Background: Similar to most high-income countries, almost 30% of consultations in Swiss hospital emergency departments (EDs) involve patients with low-severity levels. Redirecting patients with low-severity conditions to non-hospital facilities has proven effective internationally in reducing ED overcrowding, wait times, and improving patient satisfaction without compromising safety. Specifically, this study aims to understand the conditions under which the patient redirection role is exercised in triage. Methods: We conducted a mixed method study among ED triage nurses ( n = 23) in an urban teaching hospital in Western Switzerland. Data collection combined non-participant observation and semi-structured interviews. Data were analyzed through a systematic coding process where common themes across the studies were identified. Results: Structural empowerment assessed using the Conditions of Work Effectiveness Questionnaire-II evaluated six dimensions on a 5-point Likert scale (opportunities, access to information, organizational support, access to resources, formal power, informal power). Quantitative results showed high scores for opportunities and informal power, while access to information and organizational support was significantly lower. These trends converged with the qualitative data, with triage nurses describing real autonomy, but constrained by a lack of clinical feedback and variable interprofessional support. Conclusions: Although exploratory, our findings highlight the importance of organizational initiatives focusing on feedback loops, interprofessional support and continuous learning processes. Future research should transition from cross-sectional studies to longitudinal designs to assess the temporal impact of organizational changes, such as implementing formal feedback mechanisms on structural empowerment levels.

Background: Emergency department (ED) overcrowding threatens health care systems worldwide. This poses risks to patient safety, lowers quality of care, and reduces patient satisfaction. Patient input, defined as the caseload of patients presenting to the ED, is one of the factors contributing to overcrowding. Redirecting patients with nonurgent complaints to external health care services could help alleviate ED workload. Objective: The primary objective of this study is to investigate the safety and efficiency of redirection of low-acuity patients using an electronic clinical decision support system. As a secondary and exploratory aim, we will assess the impact of this intervention on subsequent health care use, patient satisfaction, and health literacy over a 6-month follow-up period. Methods: A single-center observational study with 2 consecutive cohorts of low-acuity patients presenting to the ED will be conducted. The first cohort will be triaged and offered redirection according to current practice. In the second cohort, after triage, low-acuity patients will be evaluated by an electronic clinical support system to determine eligibility for redirection. If eligible for redirection, an appointment at a nearby clinic will be arranged through the system. The primary end point is any unexpected returns to health care services within 48 hours of triage. Secondary end points are patient satisfaction as well as the number of unexpected consultations and the evolution of health literacy during a 6-month follow-up period. Results: This study is funded by an internal grant from Hôpital Fribourgeois. Recruitment began on June 20, 2025, with a total of 35 patients enrolled as of August 2025. Data analysis will begin after the recruitment and 6-month follow-up of 300 to 420 patients are completed, which is expected to occur in November 2026. We hope to publish results in December 2026. Conclusions: We expect the redirection process of low-acuity patients to other health care facilities using an electronic clinical support system to be safe and efficient. If results are positive, application of this reproducible strategy could reduce the number of patients treated in EDs and provide alternative health care pathways for low-acuity patients.

Background/Objective: Diagnostic safety is a major challenge in emergency departments (ED), where clinicians frequently make decisions under time pressure and with incomplete information. Prospective data on diagnostic discrepancies in Swiss EDs remain limited. To determine the frequency of diagnostic discrepancies between the initial ED diagnosis and the final Internal Medicine (IM) discharge diagnosis, identify associated patient-, physician-, and context-related factors, and evaluate clinical outcomes associated with diagnostic discrepancy. Methods: We conducted a prospective observational study including 515 patients admitted from the ED to an IM ward and managed by 44 physicians at a Swiss tertiary non-university hospital. The initial ED diagnosis was compared with the IM discharge diagnosis (or diagnosis on day 28 if the patient remained hospitalized). Diagnostic discrepancies were classified using a predefined algorithm with independent expert opinion where required. Generalized linear mixed-effects models were used to assess associations between diagnostic discrepancy and mortality, in-hospital transfers and length of stay; a multivariable logistic regression model was used to identify factors associated with diagnostic discrepancy. Results: Diagnostic discrepancies were identified in 10.1% of patients (n = 52). These patients had longer hospital stays (9.3 ± 9.2 vs. 6.9 ± 5.8 days; p = 0.069) and were more frequently transferred within the hospital (17% vs. 5.8%; p = 0.006). After adjustment, diagnostic discrepancies were associated with higher odds of in-hospital transfer (OR 3.35; 95% CI 1.47–7.66; p = 0.004) and a 20% longer stay (exp β = 1.20; 95% CI 1.00–1.45; p = 0.049), although the latter was attenuated after adjustment for comorbidity. Specialist involvement in the ED was independently associated with lower odds of diagnostic discrepancy (OR 0.30; 95% CI 0.10–0.72; p = 0.015), whereas each one-point increase in physician-perceived diagnostic difficulty was associated with higher odds (OR 1.42; 95% CI 1.07–1.90; p = 0.016). Conclusions: Diagnostic discrepancies occurred in approximately one in ten patients admitted from the ED to IM and were associated with increased in-hospital transfer and, less robustly, with prolonged hospitalization. Prospective multicenter studies should evaluate strategies to reduce diagnostic discrepancies and improve diagnostic safety.

Acute intoxications related to recreational drug use represent an increasing challenge for emergency departments (EDs). Worldwide, more than 600,000 deaths are attributable each year to illicit drug consumption, and in Switzerland approximately 190 deaths related to recreational drug use were reported in 2023. Most patients present after the use of recreational drugs such as stimulants (cocaine and amphetamines), opioids, cannabis or hallucinogens, with stimulants representing the majority of acute presentations in European emergency departments. In recent years, a sharp progression of amphetamine-like substance consumption derived from khat has been observed. Clinical presentations range from agitation, psychosis, seizures, and hyperthermia to respiratory depression, multi-organ failure and cardiac arrest. Emergency physicians are frequently the first to provide care, yet management is often complicated by the coexistence of multiple substances, the emergence of new psychoactive compounds, and the limited availability of toxicological testing in the acute setting. This narrative review summarises the current evidence and recommendations relevant for clinical practice. It is based on a literature search conducted in PubMed, EMBASE, Cochrane Library, but also grey literature such as MonAM, Infodrog and Tox Info Suisse regarding the specific Swiss context. The review highlights the recognition of typical toxidromes: stimulants causing sympathomimetic effects; opioids with mainly respiratory depression; hallucinogens and dissociatives; also, this review presents common pitfalls with drugs commonly encountered. Management emphasises oxygen administration, benzodiazepine sedation for agitation, and specific interventions like naloxone for opioids. Given rising trends in cocaine and novel psychoactive substance use, enhanced understanding of pharmacological profiles and standardised emergency protocols are critical for improving patient outcomes. Although specific treatment may be lacking for most drugs, novel psychoactive drugs pose new challenges due to lack of robust data preventing us from presenting a typical clinical picture and providing standardised care. This synthesis aims to support emergency physicians in the structured and evidence-based management of acute recreational drug intoxications.