Consultations in the Green Zone of the ED: Frequency, Specialties, and Outcomes

11th Eurasian Congress on Emergency Medicine, Antalya, Türkiye, 20 - 23 Kasım 2025, ss.231, (Özet Bildiri)

OBJECTIVE: Emergency departments (EDs) face increasing patient volumes, making the optimization of

patient flow and resource allocation a critical issue. The “green zone” of the ED, which generally consists of

non-urgent cases, is often considered to require minimal intervention. However, some of these patients may

necessitate specialty consultations, resulting in further diagnostic and therapeutic procedures, hospital

admissions, or even intensive care needs. Data regarding the consultation rates, specialties involved, and

clinical outcomes of green zone patients remain limited. This study aims to evaluate the characteristics,

consultation patterns, and outcomes of patients who were referred for specialty consultation in the

emergency department green zone.

MATERIAL and METHODS: This retrospective, single-center and cross-sectional study was conducted in

the Emergency Department of a university-affiliated training and research hospital in Bilecik, Türkiye.

This study examined consultations requested from patients presenting to the green-zone emergency

department between June 2024 and May 2025. Consultation-requested branches, diagnoses, consultation

hours, and hospitalization status were analyzed.

RESULT: During the study period, a total of 75,011 patients presented to Bilecik Training and Research

Hospital Emergency Department green zone. Of these, 237 (0.32%) required specialty consultation. Among

the consulted patients, 40.5% were female and 59.5% were male, with a median age of 41 years (range:

0–91). Female patients had a significantly higher median age than males (54 vs. 38 years, p<0.05). 42.6% of

consultations were requested during working hours, while 57.4% occurred outside working hours. Regarding

outcomes, 70.0% of patients were admitted, 29.5% were discharged, and 0.5% were referred to another

center. Among admissions, 96.4% were to wards, and 3.6% to intensive care units. The most frequent

diagnoses included; Forearm fractures (19.8%), shoulder and upper arm fractures (8.4%), pneumonia (7.2%),

lower leg fractures (6.3%). The most frequently consulted specialties were; Orthopedics (47.3%), Plastic and

Reconstructive Surgery (8.0%), Otorhinolaryngology (6.3%), Pediatrics (5.9%). Notably, patients consulted

by cardiology were all admitted to intensive care units, showing a statistically significant difference

compared to other specialties (p<0.05).

CONCLUSION: Although consultations in the ED green zone were relatively rare, the majority of consulted

patients required hospital admission. Orthopedics was the most frequently consulted specialty, primarily

due to traumatic fractures, while cardiology consultations were exclusively associated with intensive

care admissions. These findings highlight that even patients categorized as “non-urgent” may require

advanced medical care, emphasizing the importance of effective consultation management to ensure

optimal patient outcomes and resource utilization.

Keywords: Emergency Department, Green Zone, Consultation