ED triage at Sismanoglio General Hospital

Dr Vasileios Kaldis is trained as a surgeon and intensive care specialist consultant. Currently, he is heading the Emergency Department (ED) at the Sismanoglio General Hospital, located in the Northern part of Athens in Greece (Fig. 1).

The Sismanoglio General Hospital is a third-level institution with a 540-bed capacity. The hospital employs specialized medical personnel covering medical fields such as pathology, chronic pulmonary diseases, tuberculosis, surgical chest cases, and vascular issues, except for trauma cases.

When arriving at the ED (Fig. 2), patients enter through the established ED triage ambulatory (Fig. 3). Here, all patients are examined, and the severity of the disease is evaluated.

The hospital is open for new patients every third day from 8 am to 3 pm and every fourth day for a full 24-hour day, where 300-500 patients enter the ED¹. Each year, approximately 40.500 patients are examined. Approximately 9.000 of these are admitted. To handle the high number of tests needed to be analyzed each day, the central laboratory is well equipped with an automated high-throughput platform following ISO standardization. In total, nearly 500 order

s are processed daily, corresponding to almost 5.000 tests. Most of the admitted patients are elderly patients with comorbidities related to internal medicine, pulmonary or cardiological issues like COPD, asthma, diabetes mellitus, CRA, heart failure, ischemic heart disease, and hypertension. These high numbers of patients are a huge burden for the medical staff, with many problems to be resolved each day.

Dr Kaldis:

Since I assumed the position as head of ED in 2019, it has been my mission to integrate novel biomarker tools into our triage workflow to discharge patients safely.
suPAR was kindly brought to my attention by Professor Giamarellos-Bourboulis from the 4th Department of Internal Medicine at Attikon University Hospital through the Hellenic Sepsis Group’s excellent work. I have been a member since 2014. Last year we introduced the SUPERIOR Study protocol to guide antibiotics administration in the ED at the Sismanoglio General Hospital. The Hellenic Study Sepsis Group have been running several ambitious clinical studies for more than two decades.

I believe that suPAR is the right tool to assist in discharging decisions as the implementation of suPAR could reduce unnecessary admissions and shorten the hospital length of stay. At the same time, this will free up valuable time and save hospital beds for those who need them. Patients within an Emergency Severity Index 3 (ESI3) triage category with known comorbidities in ED will also benefit from this.
I hope and believe that the suPAR biomarker will improve and assist the clinical decision making done by my medical personnel. suPAR could be the right tool used at the right moment in this COVID-19 pandemic era that will permit the safe discharge of patients from ED, and at the same time, reduce the number of bed days and as well as the cost of healthcare.

I will be happy to use the suPAR biomarker to implement this change in our ED’s clinical decision-making.