Investigating the referral of patients with non-urgent conditions to a regional Australian emergency department: a study protocol (original) (raw)
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Family Medicine & Primary Care Review, 2017
Background. Unmet needs in the medical care of high-need patients may increase costs due to the use of emergency departments (eDs) instead of primary care. Objectives. to establish the possible correlation between the unmet needs of patients and the number of hospitalizations, and the probability of influence of the former aspect on the latter, and to analyze the level of satisfied needs of ED patients in relation to sociodemographic data. Material and methods. An original questionnaire and a modified version of the Camberwell Assessment of Need Short Appraisal Schedule (CANSAS) were used to assess the level of satisfaction of the social, medical, psychological and environmental needs of 150 ED patients. Results. Most respondents were women (54%; 81/150) of a median age of 44.5 (range: 18-87). Nearly a half of the patients (48%; 72/150) were treated due to chronic diseases. A high Camberwell index (above 0.825) was negatively correlated with the total number of hospitalizations in a three-year period (r =-0.37; p < 0.001). The chance of hospitalization in people with a low Camberwell index (below 0.825) was 3 times higher than in those with higher values (OR 0.36; 95% CI 0.17-0.72). The highest level of satisfied needs was obtained by people aged 38-47, with higher education, married, living in a relationship, declaring a very good material status. Conclusions. An ED visit prevention program should include the target primary care patient groups with the highest chance of hospitalization, in particular: people aged over 67, with chronic diseases, with primary education only, widows/widowers, declaring a poor material status and living alone.
Emergency Medicine Australasia, 2015
To determine 1) the magnitude of the increase in Emergency Department (ED) demand in Western Australia (WA) from 2007-2013, and 2) whether primary care type patients seeking care in ED is the main reason for the increase. Methods We conducted a population-based longitudinal study examining trends in ED demand, stratified by area of residence, age group, sex, Australasian Triage Scale (ATS) category and discharge disposition. The outcome measures were annual number and rate of ED presentations. We calculated average annual growth, and agespecific and age-standardised rates. We assessed the statistical significance of trends, overall and within each category, using the Mann-Kendall trend test and ANOVA. We also calculated the proportions of growth in ED demand that were attributable to changes in population and utilisation rate. Results From 2007 to 2013, ED presentations increased by an average 4.6% annually from 739,742 to 945,244. The rate increased 1.4% from 354.1 to 382.6 per 1,000 WA population (p=0.02 for the seven-year trend). Most increase occurred in metropolitan WA, age 45+ yrs, ATS 2 and 3, and admitted cohorts. About three-quarters of this increase was due to population change (growth and ageing) and one-quarter due to increase in utilisation. Conclusion Our study reveals a 4.6% annual increase in ED demand in WA in 2007-2013, mostly due to an increase in people with urgent and complex care needs, and not a 'demand transfer' from primary care. This indicates that a system-wide integrated approach is required for demand management.
International Emergency Nursing
[Background] Emergency departments worldwide report service demands which exceed resource availability. Themes such as crowding, non-urgent presentations, ambulance diversion and access block have been linked to complications in care, poorer patient outcomes, increased morbidity and staff burnout. People attending the emergency department with problems perceived as non-urgent are frequently attributed blame for increased service demand, yet little is known from the patients' perspective. [Method] This project utilised a descriptive cross-sectional waiting room survey of non-urgent patients to identify factors contributing to their decision making process to access ED services at a regional hospital in Tasmania, Australia. Data were analysed using a statistical software package and comparison made between the sample and population groups to determine broad representation. [Results] Patients' decision making processes were found to be influenced by convenience, perceived need and referral by a health care provider. Cost did not present as a significant factor. A high incidence of patients under 25 years of age were identified and musculoskeletal complaints were the most common complaint across all age groups. [Conclusion] Further consideration is required to determine how to best meet service demand to facilitate the provision of the right service at the right time to the right patient.
ED qualitative methods research protocol, 2021
A proportion of patients seeking care in emergency departments (ED) have conditions that could potentially be better managed by community-based healthcare services. There is debate about the proportion of ED attendances constituting this significant group, with estimates ranging from 10%-61% in Australia (AIHW, 2017; Nagree, et al., 2013). This group of patients are usually described from a health service perspective using labels such as "non-urgent," "low urgency," "potentially avoidable general practice," "GP (general practice) presentations" or "primary care" presentations. Yet one of the top reasons these patients seek care are their or significant others' perceptions of needing urgent care (Lobachova et al., 2014; Masso et al., 2007; Shaw et al., 2013). The language used in the literature to characterize these patients demonstrates a potential systematic bias for health professional perceptions of the appropriateness of ED care seeking. Healthcare workers' opinions about care-seeking appropriateness have been explored (Breen & McCann, 2013)
‘Did not waits’: A regional Australian emergency department experience
Emergency Medicine Australasia, 2014
Objective: Describe the characteristics, reasons for leaving and outcomes of patients who did not wait (DNW) to be seen by a health practitioner in a regional Australian ED. Methods: Prospective observational study of a convenience sample of ED DNW patients presenting to The Townsville Hospital between June 2011 and July 2012. Seven days from each month were selected, and DNW patients presenting on those days were enrolled. An investigator attempted to contact every DNW patient by telephone in the following week to elicit reasons for leaving, subsequent health contacts, outcomes and suggestions for system improvements. Additional outcome information was obtained from hospital electronic medical records. Results: Nearly 15 000 patients presented on the study days, with 648 (4.3%) DNWs: 415 (64.0%) adults, 193 (29.8%) children (1-16 years old) and 40 (6.2%) infants. Thirty-eight (5.9%) patients who DNW were Australasian Triage Scale (ATS) category 3, 546 (84.3%) were ATS category 4 and 64 (9.9%) were ATS category 5. Most DNW patients presented on Sundays and between 1600 and 2359. Just over half of the patients who DNW (52.9%) sought additional medical treatment, with 4.9% requiring subsequent hospital admission. Three psychiatric patients who DNW required urgent mental health interventions organised by the investigators. Frustration with perceived waiting times was the most common reason for leaving without being seen. Conclusions: Regional Australia ED patients who DNW often still require medical care, with approximately 1 in 20 requiring subsequent hospital admission. Patients with psychiatric conditions who DNW might be at particular risk.
Emergency department models of care in Queensland: a multisite cross-sectional study
Australian health review : a publication of the Australian Hospital Association, 2018
The acuity and number of presentations being made to emergency departments (EDs) is increasing. In an effort to safely and efficiently manage this increase and optimise patient outcomes, innovative models of care (MOC) have been implemented. What is not clear is how these MOC reflect the needs of patients or relate to each other or to ED performance. The aim of this study was to describe ED MOC in Queensland, Australia. Situated within a larger mixed-methods study, the present study was a cross-sectional study. In early 2015, leaders (medical directors and nurse managers) from public hospital EDs in Queensland were invited to complete a survey detailing ED activity, staffing profiles, treatment space, MOC and National Emergency Access Target (NEAT) performance. Routinely collected ED information system data was also used. Twenty of the 27 EDs invited participated in the study (response rate 74%). An extensive array of MOC were identified that were categorised into those that facilit...
BMJ Open Quality, 2017
Background Congruent with international rising emergency department (ED) demand, a focus on strategies and services to reduce burden on EDs and improve patient outcomes is necessary. Planned representations of non-urgent patients at a regional Australian hospital exceeded 1200 visits during the 2013-2014 financial year. Planned representations perpetuate demand and signify a lack of alternative services for non-urgent patients. The Community Nursing Enhanced Connections Service (CoNECS) collaboratively evolved between acute care and community services in 2014 to reduce planned ED representations. Objective This study aimed to investigate the evolution and impact of a community nursing service to reduce planned representations to a regional Australian ED and identify enablers and barriers to interventionist effectiveness. Methods A mixed-methods approach evaluated the impact of CoNECS. Data from hospital databases including measured numbers of planned ED representations by month, time of day, age, gender and reason were used to calculate referral rates to CoNECS. These results informed two semistructured focus groups with ED and community nurses. The researchers used a theoretical lens, 'diffusion of innovation', to understand how this service could inform future interventions. Results Analyses showed that annual ED planned representations decreased by 43% (527 presentations) after implementation. Three themes emerged from the focus groups. These were right service at the right time, nursing uncertainty and system disconnect and medical disengagement. Conclusions CoNECS reduced overall ED planned representations and was sustained longer than many complex service-level interventions. Factors supporting the service were endorsement from senior administration and strong leadership to drive responsive quality improvement strategies. This study identified a promising alternative service outside the ED, highlighting possibilities for other hospital emergency services aiming to reduce planned representations .
Characteristics of non-urgent patients
Scandinavian Journal of Primary Health Care, 2008
Objective. To describe characteristics of patients seeking medical attention for non-urgent conditions at an emergency department (ED) and patients who use non-scheduled services in primary healthcare. Design. Descriptive cross-sectional study. Setting. Primary healthcare centres and an ED with the same catchment area in Stockholm, Sweden. Patients. Nonscheduled primary care patients and non-referred non-urgent ED patients within a defined catchment area investigated by structured face-to-face interviews in office hours during a nine-week period. Main outcome measures. Sociodemographic characteristics, chief complaints, previous healthcare use, perception of symptoms, and duration of symptoms before seeking care. Results. Of 924 eligible patients, 736 (80%) agreed to participate, 194 at the ED and 542 at nine corresponding primary care centres. The two groups shared demographic characteristics except gender. A majority (47%) of the patients at the primary care centres had respiratory symptoms, whereas most ED patients (52%) had digestive, musculoskeletal, or traumatic symptoms. Compared with primary care patients, a higher proportion (35%) of the ED patients had been hospitalized previously. ED patients were also more anxious about and disturbed by their symptoms and had had a shorter duration of symptoms. Both groups had previously used healthcare frequently. Conclusions. Symptoms, previous hospitalization and current perception of symptoms seemed to be the main factors discriminating between patients studied at the different sites. There were no substantial sociodemographic differences between the primary care centre patients and the ED patients.
Asia-Pacific Journal of Health Management
Problem: The number of presentations to Emergency Departments (EDs) is increasing at levels above population growth rates and these increases are becoming unsustainable. Objective: To review evidence for emerging entry points to the health system for patients with non-life threatening urgent conditions (NLTUC) in order to consider more effective healthcare services in Australia. Methods: An in-depth review of the Emerald, Medline, CINAHL, Web of Science, Proquest Business and Medical databases from January 2005 to April 2016 matching ‘acute care’ or ‘urgent care’ with general practice andother health providers found thirteen entry point models with five currently relevant to Australia. Results: Studies examining five emerging entry points were found including urgent care community pharmacy, new prehospital practitioner community care, advanced nurse enhancement of primary care, designated urgent care clinics and integrated primary care centers. Evidence for these emerging models of ...