

Now, patients are called for triage and then proceed to the PPOE, where nurses apply pre-defined clinical protocols based on symptoms, using NEWS—an early warning score based on standardised vital signs that determines the severity level.

José Manuel Almeida explained that a “yellow” triage wristband can correspond to varying levels of severity; the NEWS (National Early Warning Score) indicates the “likelihood of patient deterioration”—that is, the “possibility of their condition worsening more rapidly than others’.”

At the PPOE, if necessary, the nurse also initiates protocols for additional diagnostic tests, such as lab work or X-rays. This step speeds up the patient’s journey, ensuring that results are already available when they are called for their initial medical assessment.

Electronic monitoring

Nurse manager Ruben Fidalgo added that “if radiology or the laboratory detects a critical result,” an alert is issued so that the patient “moves ahead of the others.”

The nurse manager also highlighted that this station offers the advantage of enabling the early identification of domestic violence victims and vulnerable individuals.

“We sometimes hear about an elderly patient going missing from the emergency department. If we identify early on that a disoriented person is there, we can activate internal monitoring protocols”—such as fitting them with a wristband like those used on infants to prevent hospital abductions, or changing them into hospital attire.

“The PPOE [Patient Prioritisation and Observation Station] performs risk stratification within each priority level and assesses the workload required for each patient—allowing for better human resource management—while also applying protocols for diagnostic tests and analgesia,” summarised José Manuel Almeida.

Electronic monitoring has become the standard at the Leiria emergency department. From an initial half-dozen devices, there are now “more than 70.” Consequently, the director asserted that “patients are never left unattended while waiting for a doctor,” which helps prevent any sudden deterioration of their clinical condition.

Health literacy

The new model is already yielding results: “Mortality rates have dropped, and the total duration of the episode has decreased,” the doctor revealed.

Wait times are not currently a priority, partly because better coordination with primary care and increased health literacy are needed; after all, an emergency department “is not the place for routine consultations.”

“We have people showing up here because they’ve had shoulder pain for three months,” he noted critically.

As part of the service’s ongoing overhaul—scheduled for completion by the end of the year—plans include creating an outpatient emergency unit.

This will comprise a senior outpatient unit and an emergency day hospital, designed to cater to patients with less urgent needs.

The director therefore advocated for “true integration” with primary care services. “When we refer patients to primary care, it isn’t just to relieve the burden on our emergency department; it’s about placing the patient in the right setting,” he observed.

“Our mission focuses on urgent and emergent cases, and we are responding effectively to those needs,” he emphasised, noting that shortening patients’ length of stay in the department frees up doctors and nurses to attend to new patients.