General Hospital of Nikaia Agios Panteleimon

Nikaia Hospital was build in 1932 and became a general hospital in 1952 (Fig. 1). The hospital has 615 beds and more than 1,700 staff members. It is one of the largest hospitals in the Athens-Piraeus region, covering the area of Attica. The hospital treats patients from all over the country and the Greek islands due to its proximity to the port of Piraeus.

Each open day the hospital is available for services, approx. 1,400 patients enter the Emergency Department (ED) and spend an average of eight hours for observation before they are either discharged or admitted to other departments. The medical staff at the ED includes nine doctors. 15 specialists and 30 residents join in to manage the incoming patients. Within the ED, the team is responsible for the triage area, the resuscitation area, the fast-track area, and the COVID-19 area. All other stations are operated by doctors from different specialities, e.g., from the cardiology and surgery departments.

Recently, we had the pleasure to visit Dr Dimitrios Tsiftsis, who last year came to Denmark to join the ED at Slagelse Hospital for an entire week. The objective of the visit was to learn how triage at the ED level is done in Denmark.

Dr Tsiftsis became aware of suPAR in 2018 after he attended a ViroGates-hosted symposium in Athens. At this event, he became convinced suPAR could be of great value in the triage of patients at the ED in Greece.
Dr Tsiftsis is a general surgeon. Being the head of the ED at Nikaia Hospital for several years, Dr Tsiftsis has become an expert in ED triage and is today one of the most experienced Heads of ED in Greece.

The Nikaia Hospital ED has been selected among the EDs in Greece to implement a newly-founded training program for the Emergency Medicine Subspecialty, Emergency nursing, and other innovative programs related to emergency medicine.

suPAR News: Why did you become interested in suPAR?
Dr Tsiftsis: ED crowding is a global problem. After being introduced to suPAR, it immediately became clear that suPAR would add value to existing scorings scales and algorithms, which could help us triage patients quicker and safer.

suPAR News:What is your biggest hurdle at the ED?
Dr Tsiftsis: Emergency medicine and autonomous EDs are a new thing in Greece. There are many hurdles we must overcome in this startup phase. Staffing, mentality, and education are my top priorities for the department.

suPAR News:You see suPAR as a biomarker with colossal potential. How come?
Dr Tsiftsis: suPAR would be a great addition to our currently used routine biomarkers in the ED. Its prognostic value and high negative predictive value will help us in the decision to discharge a patient. It will be a huge benefit to send home more patients faster in a safe way.

suPAR News:How do you see suPAR can be used at your hospital?
Dr Tsiftsis: suPAR will help stratify patients in the grey zone and help us manage the patients that otherwise would be placed for observation for up to 48 hours.
suPAR could help us, as we need to stratify our patients. Currently, we have 120 patients for 90 beds. I am convinced that suPAR could help.

suPAR News:How will suPAR be implemented in clinical routine?
Dr Tsiftsis: As with all new things, we need to see the feasibility of such an implementation. Then we need to standardize a protocol for a select subgroup of patients. After evaluating suPAR, its true potential will be able to widen its applications.

suPAR News:What are your expectations of suPAR?
Dr Tsiftsis: I believe it can help us reduce the number of patients who today are admitted based on our current triage tools. If we could send home a few of the patients every day who are now admitted and who will be sent home within the first 48 hours, then the doctors will be happy, and our hospital saves a lot of money. But even more important, it could help us to not under-triage patients that do need admission and are sent home. I guess at the end of the day, with suPAR, we will be able to berry pick those patients who need a referral for observation and further investigation after they leave the ED.

suPAR News:Based on your experience, will you recommend other hospitals to use suPAR?
Dr Tsiftsis: I believe we need more data to recommend it widely. This data will start flowing as more ED implement suPAR in clinical decision making. I strongly believe that it will have a positive impact on the everyday workload of the ED.