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Truter P, Edgar D, Mountain D, Saggers A, Bulsara C. 'I just need to find out if I had broken something or not.' A qualitative descriptive study into patient decisions to present to an Emergency Department with a simple fracture. Int Emerg Nurs 2024; 73:101420. [PMID: 38408404 DOI: 10.1016/j.ienj.2024.101420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 01/13/2024] [Accepted: 02/01/2024] [Indexed: 02/28/2024]
Abstract
Background To investigate what factors contribute to a working age adult with a simple fracture seeking care in an Australian metropolitan Emergency Department (ED) Methods In this Qualitative Descriptive study, we interviewed ED patients with simple fractures including 5th metacarpal, 5th metatarsal, toe, radial head and clavicle fractures. Results We interviewed 30 patients aged 18-65. Two thirds of participants were aware they might have a minor injury. Many were well informed health consumers and convenience was the most important decision-making factor. Participants focussed on organising imaging, diagnosis and immobilisation. This sequence of care was often perceived as more complex and inefficient in primary care. ED was trusted and preferred to urgent primary care with an unknown doctor. Some patients defaulted to attending ED without considering alternatives due to poor health system knowledge or from escalating anxiety. Conclusions ED is safe, free and equipped to manage simple and complex injuries. Patients would attend primary care if comprehensive fracture management was easily accessible from a trusted clinician. To effectively divert simple fracture presentations from ED, primary care requires collocated imaging, imaging interpretation, orthopaedic expertise, and fracture management resources. Services need to operate 7 days a week and must have accessible 'urgent' appointments.
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Affiliation(s)
- Piers Truter
- School of Health Sciences and Physiotherapy, The University of Notre Dame Australia, Fremantle, WA 6160, Australia; Fiona Stanley Hospital, Emergency Department, Perth, Murdoch, WA 6150, Australia.
| | - Dale Edgar
- Safety and Quality Unit, Armadale Kalamunda Group Health Service, East Metropolitan Health Service, Mt Nasura, WA, Australia; Institute of Health Research, The University of Notre Dame Australia, Fremantle, WA 6160, Australia
| | - David Mountain
- Emergency Department, Sir Charles Gairdner Hospital, Nedlands, WA, Australia; Curtin University Medical School, Bentley, WA, Australia
| | - Annabel Saggers
- School of Health Sciences and Physiotherapy, The University of Notre Dame Australia, Fremantle, WA 6160, Australia
| | - Caroline Bulsara
- Institute of Health Research, The University of Notre Dame Australia, Fremantle, WA 6160, Australia; School of Nursing and Midwifery, The University of Notre Dame, Fremantle, Australia
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Montoro-Pérez N, Montejano-Lozoya R, Escribano S, Richart-Martínez M. Factors associated with non-urgent presentations in the paediatric emergency department using Andersen's behavioural model: A cross-sectional descriptive study. J Clin Nurs 2024. [PMID: 38258512 DOI: 10.1111/jocn.17004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 12/11/2023] [Accepted: 01/07/2024] [Indexed: 01/24/2024]
Abstract
OBJECTIVES To explore the rate of NUPs and associated factors in the PED of the 'Hospital Universitario y Politécnico La Fe' in Valencia (Spain) using Andersen's Behavioural Model. METHODS We conducted a descriptive cross-sectional study using Andersen's Behavioural Model in parents visiting the PED with their children at the 'Hospital Universitario y Politécnico La Fe' in Valencia (Spain). RESULTS The study involved a total of 530 participants, of whom 419 (79%) had made an NUP. The predisposing factors identified were: (I) paediatric patients brought in by their fathers (OR = 0.460; p = 0.005), (II) lower educational attainment (OR = 3.841; p = 0.000), (III) first-time parenthood (OR = 2.335; p = 0.000) and (IV) higher parental stress (OR = 1.974; p = 0.023). The enabling factors included: (I) responsibility for a significant part of the childcare shared with others (OR = 0.348; p = 0.041) and (II) the perception that PEDs provide better care than primary care (PC) services (OR = 1.628; p = 0.005). The need factors were: (I) existing chronic illness in the child seeking care (OR = 0.343; p = 0.000) and (II) the perceived severity of the urgency (OR = 0.440; p = 0.031). CONCLUSIONS The NUP rates found in this study are similar to those found internationally. In accordance with Andersen's Behavioural Model, we identify predisposing, enabling and need factors to explain the multifactorial nature of NUPs in PEDs. IMPLICATIONS FOR PRACTICE Identifying the factors associated with NUPs enables interventions to be targeted at those groups most likely to engage in NUPs, thereby optimising the functioning of the PED and improving the well-being of children and families. These interventions should focus on improving parental health literacy, providing education on making appropriate decisions about accessing health services and recognising severe symptoms in children, as well as improving access to high-quality PC services. Providing support to parents during the transition to parenthood would also be beneficial. REPORTING METHOD This paper adheres to the STROBE initiative guidelines. CONTRIBUTION FROM PATIENTS OR MEMBERS OF THE PUBLIC Participants, who voluntarily agreed to take part, contributed to the study by completing a paper-based questionnaire containing all the study variables as prepared by the research team.
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Affiliation(s)
- Néstor Montoro-Pérez
- Department of Nursing, Faculty of Health Sciences, Person-Centred Care and Health Outcomes Innovation Group, University of Alicante, San Vicente del Raspeig, Spain
- GREIACC Research Group La Fe Health Research Institute, Valencia, Spain
| | | | - Silvia Escribano
- Department of Nursing, Faculty of Health Sciences, Person-Centred Care and Health Outcomes Innovation Group, University of Alicante, San Vicente del Raspeig, Spain
| | - Miguel Richart-Martínez
- Department of Nursing, Faculty of Health Sciences, Person-Centred Care and Health Outcomes Innovation Group, University of Alicante, San Vicente del Raspeig, Spain
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Liguoro I, Beorchia Y, Castriotta L, Rosso A, Pedduzza A, Pilotto C, Cogo P. Analysis of factors conditioning inappropriate visits in a paediatric emergency department. Eur J Pediatr 2023; 182:5427-5437. [PMID: 37755471 DOI: 10.1007/s00431-023-05223-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 09/14/2023] [Accepted: 09/16/2023] [Indexed: 09/28/2023]
Abstract
Recent studies estimated that about 20-30% of visits in a paediatric emergency department (PED) are inappropriate. Nonurgent visits have been negatively associated with crowding and costs, causing longer waiting and dissatisfaction among both parents and health workers. We aimed to analyze possible factors conditioning inappropriate visits and misuse in a PED. We performed a cross-sectional study enrolling children accessing an Italian PED from June 2022 to September 2022 who received a nonurgent code. The appropriateness of visits, as measured by the "Mattoni SSN" Project, comprises combination of the assigned triage code, the adopted diagnostic resources, and outcomes. A validated questionnaire was also administered to parents/caregivers of included children to correlate their perceptions with the risk of inappropriate visit. Data were analyzed using independent-samples t-tests, Wilcoxon-Mann-Whitney tests, chi-square tests, and Fisher's exact tests. The factors that were found to be associated with inappropriate visits to the PED were further evaluated by univariable and multivariable logistic regression analyses. Almost half (44.8%) of nonurgent visits resulted inappropriate. Main reasons for parents/caregivers to take their children to PED were (1) the perceived need to receive immediate care (31.5%), (2) the chance to immediately perform exams (26.7%), and (3) the reported difficulty in contacting family paediatrician (26.3%). Inappropriateness was directly related to child's age, male gender, acute illness occurred in the previous month, and skin rash or abdominal pain as complaining symptoms. Conclusion: This study highlights the urgent need to finalize initiatives to reduce misuse in accessing PED. Empowering parents' awareness and education in the management of the most frequent health problems in paediatric age may help to achieve this goal. What is Known: • About 20-30% of pediatric urgent visits are estimated as inappropriate. • Several factors may be associated with this improper use of the emergency department, such as the misperception of parents who tend to overrate their children's health conditions or dissatisfaction with primary care services. What is New: • This study evaluated almost half of pediatric emergency department visits as inappropriate adopting objective criteria. • Inappropriateness was directly related to the child's age, male gender, acute illness that occurred in the previous month, and skin rash or abdominal pain as complaining symptoms. Educational interventions for parents aimed at improving healthcare resource utilization should be prioritized.
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Affiliation(s)
- Ilaria Liguoro
- Division of Pediatrics, University Hospital of Udine, P.zzale S. Maria della Misericordia, 15. 33100, Udine, Italy.
| | - Yvonne Beorchia
- Institute of Hygiene and Clinical Epidemiology, University Hospital of Udine, Udine, Italy
| | - Luigi Castriotta
- Institute of Hygiene and Clinical Epidemiology, University Hospital of Udine, Udine, Italy
| | - Antonella Rosso
- Department of Medicine (DAME), School of Nursing, University of Udine, Udine, Italy
| | - Antonio Pedduzza
- Institute of Hygiene and Clinical Epidemiology, University Hospital of Udine, Udine, Italy
| | - Chiara Pilotto
- Division of Pediatrics, University Hospital of Udine, P.zzale S. Maria della Misericordia, 15. 33100, Udine, Italy
| | - Paola Cogo
- Division of Pediatrics, University Hospital of Udine, P.zzale S. Maria della Misericordia, 15. 33100, Udine, Italy
- Department of Medicine (DAME), University of Udine, Udine, Italy
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Huang Z, Natarajan K, Lim HC, Weng Y, Tan HY, Seow E, Peng LL, Ow JT, Kuan WS, Chow A. Applying Andersen's healthcare utilization model to assess factors influencing patients' expectations for diagnostic tests at emergency department visits during the COVID-19 pandemic. Front Public Health 2023; 11:1250658. [PMID: 38074705 PMCID: PMC10701756 DOI: 10.3389/fpubh.2023.1250658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 10/11/2023] [Indexed: 12/18/2023] Open
Abstract
Background The uncertainties surrounding the COVID-19 pandemic led to a surge in non-urgent emergency department (ED) attendance among people presenting with upper respiratory tract infection (URTI) symptoms. These non-urgent visits, often manageable in primary care, exacerbated ED overcrowding, which could compromise the quality of ED services. Understanding patients' expectations and the reasons for these ED visits is imperative to mitigate the problem of ED overcrowding. Hence, we assessed the factors influencing patients' expectations for diagnostic tests during their ED visits for uncomplicated URTI during different phases of the pandemic. Methods We conducted a cross-sectional study on adults with URTI symptoms seeking care at four public EDs in Singapore between March 2021 and March 2022. We segmented the study period into three COVID-19 pandemic phases-containment, transition, and mitigation. The outcome variables are whether patients expected (1) a COVID-19-specific diagnostic test, (2) a non-COVID-19-specific diagnostic test, (3) both COVID-19-specific and non-COVID-19-specific diagnostic tests, or (4) no diagnostic test. We built a multinomial regression model with backward stepwise selection and classified the findings according to Andersen's healthcare utilization model. Results The mean age of participants was 34.5 (12.7) years. Factors (adjusted odds ratio [95% confidence interval]) influencing expectations for a COVID-19-specific diagnostic test in the ED include younger age {21-40 years: (2.98 [1.04-8.55])}, no prior clinical consultation (2.10 [1.13-3.89]), adherence to employer's health policy (3.70 [1.79-7.67]), perceived non-severity of illness (2.50 [1.39-4.55]), being worried about contracting COVID-19 (2.29 [1.11-4.69]), and during the transition phase of the pandemic (2.29 [1.15-4.56]). Being non-employed influenced the expectation for non-COVID-19-specific diagnostic tests (3.83 [1.26-11.66]). Factors influencing expectations for both COVID-19-specific and non-COVID-19-specific tests include younger age {21-40 years: (3.61 [1.26-10.38]); 41-60 years: (4.49 [1.43-14.13])}, adherence to employer's health policy (2.94 [1.41-6.14]), being worried about contracting COVID-19 (2.95 [1.45- 5.99]), and during the transition (2.03 [1.02-4.06]) and mitigation (2.02 [1.03-3.97]) phases of the pandemic. Conclusion Patients' expectations for diagnostic tests during ED visits for uncomplicated URTI were dynamic across the COVID-19 pandemic phases. Expectations for COVID-19-specific diagnostic tests for ED visits for uncomplicated URTI were higher among younger individuals and those worried about contracting COVID-19 during the COVID-19 pandemic. Future studies are required to enhance public communications on the availability of diagnostic services in primary care and public education on self-management of emerging infectious diseases such as COVID-19.
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Affiliation(s)
- Zhilian Huang
- Infectious Diseases Research and Training Office, National Centre for Infectious Diseases, Singapore, Singapore
- Department of Preventive and Population Medicine, Office of Clinical Epidemiology, Analytics, and Knowledge [OCEAN], Tan Tock Seng Hospital, Singapore, Singapore
| | - Karthiga Natarajan
- Infectious Diseases Research and Training Office, National Centre for Infectious Diseases, Singapore, Singapore
- Department of Preventive and Population Medicine, Office of Clinical Epidemiology, Analytics, and Knowledge [OCEAN], Tan Tock Seng Hospital, Singapore, Singapore
| | - Hoon Chin Lim
- Department of Accident and Emergency, Changi General Hospital, Singapore, Singapore
| | - Yanyi Weng
- Department of Emergency Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - Hann Yee Tan
- Department of Acute and Emergency Care, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Eillyne Seow
- Department of Acute and Emergency Care, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Li Lee Peng
- Department of Emergency Medicine, National University Hospital, Singapore, Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jing Teng Ow
- Infectious Diseases Research and Training Office, National Centre for Infectious Diseases, Singapore, Singapore
- Department of Preventive and Population Medicine, Office of Clinical Epidemiology, Analytics, and Knowledge [OCEAN], Tan Tock Seng Hospital, Singapore, Singapore
| | - Win Sen Kuan
- Department of Emergency Medicine, National University Hospital, Singapore, Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Angela Chow
- Infectious Diseases Research and Training Office, National Centre for Infectious Diseases, Singapore, Singapore
- Department of Preventive and Population Medicine, Office of Clinical Epidemiology, Analytics, and Knowledge [OCEAN], Tan Tock Seng Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
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Montoro-Pérez N, Montejano-Lozoya R, Escribano S, Oliver-Roig A, Juliá-Sanchis R, Richart-Martínez M. Development and validation of a parental competence questionnaire in the paediatric hospital emergency setting (ECP-U). J Pediatr Nurs 2023; 73:e54-e64. [PMID: 37558568 DOI: 10.1016/j.pedn.2023.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 07/11/2023] [Accepted: 07/11/2023] [Indexed: 08/11/2023]
Abstract
OBJECTIVE To develop and validate a parental competence questionnaire for parents of children seeking care in hospital emergency departments. METHODS An instrumental study of the development of an assessment questionnaire was carried out in three phases: 1) review of relevant measures and item generation, 2) content validity evaluation, 3) psychometric evaluation. Exploratory factor analysis was performed to examine the factorial structure. Internal consistency was evaluated using ordinal alpha. Hypothesis testing was determined between the resulting factors, the Parental Stress Scale and the State-Trait Anxiety Inventory. RESULTS The participants were 270 parents of children aged 0-14 years old from a referral hospital in Valencia (Spain). An 18-item questionnaire was developed, comprising five factors that explain 53.0% of the variance: 1) "emotional management and expression", 2) "passive social support", 3) "parental agency", 4) "basic needs and care" and 5) "active social support". The internal consistency for the different factors was modest (>0.70). A negative correlation between the Parental Stress Scale and the parental competence questionnaire was found for most of the factors. CONCLUSIONS This questionnaire on parental competence in the hospital emergency department (ECP-U) is a useful and simple self-report instrument for assessing the parental competence of parents with children in the emergency department. PRACTICAL IMPLICATIONS The resulting questionnaire is of practical value to both healthcare professionals and researchers in this field. It can be administered quickly in clinical practice and used to identify parents' levels of parental competence and refer those with difficulties to appropriate support services.
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Affiliation(s)
- Néstor Montoro-Pérez
- Department of Nursing, Faculty of Health Sciences, Person-centred Care and Health Outcomes Innovation Group, University of Alicante, San Vicente del Raspeig, Spain; GREIACC research group, La Fe Health Research Institute, Valencia, Spain
| | | | - Silvia Escribano
- Department of Nursing, Faculty of Health Sciences, Person-centred Care and Health Outcomes Innovation Group, University of Alicante, San Vicente del Raspeig, Spain.
| | - Antonio Oliver-Roig
- Department of Nursing, Faculty of Health Sciences, Person-centred Care and Health Outcomes Innovation Group, University of Alicante, San Vicente del Raspeig, Spain
| | - Rocio Juliá-Sanchis
- Department of Nursing, Faculty of Health Sciences, Person-centred Care and Health Outcomes Innovation Group, University of Alicante, San Vicente del Raspeig, Spain
| | - Miguel Richart-Martínez
- Department of Nursing, Faculty of Health Sciences, Person-centred Care and Health Outcomes Innovation Group, University of Alicante, San Vicente del Raspeig, Spain
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Hörauf JA, Schindler CR, Mühlenfeld N, Zabel J, Störmann P, Marzi I, Söhling N, Verboket RD. Who, When, Why?-Traumatological Patients in the Emergency Department of a Maximum Care Provider. Life (Basel) 2023; 13:2046. [PMID: 37895428 PMCID: PMC10607953 DOI: 10.3390/life13102046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 09/28/2023] [Accepted: 10/10/2023] [Indexed: 10/29/2023] Open
Abstract
Nationwide, there is an annual increase in the number of patients in German emergency departments resulting in a growing workload for the entire emergency department staff. Several studies have investigated the situation in emergency departments, most of which were interdisciplinary, but there are no data on a solely traumatological patient population. The present study therefore aims to investigate the situation in a university-based trauma surgery emergency department. A total of 8582 traumatological patients attending a university hospital from 1 January 2019 to 31 December 2019 were studied. Various variables, such as reason for presentation, time of accident, diagnosis, and diagnostic as well as therapeutic measures performed were analyzed from the admission records created. The mean age was 36.2 years, 60.1% were male, 63.3% presented on their own to the emergency department, and 41.2% presented during regular working hours between 8:00 a.m. and 6:00 p.m., Monday through Friday. The most common reason for presentation was outdoor falls at 17.4%, and 63.3% presented to the emergency department within the first 12 h after the sustained trauma. The most common diagnosis was bruise (27.6%), and 14.2% of patients were admitted as inpatients. Many of the emergency room patients suffered no relevant trauma sequelae. In order to reduce the number of patients in emergency rooms in the future, existing institutions in the outpatient emergency sector must be further expanded and effectively advertised to the public. In this way, the emergency medical resources of clinics, including staff, can be relieved to provide the best possible care for actual emergency patients.
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Affiliation(s)
- Jason-Alexander Hörauf
- Department of Trauma, Hand and Reconstructive Surgery, Goethe University Frankfurt am Main, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; (C.R.S.); (N.M.); (J.Z.); (P.S.); (I.M.); (N.S.); (R.D.V.)
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Shaw V, Yu A, Parsons M, Olsen T, Walker C. Acute assessment services for patient flow assistance in hospital emergency departments. Cochrane Database Syst Rev 2023; 7:CD014553. [PMID: 37439227 PMCID: PMC10334694 DOI: 10.1002/14651858.cd014553.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
Abstract
BACKGROUND Emergency departments (EDs) are facing serious and significant issues in the delivery of effective and efficient care to patients. Acute assessment services have been implemented at many hospitals internationally to assist in maintaining patient flow for identified groups of patients attending the ED. Identifying the risks and benefits, and optimal configurations of these services may be beneficial to those wishing to utilise an acute assessment service to improve patient flow. OBJECTIVES To assess the effects of acute assessment services on patient flow following attendance at a hospital ED. SEARCH METHODS We searched MEDLINE, CENTRAL, Embase and two trials registers on 24 September 2022 to identify studies. No restrictions were imposed on publication year, publication type, or publication language. SELECTION CRITERIA Studies eligible for inclusion were randomised trials and cluster-randomised trials with at least two intervention and two control sites. Participants were adults (as defined by study authors) receiving care either in the ED or the acute assessment service, where both were based in the hospital setting. The comparison was hospital-based acute assessment services with usual, ED-only care. The outcomes of this review were mortality at time point closest to 30 days, length of stay in the service (in minutes), and waiting time to see a doctor (in minutes). DATA COLLECTION AND ANALYSIS We followed the standard procedures of Cochrane Effective Practice and Organisation of Care for this review (https://epoc.cochrane.org/resources). MAIN RESULTS We identified a total of 5754 records in the search. Following assessment of 3609 de-duplicated records, none were found to be eligible for inclusion in this review. AUTHORS' CONCLUSIONS At present there are no randomised controlled trials exploring the effects of acute assessment services on patient flow in hospital-based emergency departments compared to usual, ED-only care.
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Affiliation(s)
- Victoria Shaw
- Department of Nursing, Toi Ohomai Institute of Technology, Rotorua, New Zealand
| | - An Yu
- Infrastructure and investment, Te Whatu Ora, Wellington, New Zealand
| | - Matthew Parsons
- Faculty of Health, The University of Waikato, Hamilton, New Zealand
| | - Tava Olsen
- Melbourne Business School, The University of Melbourne, Melbourne, Australia
| | - Cameron Walker
- Engineering Science, The University of Auckland, Auckland, New Zealand
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Barnes K, Arpel C, Douglas K. Low agreement among patients and clinicians about urgency and safety to wait for assessment in primary care after hours medical care: results of cross-sectional matched surveys. BMC Health Serv Res 2023; 23:422. [PMID: 37131199 PMCID: PMC10152437 DOI: 10.1186/s12913-023-09399-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 04/13/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND Discordance between patient and clinician perceived urgency may drive "inappropriate" presentations to after-hours medical services. This paper investigates the level of agreement between patient and clinicians' perceptions of urgency and safety to wait for an assessment at after-hours primary care services in the ACT. METHODS Cross-sectional survey voluntarily completed by patients and then clinicians at after-hours medical services in May/June, 2019. Agreement between patients and clinicians is measured by Fleiss kappa. Agreement is presented overall, within specific categories of urgency and safety to wait, and by after-hours service type. RESULTS 888 matched records were available from the dataset. Overall inter-observer agreement between patients and clinicians on the urgency of presentations was slight (Fleiss kappa = 0.166; 95% CI 0.117-0.215, p < 0.001). Agreement within specific ratings of urgency ranged from very poor to fair. Overall inter-rater agreement on how long it would be safe to wait for assessment was fair (Fleiss kappa = 0.209; 95% CI 0.165-0.253, p < 0.001). Agreement within specific ratings ranged from poor to fair. By site type, agreement between patients and clinicians on urgency ranged from not significant to fair and agreement for safety to wait ranged from very poor to slight. Agreement on urgency of issue was more often reported among patients attending their usual health service or seeing their usual clinician compared to patients attending an unfamiliar health service or clinician (χ2(1) = 7.283, p = 0.007 and χ2(1) = 16.268, p < 0.001, respectively). CONCLUSIONS Low levels of agreement between patients and clinicians on perceived urgency and safety to wait for issues to be assessed indicate potential inefficiency in primary care use after-hours. Agreement on urgency of issues was more common among patients attending a familiar health service or familiar clinician. Improving health literacy, particularly health system literacy, and supporting continuity of care may help to support patients to engage with the most appropriate level of care at the most appropriate time.
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Affiliation(s)
- Katelyn Barnes
- Academic Unit of General Practice, Office of Professional Leadership and Education, ACT Health Directorate, Canberra, Australia.
- School of Medicine and Psychology, College of Health and Medicine, Australian National University, Canberra, Australia.
| | - Caitlin Arpel
- School of Medicine and Psychology, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Kirsty Douglas
- Academic Unit of General Practice, Office of Professional Leadership and Education, ACT Health Directorate, Canberra, Australia
- School of Medicine and Psychology, College of Health and Medicine, Australian National University, Canberra, Australia
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McIntyre A, Janzen S, Shepherd L, Kerr M, Booth R. An integrative review of adult patient-reported reasons for non-urgent use of the emergency department. BMC Nurs 2023; 22:85. [PMID: 36991388 DOI: 10.1186/s12912-023-01251-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 03/15/2023] [Indexed: 03/31/2023] Open
Abstract
OBJECTIVE To conduct an integrative review of the scientific literature to explore adult patient-reported reasons for using the emergency department (ED) non-urgently. METHOD A literature search of CINAHL, Cochrane, Embase, PsycINFO, and MEDLINE was conducted with filters for humans, published January 1, 1990-September 1, 2021, and English language. Methodological quality was assessed using Critical Appraisal Skills Programme Qualitative Checklist for qualitative and National Institutes Health (NIH) Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies for quantitative studies. Data was abstracted on study and sample characteristics, and themes/reasons for ED use. Cited reasons were coded using thematic analysis. RESULTS Ninety-three studies met inclusion criteria. Seven themes were found: need to be risk averse with respect to the health issue; knowledge and awareness of alternative sources of care; dissatisfaction with primary care provider; satisfaction with ED; ED accessibility and convenience resulting in low access burden; referred to the ED by others; and relationships between patients and health care providers. DISCUSSION This integrative review examined patient-reported reasons for attending the ED on a non-urgent basis. The results suggest that ED patients are heterogenous and many factors influence their decision-making. Considering the complexity with which patients live, treating them as a single entity may be problematic. Limiting excessive non-urgent visits likely requires a multi-pronged approach. CONCLUSION For many ED patients, they have a very clear problem which needed to be addressed. Future studies should explore psychosocial factors driving decision-making (e.g., health literacy, health-related personal beliefs, stress and coping ability).
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Affiliation(s)
- Amanda McIntyre
- Arthur Labatt Family School of Nursing, University of Western Ontario, London, Canada.
- Department of Emergency Medicine, University Hospital, London Health Sciences Centre, London, Canada.
| | | | - Lisa Shepherd
- Department of Emergency Medicine, University Hospital, London Health Sciences Centre, London, Canada
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, Canada
| | - Mickey Kerr
- Arthur Labatt Family School of Nursing, University of Western Ontario, London, Canada
| | - Richard Booth
- Arthur Labatt Family School of Nursing, University of Western Ontario, London, Canada
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Montoro-Pérez N, Richart-Martínez M, Montejano-Lozoya R. Factors associated with the inappropriate use of the pediatric emergency department. A systematic review. J Pediatr Nurs 2023; 69:38-46. [PMID: 36657264 DOI: 10.1016/j.pedn.2022.12.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 12/21/2022] [Accepted: 12/24/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND Pediatric emergency department (PED) admissions have risen in recent years, a trend not justified by the severity of the pathologies presented. The aim of this study is to analyse factors related to the inappropriate use of pediatric emergency departments. METHODS This is a systematic review reported in accordance with the PRISMA statement. We searched the PubMed, Web of Science and Science Direct databases, using keywords extracted from MeSH, and conducted a reverse search using Google Scholar and Open Grey, for the period January 2017 to August 2022. The quality of the papers was assessed using STROBE, CASPe, AMSTAR-2, GRADE, Levels Of Evidence and Grades Of Recommendation. RESULTS A total of 20 studies were selected. Factors related to inappropriate use included the younger age of children, black caregivers, lower socioeconomic status, lower parental educational attainment, perceived urgent demand for care, parental emotions in response to their children's health problems, psychological distress, the ineffective exercise of the parental role, the advantages of the PED and the nature of health insurance. CONCLUSIONS AND IMPLICATIONS The results illustrate the heterogeneous nature of the phenomenon under investigation. Gaining an understanding of the factors related to the inappropriate demand of PEDs, from the perspective of health professionals, can help in developing interventions to reduce unnecessary consultations and relieve pressure on these healthcare services.
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Affiliation(s)
- Néstor Montoro-Pérez
- Department of Nursing, Faculty of Health Science, University of Alicante, Spain; GREIACC Research Group, La Fe Health Research Institute, Valencia, Spain.
| | | | - Raimunda Montejano-Lozoya
- "La Fe" School of Nursing, Affiliated centre of the University of Valencia, Spain; GREIACC Research Group, La Fe Health Research Institute, Valencia, Spain.
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11
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Takeuchi S, Minami M, Asabe Y, Miyauchi M, Suganuma N, Nishiyama K. Impact of school closures on pediatric ambulance transport in Japan. Pediatr Int 2023; 65:e15427. [PMID: 36445005 DOI: 10.1111/ped.15427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 11/01/2022] [Accepted: 11/28/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND After the coronavirus disease (COVID-19) pandemic, nationwide school closures were implemented in many countries. This study aimed to determine the impact of the school closures on pediatric ambulance transport, comparing the situation before and after the COVID-19 pandemic. METHODS This retrospective observational study was conducted using data from the Kochi-Iryo.net database. In Kochi prefecture, schools were closed from March 6 to May 24, 2020. Pediatric emergency transport during the school closure period in 2020 was compared with that in the same period in 2019 (before the COVID-19 pandemic) and in 2021 (when schools were not closed). Statistical analysis comprised χ2 tests with Bonferroni adjustments for multiple testing. To adjust for patient backgrounds, we also performed multiple logistic regression analyses for numbers of pediatric ambulance transports. RESULTS The rate of pediatric ambulance transports was significantly lower (p = 0.008) in 2020 (276; 3.97%) than in 2019 (391; 4.87%), but there was no significant difference (p = 0.360) between 2019 (391; 4.87%) and 2021 (352; 4.56%). Multivariable analysis revealed similar trends (2019 vs. 2020: OR 0.86, 95% CI 0.73-1.00; 2019 vs. 2021: OR 0.96, 95% CI 0.82-1.11). Regarding the characteristics of pediatric ambulance transport journeys, there were no significant differences in 2019, 2020, and 2021 in terms of sex, severity, locations of ambulance stations, and disease classification. CONCLUSIONS There was a decrease in pediatric ambulance transportation due to the public health interventions for COVID-19, including school closures. However, this decrease was not solely due to school closures.
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Affiliation(s)
- Shinya Takeuchi
- Department of Disaster and Emergency Medicine, Kochi Medical School, Nankoku, Kochi, Japan
| | - Marina Minami
- Integrated Center for Advanced Medical Technologies, Kochi Medical School, Nankoku, Kochi, Japan
| | - Yuina Asabe
- Department of Environmental Medicine, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Masato Miyauchi
- Department of Disaster and Emergency Medicine, Kochi Medical School, Nankoku, Kochi, Japan
| | - Narufumi Suganuma
- Integrated Center for Advanced Medical Technologies, Kochi Medical School, Nankoku, Kochi, Japan
| | - Kingo Nishiyama
- Department of Disaster and Emergency Medicine, Kochi Medical School, Nankoku, Kochi, Japan
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12
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Meysman J, Morreel S, Lefevere E, Verhoeven V, De Graeve D, Monsieurs KG, Philips H. Triaging and referring in adjacent general and emergency departments (the TRIAGE-trial): A process evaluation of medical staff experiences in a nurse-led triage system. Int Emerg Nurs 2022; 63:101191. [PMID: 35810679 DOI: 10.1016/j.ienj.2022.101191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 05/23/2022] [Accepted: 06/04/2022] [Indexed: 11/26/2022]
Abstract
AIMS This process evaluation aims at identifying the facilitators and inhibitors that influenced the successful uptake of a nurse-led triage system streaming low-risk patients from an emergency department (ED) to the general practitioner (GP). DESIGN & METHODS Semi-structured interviews with ED nurses (n = 12), ED doctors (n = 6) from the ED of a Belgian general hospital and GPs (n = 5) affiliated with the adjacent GP cooperative (GPC). The process evaluation ran in parallel with the TRIAGE trial that started in March 2019 and ended 31st of December 2019. The first set of interviews was conducted in June 2019 and the second set in January 2020. Data were analysed based on grounded theory. RESULTS Through a deductive framework, facilitators and inhibitors could be identified on three levels: the organisational, group and individual level. Main inhibitors are the degree of risk aversion of individual nurses, possible language barriers during delivery of the triage advice and the non-adapted ED infrastructure. Training on both the use of the triage protocol and effective delivery of the triage advice, in combination with periodical feedback from the GPC were the most important facilitators. CONCLUSION Based on the process evaluation we can conclude that a consensus exists among stakeholders that the ED Nurses are considered ideally positioned to perform the triage of walk-in patients, although a certain degree of experience is necessary. Although the extended triage protocol and GPC referral increases the complexity and duration of triage and entails a higher workload for the triage nurses, ED nurses found it did lead to a lower (perceived) workload for the ED in general.
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Affiliation(s)
- Jasmine Meysman
- Faculty of Business and Economics, University of Antwerp, Prinsstraat 13, 2000 Antwerp, Belgium.
| | - Stefan Morreel
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium
| | - Eva Lefevere
- Faculty of Business and Economics, University of Antwerp, Prinsstraat 13, 2000 Antwerp, Belgium
| | - Veronique Verhoeven
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium
| | - Diana De Graeve
- Faculty of Business and Economics, University of Antwerp, Prinsstraat 13, 2000 Antwerp, Belgium
| | - Koenraad G Monsieurs
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium; Department of emergency medicine, Antwerp University Hospital, University of Antwerp, Belgium
| | - Hilde Philips
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium
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13
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Ridge A, Peterson GM, Seidel BM, Anderson V, Nash R. Rural Patients' Perceptions of Their Potentially Preventable Hospitalisation: A Qualitative Study. J Patient Exp 2022; 9:23743735211069825. [PMID: 35005222 PMCID: PMC8733360 DOI: 10.1177/23743735211069825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Potentially preventable hospitalisations (PPHs) occur when patients receive hospital care for a condition that could have been more appropriately managed in the primary healthcare setting. It is anticipated that the causes of PPHs in rural populations may differ from those in urban populations; however, this is understudied. Semi-structured interviews with 10 rural Australian patients enabled them to describe their recent PPH experience. Reflexive thematic analysis was used to identify the common factors that may have led to their PPH. The analysis revealed that most participants had challenges associated with their health and its optimal self-management. Self-referral to hospital with the belief that this was the only treatment option available was also common. Most participants had limited social networks to call on in times of need or ill health. Finally, difficulty in accessing primary healthcare, especially urgently or after-hours, was described as a frequent cause of PPH. These qualitative accounts revealed that patients describe nonclinical risk factors as contributing to their recent PPH and reinforces that the views of patients should be included when designing interventions to reduce PPHs.
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Affiliation(s)
- Andrew Ridge
- School of Pharmacy and Pharmacology, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia.,Huon Valley Health Centre, Huonville, Tasmania, Australia
| | - Gregory M Peterson
- School of Pharmacy and Pharmacology, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Bastian M Seidel
- Huon Valley Health Centre, Huonville, Tasmania, Australia.,School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Vinah Anderson
- School of Health Sciences, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Rosie Nash
- School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
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Almulhim N, Almulhim F, Al Gharash A, Alghannam Z, Al-Ghamdi RS, Alghamdi MH, Alghareeb AH, Alabdulrahman AY. Preference for Visiting Emergency Department Over Primary Health Care Center Among Population in Saudi Arabia. Cureus 2021; 13:e20073. [PMID: 34900498 PMCID: PMC8648185 DOI: 10.7759/cureus.20073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction Demand for urgent care is increasing, and the pressure on emergency departments (EDs) is of significant concern. Demand growth is to some extent due to the over-utilization of EDs by patients who seek care for non-urgent problems. It has been estimated that up to one-third of all ED visits are non-emergent. In EDs, patients with non-urgent problems are blamed for increased demand, even though most of the patients’ reasons for attending EDs are not well studied. The aim of this study is primarily to determine the factors that influence the decision of patients to visit EDs instead of their primary care physician for non-urgent problems. Secondary aim of this study is to assess the level of ED knowledge among the participants. Methods This is a descriptive, cross-sectional study following a convenient sampling technique conducted through an online questionnaire distributed to the population in Saudi Arabia (SA). The data, which includes sociodemographic data, ER knowledge, the correct definition of ED, cases that ED deals with, and reasons for visiting an ED over a primary health care center (PHC), were collected during August and September 2021. Results Of the 915 respondents, the most common age group was 25 years old or less (34.4%) and the majority were females (68.3%). It was observed that slightly more respondents preferred to visit a PHC (50.4%) while 49.6% preferred to visit EDs when having a medical condition. The proportion of respondents who would visit a PHC was 90.9%, and 36.6% indicated having good experiences there. The overall mean knowledge score was 4.63 (standard deviation [SD] 1.51) out of 6 points, with low, moderate, and high knowledge classified among 12.9%, 22.4%, and 64.7% of respondents, respectively. The five most reported reasons for choosing the ER as the preferred clinic over a PHC were: (1) ED provided quick medical care, (2) easy access to emergency care, (3) unavailability of appointments at a PHC center on the same day, (4) lack of full investigation at the PHC center, (5) lack of primary care providers at the PHC. The least reported reason was advice from another person to visit the emergency department. It was found that a significantly low knowledge was demonstrated by the over 45-years age group (p <0.001) and those who were unemployed (p = 0.018). Conclusion This study showed that 49.6% would prefer to visit the ED. It demonstrated the reasons for choosing the ED over a PHC, with the most reported reason being that the ED provides quick medical service, while the least reported reason was advice from another person to visit the ED. For the correct utilization of EDs, it is recommended to increase the knowledge and awareness level of the general population through public campaigns and awareness videos on social media applications.
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15
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Toloo GS, Lim D, Chu K, Kinnear FB, Morel DG, Wraith D, FitzGerald G. Acceptability of emergency department triage nurse's advice for patients to attend general practice: A cross-sectional survey. Emerg Med Australas 2021; 34:376-384. [PMID: 34788904 DOI: 10.1111/1742-6723.13903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 10/26/2021] [Accepted: 10/26/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Demand for ED care is increasing at a rate higher than population growth. Strategies to attenuate ED demands include diverting low-acuity general practice-type ED attendees to alternate primary healthcare settings. The present study assessed the ED attendees' receptiveness to accept triage nurse's face-to-face advice to explore alternate options for medical care and what factors influence the level of acceptance. METHODS The ED attendees of four major public hospital EDs in Brisbane were surveyed between August and October 2018, using a questionnaire informed by Health Belief Model's cues to action. RESULTS Of the 514 valid responses, 81% of respondents were very likely/likely to accept the triage nurse's advice to see a general practitioner. Self-perceived urgency of presenting condition/s (odds ratio [OR] 0.87, 95% confidence interval [CI] 0.78-0.97), not having confidence in general practitioner (OR 0.37, 95% CI 0.21-0.66) and having a medical record at the hospital (OR 0.60, 95% CI 0.36-0.99) were negatively associated with the likelihood of accepting the advice. For every point increase in perceived seriousness, the odds of accepting the advice decreased by 16% (95% CI 6-25%). CONCLUSION Most of the participants believed that EDs were for emergent care and they attended the ED because they perceived their presenting condition/s to be serious and/or urgent. The acceptability of face-to-face advice by triage nurse to seek help in general practice was influenced by perceived threats of the illness, and the underlying beliefs about availability, accessibility, suitability and affordability of the service.
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Affiliation(s)
- Ghasem Sam Toloo
- School of Public Health and Social Work, Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - David Lim
- School of Health Sciences, Western Sydney University, Sydney, New South Wales, Australia.,College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Kevin Chu
- Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Frances B Kinnear
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Department of Emergency Medicine and Children's Service, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Douglas G Morel
- Emergency Department, Redcliffe Hospital, Brisbane, Queensland, Australia
| | - Darren Wraith
- School of Public Health and Social Work, Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Gerry FitzGerald
- School of Public Health and Social Work, Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Queensland, Australia
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16
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Proctor A, Baxter H, Booker MJ. What factors are associated with ambulance use for non-emergency problems in children? A systematic mapping review and qualitative synthesis. BMJ Open 2021; 11:e049443. [PMID: 34588248 PMCID: PMC8480005 DOI: 10.1136/bmjopen-2021-049443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To explore what factors are associated with ambulance use for non-emergency problems in children. METHODS This study is a systematic mapping review and qualitative synthesis of published journal articles and grey literature. Searches were conducted on the following databases, for articles published between January 1980 and July 2020: MEDLINE, EMBASE, PsycINFO, CINAHL and AMED. A Google Scholar and a Web of Science search were undertaken to identify reports or proceedings not indexed in the above. Book chapters and theses were searched via the OpenSigle, EThOS and DART databases. A literature advisory group, including experts in the field, were contacted for relevant grey literature and unpublished reports. The inclusion criteria incorporated articles published in the English language reporting findings for the reasons behind why there are so many calls to the ambulance service for non-urgent problems in children. Data extraction was divided into two stages: extraction of data to generate a broad systematic literature 'map', and extraction of data from highly relevant papers using qualitative methods to undertake a focused qualitative synthesis. An initial table of themes associated with reasons for non-emergency calls to the ambulance for children formed the 'thematic map' element. The uniting feature running through all of the identified themes was the determination of 'inappropriateness' or 'appropriateness' of an ambulance call out, which was then adopted as the concept of focus for our qualitative synthesis. RESULTS There were 27 articles used in the systematic mapping review and 17 in the qualitative synthesis stage of the review. Four themes were developed in the systematic mapping stage: socioeconomic status/geographical location, practical reasons, fear of consequences and parental education. Three analytical themes were developed in the qualitative synthesis stage including practicalities and logistics of obtaining care, arbitrary scoring system and retrospection. CONCLUSIONS There is a lack of public and caregiver understanding about the use of ambulances for paediatrics. There are factors that appear specific to choosing ambulance care for children that are not so prominent in adults (fever, reassurance, fear of consequences). Future areas for attention to decrease ambulance activation for paediatric low-acuity reports were highlighted as: identifying strategies for helping caregivers to mitigate perceived risk, increasing availability of primary care, targeted education to particular geographical areas, education to first-time parents with infants and providing alternate means of transportation. PROSPERO REGISTRATION NUMBER CRD42019160395.
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Affiliation(s)
- Alyesha Proctor
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK
| | - Helen Baxter
- Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
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Biagioli V, Pol A, Gawronski O, Carlin C, Cirulli L, Piga S, Stelitano R, Offidani C, Raucci U, Reale A, Tiozzo E, Villani A, Dall'Oglio I. Pediatric patients accessing Accident and Emergency Department (A&E) for non-urgent treatment: Why do parents take their children to the A&E? Int Emerg Nurs 2021; 58:101053. [PMID: 34520965 DOI: 10.1016/j.ienj.2021.101053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 06/04/2021] [Accepted: 07/20/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION About 20-30% of children access the Pediatric Accident and Emergency Department (A&E) for non-urgent health care that should normally follow other health care paths. This study aimed to investigate why parents take their children to the A&E for non-urgent visits rather than using primary care services. METHODS A one-year cross-sectional study was conducted in a large pediatric A&E in Italy. A paper-and-pencil 40-item questionnaire was administered to parents of children aged between 3 months to 6 years who accessed the A&E for non-urgent visits between July 2018 and June 2019. RESULTS Parents of 238 children completed the questionnaire (mean age = 2.6 years; male 58%). The most common symptoms were fever (n = 105; 44.1%) and skin rash (n = 63; 26.5%); symptoms usually started more than 24 h earlier (n = 163; 69.4%). Reasons for accessing the A&E for non-urgent visits included the availability of rapid medical tests (n = 71; 29.8%), deterioration of the clinical conditions after the pediatrician's visit (n = 67; 28.2%), and the perceived need for urgent care (n = 65; 27.3%). Besides, 26.6% (n = 63) of parents reported not being able to contact their pediatrician before accessing A&E. CONCLUSION Parents may need further education to distinguish between urgent and non-urgent pediatric health conditions.
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Affiliation(s)
- Valentina Biagioli
- Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
| | - Alessandra Pol
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
| | - Orsola Gawronski
- Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
| | - Claudia Carlin
- Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
| | - Luisa Cirulli
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
| | - Simone Piga
- Bachelor for Pediatric Nursing, Sapienza University of Rome, Italy.
| | - Rocco Stelitano
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
| | - Caterina Offidani
- Paediatric Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
| | - Umberto Raucci
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
| | - Antonino Reale
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
| | - Emanuela Tiozzo
- Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
| | - Alberto Villani
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
| | - Immacolata Dall'Oglio
- Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
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O Loughlin M, Mills J, McDermott R, Harriss LR. Exploring the measure of potentially avoidable general practitioner-type presentations to the emergency department in regional Queensland using linked, patient-perspective data. AUST HEALTH REV 2021; 45:90-96. [PMID: 33121590 DOI: 10.1071/ah19210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 05/12/2020] [Indexed: 11/23/2022]
Abstract
Objective To explore measures of potentially avoidable general practitioner (PAGP)-type presentations to the emergency department (ED) of a large regional hospital in northern Queensland. Methods Linkage of an ED administrative dataset to a face-to-face patient survey of local residents (n=1000); calculation of Australian Institute of Health and Welfare (AIHW) and Australasian College of Emergency Medicine (ACEM) measures of PAGP-type presentations to the ED; and exploration of these measures with patient-perspective linked data. Results PAGP-type presenters to the ED were younger in age (median age in years: total cohort: 49; AIHW 38, P<0.001; ACEM 36, P<0.001); with the odds of having a chronic condition being less likely for AIHW PAGP-type presenters than other ED presenters (OR (95% CI) 0.54 (0.38-0.77): P=0.001)) after adjustment for age. PAGP-type presenters nominated reasons of convenience rather than urgency as their rationale for attending the ED, irrespective of measure. The number of PAGP-type presentations to the ED identified by the AIHW measure was more than three-fold higher than the ACEM measure (AIHW: n=227; ACEM: n=67). Influencing factors include the low proportion of ED attendees who had a medical consultation time of <1h at this hospital site (1-month survey period: 17.8%); and differences between the patient self-report and ED administrative record for 'self-referral to the ED' (Self-referred: Survey 71% vs EDIS 93%, P<0.001). Conclusions Identification of PAGP-type presentations to the ED could be enhanced with improvements to the quality of administrative processes when recording patient 'self-referral to the ED', along with further consideration of hospital site variation for the length of medical consultation time. What is known about the topic? PAGP-type presentations to the ED are an Australian National Healthcare Agreement progress indicator. Methods of measuring this indicator have been under review since 2012 and debate remains on how to accurately determine the measure. What does this paper add? By using patient perspective-linked data to explore different measures of PAGP-type presentations to EDs, this paper identifies issues with measure elements and suggests ways to improve these measures. What are the implications for practitioners? Measure elements of patient 'self-referral to the ED' and 'medical consultation time' require further consideration if they are to be used to measure PAGP-type presentations to the ED.
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Affiliation(s)
- Mary O Loughlin
- Australian Institute of Tropical Health and Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, PO Box 6811, Cairns, Qld 4870, Australia. ; ; and Corresponding author.
| | - Jane Mills
- La Trobe Rural Health School, Bendigo Campus, Edwards Road, Flora Hill, Bendigo , Vic. 3552.
| | - Robyn McDermott
- Australian Institute of Tropical Health and Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, PO Box 6811, Cairns, Qld 4870, Australia. ; ; and School of Health Sciences, University of South Australia, GPO Box 2471, Adelaide, SA 5001, Australia
| | - Linton R Harriss
- Australian Institute of Tropical Health and Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, PO Box 6811, Cairns, Qld 4870, Australia. ;
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Long J, Knowles E, Bishop-Edwards L, O'Cathain A. Understanding young adults' reasons for seeking 'clinically unnecessary' urgent and emergency care: A qualitative interview study. Health Expect 2021; 24:1535-1544. [PMID: 34118177 PMCID: PMC8369113 DOI: 10.1111/hex.13301] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 05/03/2021] [Accepted: 05/27/2021] [Indexed: 01/15/2023] Open
Abstract
Background Studies have identified young adults as more likely to use emergency departments for ‘clinically unnecessary’ problems, with limited similar evidence for emergency ambulance use. Media portrayals depict young adults as motivated by ‘convenience’, but little research has explored the reasons for their help‐seeking behaviour. Methods Qualitative interviews with 16 young adults (18‐30) considered by clinicians to have made unnecessary use of emergency ambulance, emergency department or an urgent GP appointment. Data analysis was informed by interpretive phenomenological analysis. Findings A number of interrelated factors contributed to participants’ decisions. They were anxious about the seriousness of their symptoms, sometimes exacerbated by reduced coping capacity due to poor mental health or life stresses. They looked to others to facilitate their decision making, who sometimes encouraged urgent contact. They wanted to avoid impact on existing day‐to‐day commitments including work or study. They had strong views about different health services, sometimes based on frustration with lack of resolution of on‐going health problems. Convenience was not identified as a significant factor, although some actions could be interpreted in this light if the context was not considered. Conclusions Young adults make ‘clinically unnecessary’ use of urgent and emergency care for more than convenience. Their decisions need to be understood in relation to the complexity of their experience, including lack of confidence in making health‐related decisions, lowered coping capacity and concern to maintain normal daily life.
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Affiliation(s)
- Jaqui Long
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Emma Knowles
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | | | - Alicia O'Cathain
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
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20
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Abdelhadi A. The Effects on the Number of Patients Visiting the Emergency Units: Comparison Study Before and During COVID-19 Pandemic in Saudi Arabia. J Multidiscip Healthc 2021; 14:1207-1211. [PMID: 34079279 PMCID: PMC8166328 DOI: 10.2147/jmdh.s314191] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 05/10/2021] [Indexed: 01/09/2023] Open
Abstract
Background The number of patients attending emergency departments (EDs) fell dramatically in 2020, during the COVID-19 pandemic, compared with similar periods in 2019 or 2018, and healthcare providers have had to adjust to this change. The aim of this study was to compare the number and type of patients attending a hospital emergency unit before and during the COVID-19 pandemic in order to avoid the impact of any difference on the community’s healthcare and on healthcare providers. Methods This study assessed differences in the numbers of patients attending the emergency department in 2018, 2019 and 2020, and then determined whether a particular patient type accounted for any such difference. An open-source data repository was accessed to collect the data targeting a private hospital in Riyadh city, the capital of Saudi Arabia. Descriptive statistics and a paired t-test were used to verify the level of variations in the number of patients attending the emergency rooms. Results Results showed no statistically significant difference in the number of patients attending the emergency department between 2018 and 2019, while a noticeable drop was found in the number of patients attending the department between 2019 and 2020. Conclusion The reduction in the number of patients attending the emergency department was found in some but not all patient types. These conclusion highlight variations in ED attendance of which hospital management should be aware so that action can be taken to avoid negative consequences.
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Affiliation(s)
- Abdelhakim Abdelhadi
- Engineering Management Department, Prince Sultan University, Riyadh, Saudi Arabia
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21
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Dalton MK, Andriotti T, Matsas B, Chaudhary MA, Tilley L, Lipsitz S, Learn PA, Schoenfeld AJ, Jarman MP, Goralnick E. Emergency Department Utilization in the U.S. Military Health System. Mil Med 2021; 186:606-612. [PMID: 33331640 DOI: 10.1093/milmed/usaa547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 11/16/2020] [Accepted: 12/02/2020] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Emergency department (ED) utilization represents an expensive and growing means of accessing care for a variety of conditions. Prior studies have characterized ED utilization in the general population. We aim to identify the clinical conditions that drive ED utilization in a universally insured population and the impacts of care setting on ED use and admissions in the U.S. Military Health System. METHODS We queried TRICARE claims data from October 1, 2012, to September 30, 2015, to identify all ED visits for adult patients (age 18-64). The primary presenting diagnoses of all ED visits and those leading to admission are presented with descriptive statistics. Logistic regression was used to identify clinical and sociodemographic factors associated with admission from the ED. RESULTS A total of 4,687,205 ED visits were identified, of which 46% took place in the DoD healthcare facilities (direct care). The most common diagnoses across all ED visits were abdominal pain, chest pain, headache, nausea and vomiting, and urinary tract infection. A total of 270,127 (5.8%) ED visits led to inpatient admission. The most common diagnoses leading to admission were chest pain, abdominal pain, depression, conditions relating to acute psychological stress, and pneumonia. For patients presenting with 1 of the 10 most common ED diagnoses, those who were seen at a civilian ED were significantly less likely to be admitted (3.4%) compared to direct care facilities (4.1%) in an adjusted logistic regression model (Adjusted Odds Ratio 0.40 [95% CI: 0.40-0.41], P < .001). CONCLUSIONS Ultimately, we show that abdominal pain and chest pain are the most common reasons for presentation to the ED in the Military Health System and the most common presenting diagnoses for admission from the ED. Among patients presenting with the most common ED conditions, direct care EDs were significantly more likely to admit patients than civilian facilities.
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Affiliation(s)
- Michael K Dalton
- Center for Surgery and Public Health, Harvard Medical School, Harvard T. H. Chan School of Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, MA 02120, USA
| | - Tomas Andriotti
- Center for Surgery and Public Health, Harvard Medical School, Harvard T. H. Chan School of Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, MA 02120, USA
| | | | - Muhammad Ali Chaudhary
- Center for Surgery and Public Health, Harvard Medical School, Harvard T. H. Chan School of Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, MA 02120, USA
| | - Laura Tilley
- F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Stuart Lipsitz
- Center for Surgery and Public Health, Harvard Medical School, Harvard T. H. Chan School of Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, MA 02120, USA.,Division of General Internal Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA
| | - Peter A Learn
- F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Andrew J Schoenfeld
- Center for Surgery and Public Health, Harvard Medical School, Harvard T. H. Chan School of Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, MA 02120, USA
| | - Molly P Jarman
- Center for Surgery and Public Health, Harvard Medical School, Harvard T. H. Chan School of Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, MA 02120, USA
| | - Eric Goralnick
- Center for Surgery and Public Health, Harvard Medical School, Harvard T. H. Chan School of Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, MA 02120, USA.,Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA
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22
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Saggers A, Wand BM, Bulsara C, Truter P. 'I'm not in GP pain, I'm in hospital pain': Qualitative study regarding patient decision-making factors in seeking care in the emergency department with non-specific low back pain. Emerg Med Australas 2021; 33:1013-1020. [PMID: 33960124 DOI: 10.1111/1742-6723.13792] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 04/14/2021] [Accepted: 04/15/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate factors contributing to the decision for a working age adult experiencing non-specific low back pain (NSLBP) to seek care at an Australian metropolitan tertiary ED. METHODS Participants triaged with NSLBP were recruited from one metropolitan tertiary Australian ED. We employed a qualitative descriptive methodology using semi-structured interviews to collect data. The short-form Orebro musculoskeletal pain screening questionnaire was administered pre-interview and used to inform discussion of psychosocial factors in the interview. RESULTS Patient perception and interpretation of their low back pain symptoms was the most important participant decision-making factor. This was part of the care-seeking decision for all participants. Convenience of care accessed in the ED was also important with many participants aiming to avoid multiple appointments in primary care settings while in pain or attending ED because it was close to home. Participants expected high-quality care in the ED and often did not identify an alternative in primary care they believed could provide an equivalent standard of care. Few participants were advised to attend ED by a GP or physiotherapist, but when given, this advice was a critical factor. CONCLUSIONS Patient beliefs about NSLBP are important drivers of ED care seeking. Evidence-based guidelines recommend screening for red flags and then addressing pain and disability through engagement with patient concerns and providing a management plan/pathway. In the ED setting, addressing the anxieties of these patients and re-interpreting the significance of their pain may be a path to providing time efficient high-value care.
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Affiliation(s)
- Annabel Saggers
- School of Physiotherapy, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Benedict M Wand
- School of Physiotherapy, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Caroline Bulsara
- School of Nursing, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Piers Truter
- School of Physiotherapy, The University of Notre Dame Australia, Fremantle, Western Australia, Australia.,Emergency Department, Fiona Stanley Hospital, Perth, Western Australia, Australia
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23
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Shaw VM, Yu A, Parsons M, Olsen T, Walker C. Acute assessment services for patient flow assistance in hospital emergency departments. Hippokratia 2021. [DOI: 10.1002/14651858.cd014553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Victoria M Shaw
- School of Nursing; The University of Auckland; Auckland New Zealand
| | - An Yu
- School of Nursing; The University of Auckland; Auckland New Zealand
| | - Matthew Parsons
- Faculty of Health; The University of Waikato; Hamilton New Zealand
| | - Tava Olsen
- Information Systems and Operations Management; The University of Auckland; Auckland New Zealand
| | - Cameron Walker
- Engineering Science; The University of Auckland; Auckland New Zealand
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24
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Reasons for patients with non-urgent conditions attending the emergency department in Kenya: A qualitative study. Afr J Emerg Med 2021; 11:113-117. [PMID: 33680731 PMCID: PMC7910189 DOI: 10.1016/j.afjem.2020.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 07/05/2020] [Accepted: 09/04/2020] [Indexed: 10/25/2022] Open
Abstract
INTRODUCTION Scant literature exists on the non-urgent use of emergency departments in Sub-Saharan Africa and its effects on the provision of effective emergency care services. With the surge in the prevalence of non-communicable diseases compounded by an already prevailing significant problem of communicable diseases and injuries in this setting, there has been a rising demand for emergency care services. This has led to ED overcrowding, increased healthcare costs, extended waiting periods and overstretched essential services. The main objective of this study was to determine why patients visit the ED for non-urgent care. METHODS A descriptive qualitative study was conducted at a tertiary university hospital ED in Nairobi, Kenya. Purposive sampling was used to select patients triaged as less urgent or non-urgent. In-depth interviews were conducted until thematic saturation was achieved. The interviews were audio recorded, transcribed verbatim and analyzed thematically. RESULTS Thematic saturation was reached after interviewing twenty-four patients. The obtained data was discussed under three main themes: (1) reasons why patients visited the ED for non-urgent care, (2) patients understanding of the roles of the ED, and (3) patients' perceptions about the urgency of their medical conditions. Several factors were identified as contributing to the non-urgent use of the ED including positive experiences during past visits, a perception of availability of better services and the closure of other departments after office-hours and on weekends. It was found that non-urgent ED visits occurred despite most patients having an understanding of the role of the ED as an appropriate location for the treatment of patients with life threatening conditions. CONCLUSION This study highlights several reasons why patients with non-urgent medical conditions seek care in the ED despite being able to correctly identify its purpose within the national emergency care framework. Regular patient education regarding which conditions warrant ED attendance and alternative sites of care for non-urgent conditions could potentially help reduce ED patient numbers.
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25
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Truter P, Edgar D, Mountain D, Bulsara C. An emergency department optimized protocol for qualitative research to investigate care seeking by patients with non-urgent conditions. Nurs Open 2021; 8:628-635. [PMID: 33570278 PMCID: PMC7877135 DOI: 10.1002/nop2.667] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 09/09/2020] [Accepted: 10/02/2020] [Indexed: 11/11/2022] Open
Abstract
AIM To describe a tailored qualitative research methodology for exploring the complex interaction of factors driving non-urgent care seeking in the emergency department. DESIGN Qualitative descriptive design with a literature informed semi-structured interview and analysis structure. Triangulation with the State-Trait Anxiety Inventory allows expedited exploration of biopsychosocial factors. Consolidated criteria for reporting qualitative research requirements integrated. METHODS With a short 10- to 15-min interview and a low-inference analysis process, this methodology offers a structured way to explore the "go to ED" decision, to understand the patient perspective on their healthcare needs and feed into the development of suitable local services that meet patient healthcare needs. RESULTS This methodology offers a structured way for clinician-researchers to explore the factors that influence patients seeking care in the emergency departments for non-urgent conditions that are specific to their local health service environment. The described methodology is accessible to novice qualitative researchers and includes the semi-structured interview, coding and analysis frameworks.
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Affiliation(s)
- Piers Truter
- School of PhysiotherapyUniversity of Notre Dame AustraliaFremantleWAAustralia
- Emergency DepartmentFiona Stanley HospitalMurdochWAAustralia
- SJOG Midland Public and Private HospitalMidlandWAAustralia
| | - Dale Edgar
- School of PhysiotherapyUniversity of Notre Dame AustraliaFremantleWAAustralia
- Fiona Wood FoundationPerthWAAustralia
| | - David Mountain
- Emergency DepartmentSir Charles Gairdner HospitalNedlandsWAAustralia
- University of Western AustraliaNedlandsWAAustralia
| | - Caroline Bulsara
- School of Nursing and MidwiferyUniversity of Notre Dame AustraliaFremantleWAAustralia
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26
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Kok MR, Tuson M, Yap M, Turlach B, Boruff B, Vickery A, Whyatt D. Impact of the modifiable areal unit problem in assessing determinants of emergency department demand. Emerg Med Australas 2021; 33:794-802. [PMID: 33517585 DOI: 10.1111/1742-6723.13727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 12/22/2020] [Accepted: 01/01/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To examine the impact of the modifiable areal unit problem (MAUP) in an investigation of factors associated with ED demand in Perth, Western Australia, in 2016. Furthermore, to advocate a means of avoiding this impact. METHODS ED presentations were classified as: urgent medical, non-urgent medical, urgent trauma or non-urgent trauma. In each group, sex-stratified, age-adjusted multivariate associations with socio-economic status and distance to the nearest ED and general practitioner (GP) were estimated. Modelling was undertaken using different sets of spatial units: Australian Bureau of Statistics (ABS) Statistical Areas Level 1 (SA1s) and numerous aggregate-level zonations of SA1s (ABS SA2s and others). RESULTS Estimates obtained using the different units often varied widely: for seven (30%) of 24 strata defined by combinations of sex, ED type and covariate, the smallest and largest effect sizes differed in terms of direction; further, for 11 (65%) of the remaining 17 strata, the largest effect size was at least twice as high as the smallest. This demonstrates the MAUP's impact and that analyses based on a single set of spatial units are unreliable. To resolve the observed variation, we highlight the SA1-level estimates. CONCLUSIONS When formulating interventions targeting reduced ED utilisation, policy planners should be guided by evidence based on analysis of appropriate spatial units. This ideal is undermined by the widespread lack of acknowledgement of the MAUP in studies examining drivers of ED demand using spatially aggregated data. To avoid the MAUP, only estimates obtained through examining a minimal geographic unit should be relied upon.
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Affiliation(s)
- Mei Ruu Kok
- Division of General Practice, Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Matthew Tuson
- Division of General Practice, Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia.,Department of Mathematics and Statistics, Faculty of Engineering and Mathematical Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Matthew Yap
- Division of General Practice, Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Berwin Turlach
- Department of Mathematics and Statistics, Faculty of Engineering and Mathematical Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Bryan Boruff
- Department of Geography, Faculty of Arts, Business, Law and Education, The University of Western Australia, Perth, Western Australia, Australia.,UWA School of Agriculture and Environment, Faculty of Science, The University of Western Australia, Perth, Western Australia, Australia
| | - Alistair Vickery
- Division of General Practice, Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - David Whyatt
- Division of General Practice, Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
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27
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Pak A, Gannon B. Do access, quality and cost of general practice affect emergency department use? Health Policy 2021; 125:504-511. [PMID: 33546911 DOI: 10.1016/j.healthpol.2021.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 01/17/2021] [Accepted: 01/20/2021] [Indexed: 11/28/2022]
Abstract
Limited access, poor experience, and high out-of-pocket (OOP) costs of primary care services may lead to avoidable emergency department (ED) presentations. But, the evidence has been limited with most of the studies using surveys conducted in EDs. Using detailed health survey data of Australian women linked to multiple administrative datasets, we extend the literature by estimating the effects of access, costs, and experience of general practice (GP) services on the probability of ED attendance while accounting for a large set of health and socioeconomic covariates. Our findings suggest that improvements in access to primary care services can significantly reduce the demand for low acuity ED presentations. We also show that the impact of increased accessibility of GP services is expected to be the highest for socioeconomic vulnerable populations and patients whose access is the poorest. This evidence can be useful for the design of targeted policies aimed at improving access to doctors in particular areas that are socioeconomically disadvantaged and where medical skill shortages are significant. However, policies aimed at reduction in primary care OOP costs or improvement in the perception of GP quality are less likely to be effective in reducing the number of non-urgent ED presentations.
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Affiliation(s)
- Anton Pak
- James Cook University, Australian Institute of Tropical Health and Medicine, Australia; The University of Queensland, School of Economics, Australia.
| | - Brenda Gannon
- The University of Queensland, School of Economics, Australia; The University of Queensland, Centre for the Business and Economics of Health, Australia.
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28
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Explaining variation in health information seeking behaviour - Insights from a multilingual survey. Health Policy 2021; 125:618-626. [PMID: 33579562 DOI: 10.1016/j.healthpol.2021.01.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 01/04/2021] [Accepted: 01/19/2021] [Indexed: 12/28/2022]
Abstract
OBJECTIVE How best to provide an increasingly diverse population with health information has become a major concern for health policy makers in Europe and beyond. Our study aims to investigate factors explaining variation in people's health information seeking behaviour. Our findings can be used to identify target groups for policy interventions that aim to provide health information efficiently. METHODS Cross-sectional, paper-based, multilingual survey of a random sample of enrolees of two statutory health insurers in Hamburg, Germany. Data were collected from September to December 2017. Multivariable logistic regression was used to examine sociodemographic and health-related individual characteristics and their associations with participants' choice of ten sources of health information. FINDINGS Participants' choice of information sources differed significantly across the following sociodemographic and health-related characteristics: age, gender, immigration status, education, employment status, marital status and general state of health. Immigrants and individuals with low educational attainment were most likely to use emergency departments as sources of health information. CONCLUSION Policy interventions aiming to manage the use of health information sources should focus on immigrants and individuals with low educational attainment. Providing multilingual, low-threshold counselling and information services could be an efficient way to reduce short-term costs of health information seeking behaviour to health insurers or other payers of care while improving patient empowerment.
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Copson B, Wijewickrema S, Sorace L, Jones R, O'Leary S. Development of a virtual reality clinically oriented temporal bone anatomy module with randomised control study of three-dimensional display technology. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2020; 7:352-359. [DOI: 10.1136/bmjstel-2020-000592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/26/2020] [Indexed: 11/03/2022]
Abstract
ObjectiveTo investigate the effectiveness of a virtual reality (VR), three-dimensional (3D) clinically orientated temporal bone anatomy module, including an assessment of different display technologies.MethodsA clinically orientated, procedural and interactive anatomy module was generated from a micro-CT of a cadaveric temporal bone. The module was given in three different display technologies; 2D, 3D with monoscopic vision, and 3D with stereoscopic vision. A randomised control trial assessed the knowledge acquisition and attitudes of 47 medical students though a pretutorial and post-tutorial questionnaire. The questionnaire included questions identifying anatomic structures as well as understanding structural relations and clinical relevance. Furthermore, a five-point Likert scale assessed the students’ attitudes to the module and alternative learning outcomes, such as interest in otology and preparedness for clinical rotations.ResultsAs a whole cohort, the total test score improved significantly, with a large effect size (p≤0.005, Cohen’s d=1.41). The 23 students who returned the retention questionnaire had a significant improvement in total test score compared with their pretutorial score, with a large effect size (p≤0.005, Cohen’s d=0.83). Display technology did not influence the majority of learning outcomes, with the exception of 3D technologies, showing a significantly improvement in understanding of clinical relevance and structural relations (p=0.034). Students preferred 3D technologies for ease of use, perceived effectiveness and willingness to use again.ConclusionsThe developed VR temporal bone anatomy tutor was an effective self-directed education tool. 3D technology remains valuable in facilitating spatial learning and superior user satisfaction.
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Akbayram HT, Coskun E. Paediatric emergency department visits for non-urgent conditions: Can family medicine prevent this? Eur J Gen Pract 2020; 26:134-139. [PMID: 33025832 PMCID: PMC7580770 DOI: 10.1080/13814788.2020.1825676] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background In Turkey, family physicians serve only during office hours, while emergency services have 7/24 free access. Non-urgent patients commonly use Paediatric Emergency departments (PEDs). In Turkey, there is little evidence as to why emergency services are used instead of family medicine for non-urgent paediatric healthcare. Objectives To evaluate the causes and factors affecting non-urgent PED visits. To determine the reason for non-use of family medicine for non-urgent paediatric healthcare. Methods We conducted a cross-sectional study at Gaziantep University PED between April and May 2019. We administered a questionnaire to the parents of children (from one month to 16 years) triaged to non-urgent (level-5) using a 5-level triage system. Results A total of 457 parents were surveyed. The average patient age was 6.5 ± 4.7 years and 24.5% had a chronic disease. One-third of the parents (33.7%) considered their children’s condition ‘very urgent’. The most important reason for preferring PED (42.5%) instead of family physician or alternative health facilities was the thought that the condition of children would worsen. Two hundred fifty-three (55.4%) of the patients presented outside working hours. Although 58.9% of parents were satisfied with the family physician, most (67.8%) stated that they preferred other specialists rather than family physicians when the child had health problems. Fathers who were primary school graduates were more likely to prefer other specialists than family physicians. Conclusion Parents’ perception of urgency and the thought that their child’s condition will worsen are the main reasons for non-urgent using PED.
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Affiliation(s)
- Hatice Tuba Akbayram
- Department of Family Medicine, Gaziantep University Faculty of Medicine, Gaziantep, Turkey
| | - Enes Coskun
- Department of Pediatrics, Gaziantep University Faculty of Medicine, Gaziantep, Turkey
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Holzinger F, Oslislo S, Möckel M, Schenk L, Pigorsch M, Heintze C. Self-referred walk-in patients in the emergency department - who and why? Consultation determinants in a multicenter study of respiratory patients in Berlin, Germany. BMC Health Serv Res 2020; 20:848. [PMID: 32912185 PMCID: PMC7481545 DOI: 10.1186/s12913-020-05689-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 08/26/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Emergency department (ED) consultations are on the rise, and frequently consultations by non-urgent patients have been held accountable. Self-referred walk-in (SRW) consulters supposedly represent a predominantly less urgent patient population. The EMACROSS study aimed to explore consultation determinants and motives in SRW patients with respiratory symptoms. METHODS Multicenter survey of adult ED patients with respiratory complaints in eight emergency departments in central Berlin, Germany. Secondary hospital records data including diagnoses was additionally assessed. Characteristics of SRW and non-SRW patients were compared. Determinants of SRW consultation were evaluated by binary logistic regression. Consultation motives were analyzed descriptively. As a supplemental approach, network analysis (lasso-regularized mixed graphical model) was performed to explore connections between consultation determinants, consultation features and motives. RESULTS Between June 2017 and November 2018, n = 472 participants were included, the median age was 55 years (range 18-96), 53.2% of patients were male and n = 185 cases (39.2%) were SRW consulters. The SRW group showed lower proportions of potentially severe (pneumonia and respiratory failure, p < 0.001, χ2 test) and chronic pulmonary conditions. Determinants of SRW consultation identified by logistic regression were younger age (p < 0.001), tertiary education (p = 0.032), being a first-generation migrant (p = 0.002) or tourist (p = 0.008), having no regular primary care provider (p = 0.036) and no chronic pulmonary illness (p = 0.017). The area under the curve (AUC) for the model was 0.79. Personal distress and access problems in ambulatory care were stated most frequently as consultation motives in the SRW group; network analysis showed the scarcity of associations between demographic and medical SRW determinants and motives triggering the actual decision to consult. CONCLUSIONS As to "who" consults, this study identified demographic and medical predictors of SRW utilization. The said markers seem only remotely connected to "why" people decide for SRW visits. To alleviate ED crowding by addressing frequent SRW consultation motives, interventions focused on the ability for symptom self-assessment and at better-accessible alternative care seem sensible. TRIAL REGISTRATION German Clinical Trials Register ( DRKS00011930 ); date: 2017/04/25.
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Affiliation(s)
- Felix Holzinger
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of General Practice, Charitéplatz 1, 10117, Berlin, Germany.
| | - Sarah Oslislo
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of General Practice, Charitéplatz 1, 10117, Berlin, Germany
| | - Martin Möckel
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Division of Emergency Medicine, Berlin, Germany
- The College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia
| | - Liane Schenk
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Medical Sociology and Rehabilitation Science, Berlin, Germany
| | - Mareen Pigorsch
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Biometry and Clinical Epidemiology, Berlin, Germany
| | - Christoph Heintze
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of General Practice, Charitéplatz 1, 10117, Berlin, Germany
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Leite H. The impact of non-urgent patients in emergency departments' operations. INTERNATIONAL JOURNAL OF QUALITY & RELIABILITY MANAGEMENT 2020. [DOI: 10.1108/ijqrm-01-2020-0016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeGlobally, the presence of non-urgent patients in emergency departments (EDs) is considered one of the main reasons for creating excessive waiting times and overcrowding in units. This paper aims to understand the impact of non-urgent patients in EDs' operations.Design/methodology/approachThis study is based on qualitative case studies conducted within two Brazilian EDs, and uses interviews and observations to access the data.FindingsFrom a thematic analysis, three key themes emerged: characteristics of non-urgent demands in EDs, negative aspects of non-urgent patients in EDs, and the impact of the healthcare system model on EDs. These themes bring to light the impact that non-urgent patients have in EDs' operations, and provide theoretical and practical implications.Research limitations/implicationsThe limitation of this work is bound by the understanding of the non-urgent demands in EDs. Therefore, a benchmarking approach (investigating state-of-the-art practices to avoid such impact) was not applied but was suggested for future research instead.Practical implicationsThe research provides significant contributions to practitioners and policymakers, aiding future discussions to improve healthcare coverage and performance.Social implicationsThe research provides significant contributions for managers and policymakers, aiding future discussions to improve healthcare. For instance, the use of well-known techniques (e.g. lean, six sigma) are discussed and suggested to enhance healthcare capacity and performance. Furthermore, the policymakers are called upon to evaluate the healthcare access and provide regulations that involve innovative approaches to widen healthcare access.Originality/valueBased upon empirical data, this research extends the discussions related to non-urgent patient in EDs and is not limited merely to descriptive analysis, but by providing practical propositions and discussions related to the impact of these patients' presence in EDs' operations. Finally, the research provides a range of suggestions for future research related to the EDs' operational performance.
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El-Masri M, Bornais J, Omar A, Crawley J. Predictors of Nonurgent Emergency Visits at a Midsize Community-Based Hospital System: Secondary Analysis of Administrative Health Care Data. J Emerg Nurs 2020; 46:478-487. [DOI: 10.1016/j.jen.2020.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 01/31/2020] [Accepted: 02/01/2020] [Indexed: 12/01/2022]
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Impact of Advanced Practice Prehospital Programs on Health Care Costs and ED Overcrowding: A Literature Review. Adv Emerg Nurs J 2020; 42:128-136. [PMID: 32358429 DOI: 10.1097/tme.0000000000000291] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Health care costs in the United States continue to increase, requiring solutions that permit safe, quality care with a lower financial investment. Utilization of the emergency department for nonemergent care is considered to be one of the costliest, and most preventable methods of health care delivery. This review seeks to demonstrate how advanced practice prehospital programs can potentially decrease the cost of health care without sacrificing quality or safety. Utilization of the emergency department for nonemergent care contributes to the escalating cost of health care as well as to emergency department overcrowding. Advanced practice prehospital programs are a novel approach to potentially decreasing health care costs and emergency department overcrowding. This review introduces the current state of health care costs, emergency department overcrowding, and advanced practice prehospital programs. Further research is needed to determine the actual fiscal impact of these programs.
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Viotti S, Cortese CG, Garlasco J, Rainero E, Emelurumonye IN, Passi S, Boraso F, Gianino MM. The Buffering Effect of Humanity of Care in the Relationship between Patient Satisfaction and Waiting Time: A Cross-sectional Study in an Emergency Department. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17082939. [PMID: 32344530 PMCID: PMC7216114 DOI: 10.3390/ijerph17082939] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 04/20/2020] [Accepted: 04/21/2020] [Indexed: 11/28/2022]
Abstract
This study aims to examine whether humanity of care and environmental comfort played a role in moderating the relationship between waiting time and patient satisfaction in an emergency department (ED). The study used a cross-sectional and non-randomized design. A total of 260 ED patients in two hospitals in Italy completed a self-report questionnaire. Moderated regression showed that after adjusting for control variables, waiting time was significantly and inversely associated with patient satisfaction. Humanity of care and environmental comfort showed a positive and significant association with patient satisfaction. Finally, the interaction term between waiting time and humanity of care was found to be significant, whereas the interaction effect between waiting time and environmental comfort was not significant. The conditional effect showed that when humanity of care was low, waiting time was negatively and significantly related to patient satisfaction. By contrast, when humanity of care was medium and high, the relationship between waiting time and patient satisfaction was not significant. These findings shed light on the key role of humanity of care in moderating the relationship between waiting time and patient satisfaction. The complex interrelations emerged should be carefully considered when interventions to foster patient satisfaction in an ED context are planned.
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Affiliation(s)
- Sara Viotti
- Dipartimento di Psicologia, Università degli Studi di Torino, 10124 Torino, Italy;
| | - Claudio Giovanni Cortese
- Dipartimento di Psicologia, Università degli Studi di Torino, 10124 Torino, Italy;
- Correspondence:
| | - Jacopo Garlasco
- Dipartimento di Scienze della Sanità Pubblica e Pediatriche, Università degli Studi di Torino, 10126 Torino, Italy; (J.G.); (E.R.); (I.N.E.); (M.M.G.)
| | - Erika Rainero
- Dipartimento di Scienze della Sanità Pubblica e Pediatriche, Università degli Studi di Torino, 10126 Torino, Italy; (J.G.); (E.R.); (I.N.E.); (M.M.G.)
| | - Ifeoma Nneka Emelurumonye
- Dipartimento di Scienze della Sanità Pubblica e Pediatriche, Università degli Studi di Torino, 10126 Torino, Italy; (J.G.); (E.R.); (I.N.E.); (M.M.G.)
| | - Stefano Passi
- Azienda Sanitaria Locale Torino 3 (ASL TO3), Italy; (S.P.); (F.B.)
| | - Flavio Boraso
- Azienda Sanitaria Locale Torino 3 (ASL TO3), Italy; (S.P.); (F.B.)
| | - Maria Michela Gianino
- Dipartimento di Scienze della Sanità Pubblica e Pediatriche, Università degli Studi di Torino, 10126 Torino, Italy; (J.G.); (E.R.); (I.N.E.); (M.M.G.)
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Klingberg K, Stoller A, Müller M, Jegerlehner S, Brown AD, Exadaktylos A, Jachmann A, Srivastava D. Asylum Seekers and Swiss Nationals with Low-Acuity Complaints: Disparities in the Perceived level of Urgency, Health Literacy and Ability to Communicate-A Cross-Sectional Survey at a Tertiary Emergency Department. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17082769. [PMID: 32316445 PMCID: PMC7215914 DOI: 10.3390/ijerph17082769] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 04/15/2020] [Accepted: 04/16/2020] [Indexed: 12/28/2022]
Abstract
Background: Emergency departments (EDs) are being increasingly used for low-acuity conditions and as primary care providers. Research indicates that patients with the status of asylum seeker (AS) may be seeking care in EDs at higher levels than nationals. The aim of this study was to identify disparities in the use of emergency care between AS and Swiss nationals (SN) with non-urgent complaints. Methods: Data were obtained from a survey in the period 01/12/2016–31/07/2017 of walk-in low-acuity patients attending the ED of the University Hospital Bern (Switzerland). AS and a gender, age-matched control group of SN of ≥16 years of age were included. Sociodemographic and survey data comprised information about health-seeking behavior in the home and reception country, knowledge of health care systems (HCSs), barriers to care and perceived acuity of the visit. Furthermore, attending physicians assessed the level of urgency of each case. Results: Among AS patients, 30.2% reported that they had no knowledge of the Swiss HCS. In total, 14.2% considered that their medical needs were non-urgent. On the other hand, 43.4% of the attending physicians in the ER considered that the medical needs were non-urgent. This contrast was less pronounced in SN patients. The majority of AS (63.2%) and SN (67.6%) patients sought care from the ED without first contacting a GP. In 53.8% of cases, an interpreter was needed during the ED consultation. Conclusions: Several factors associated with health-seeking behavior in the ED differed between AS and SN patients. Measures to increase health literacy, provision of easily accessible primary care services and intercultural-trained staff could improve quality of care and reduce the usage of EDs as primary care providers.
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Affiliation(s)
- Karsten Klingberg
- Emergency Department, University Hospital Bern, 3010 Bern, Switzerland; (K.K.); (A.S.); (M.M.); (S.J.); (A.E.); (A.J.)
| | - Adrian Stoller
- Emergency Department, University Hospital Bern, 3010 Bern, Switzerland; (K.K.); (A.S.); (M.M.); (S.J.); (A.E.); (A.J.)
| | - Martin Müller
- Emergency Department, University Hospital Bern, 3010 Bern, Switzerland; (K.K.); (A.S.); (M.M.); (S.J.); (A.E.); (A.J.)
| | - Sabrina Jegerlehner
- Emergency Department, University Hospital Bern, 3010 Bern, Switzerland; (K.K.); (A.S.); (M.M.); (S.J.); (A.E.); (A.J.)
- Accident & Emergency, Barts Health NHS Trust, London EC1A 7BE, UK
| | - Adam D. Brown
- Department of Psychology, New School of Social Research, New York, NY 10011, USA;
| | - Aristomenis Exadaktylos
- Emergency Department, University Hospital Bern, 3010 Bern, Switzerland; (K.K.); (A.S.); (M.M.); (S.J.); (A.E.); (A.J.)
| | - Anne Jachmann
- Emergency Department, University Hospital Bern, 3010 Bern, Switzerland; (K.K.); (A.S.); (M.M.); (S.J.); (A.E.); (A.J.)
| | - David Srivastava
- Emergency Department, University Hospital Bern, 3010 Bern, Switzerland; (K.K.); (A.S.); (M.M.); (S.J.); (A.E.); (A.J.)
- Correspondence:
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Socioeconomic disadvantage as a driver of non-urgent emergency department presentations: A retrospective data analysis. PLoS One 2020; 15:e0231429. [PMID: 32282818 PMCID: PMC7153867 DOI: 10.1371/journal.pone.0231429] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 03/23/2020] [Indexed: 12/01/2022] Open
Abstract
Background Globally, emergency departments (EDs) are struggling to meet the service demands of their local communities. Across Australia, EDs routinely collect data for every presentation which is used to determine the ability of EDs to meet key performance indicators. This data can also be used to provide an overall picture of service demand and has been used by healthcare planners to identify local needs and inform service provision, thus, using ED presentations as a microcosm of the communities they serve. The aim of this study was to use ED presentation data to identify who, when and why people accessed a regional Australian ED with non-urgent conditions. Method and materials A retrospective data analysis of routinely collected ED data was undertaken. This included data obtained over a seven-year period (July 2009 to June 2016) in comparison with the Australian Bureau of Statistics census data. Analysis included descriptive statistics to identify the profile of non-urgent attendees and linear regression to identify trends in ED usage. Results This study revealed a consistently high demand for ED services by people with non-urgent conditions (54.1% of all presentations). People living in the most disadvantaged socioeconomic decile contributed to 36.8% of these non-urgent presentations while those under 25 years of age contributed to 41.1%. Diagnoses of mental health and behavioural issues and of non-specific symptoms significantly increased over the study period (p < 0.001) for both diagnostic groups. Conclusion The over-representation by those from the most socioeconomically disadvantaged areas highlights an inequity in access to services. The over-representation by those younger in age indicates behavioural patterns based on age. These key issues faced by our local community and the disparity in current service provision will be used to inform future health policy and service planning.
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Jiang L, Ye L, Dai M, Zhou J, Li Q. Use Andersen's behavior model to explain non-urgent visits in emergency department: A single center study in southwest China. Int Emerg Nurs 2020; 52:100845. [PMID: 32205107 DOI: 10.1016/j.ienj.2020.100845] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 11/26/2019] [Accepted: 01/13/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Non-urgent ED visit was an important contributor of emergency overcrowding. Previous studies showed that patients make non-urgent ED visits for many reasons and their ED use patterns may be influenced by many factors. However, seldom studies were theory-based research aimed to offer a systemic insight regarding this question. METHODS This was a cross-sectional study conducted in the ED of a tertiary hospital in China guided by Andersen's behavior model of health service use. Patients triaged as non-urgent were surveyed using a self-administrated questionnaire to investigate the reasons for ED presentation and associated factors influenced their ED use patterns. RESULTS Perceived severity of illness and urgent treatment need (374, 68.6%), accessible problems to alternative services (144, 26.4%) and referral by medical staffs (134, 24.6%) were most commonly reported reasons for ED presentation. Alternative service attempt before ED presentation was determined by two predisposing factors: education level (OR = 0.638, P < 0.05) and use of nearest medical institution (OR = 1.588, P < 0.05). Prior non-urgent ED use was explained by both predisposing and need factors. They were: nationality (OR = 3.057, P < 0.01), type of health problems (OR = 1.641, P < 0.01) and self-rated health status (OR = 0.769, P < 0.01). CONCLUSION Patients' perceived need of emergency care played an extremely important role in driving ED use although several factors were identified. Future studies aim to decrease non-urgent ED use in China may firstly gain success from patient education programs.
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Affiliation(s)
- Lingjun Jiang
- Department of Emergency Medicine/Institute of Disaster Medicine, West China Hospital, Sichuan University, China; West China School of Nursing, West China Hospital, Sichuan University, China
| | - Lei Ye
- Department of Emergency Medicine/Institute of Disaster Medicine, West China Hospital, Sichuan University, China.
| | - Min Dai
- Department of Emergency Medicine/Institute of Disaster Medicine, West China Hospital, Sichuan University, China
| | - Jing Zhou
- Department of Emergency Medicine/Institute of Disaster Medicine, West China Hospital, Sichuan University, China
| | - Qin Li
- Department of Emergency Medicine/Institute of Disaster Medicine, West China Hospital, Sichuan University, China
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Experiences of nurses working in a triage area: An integrative review. Aust Crit Care 2020; 33:567-575. [PMID: 32143883 DOI: 10.1016/j.aucc.2020.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 01/19/2020] [Accepted: 01/19/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES The aim of the study is to review the literature on the experiences of nurses working in triage within emergency departments in hospitals. REVIEW METHOD This is an integrative review based on Cooper's five-stage framework. DATA SOURCES Primary research articles published from January 2008 to January 2018 were identified from seven databases: PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Cochrane, ProQuest, and Scopus. A manual search of the end references from the published studies was also conducted to ensure a comprehensive search. REVIEW METHOD The included studies were evaluated independently by two authors based on the Joanna Briggs Institute appraisal checklist for Interpretive and Critical Research and Descriptive/Case Series to ensure methodological rigour and validity of the review. RESULTS The literature review included 35 articles; of which, 18 were qualitative studies, 13 were quantitative studies, and four were mixed-method studies. The findings from this review were categorised into three themes: (1) making judgement, (2) service delivery, and (3) effective communication. CONCLUSIONS The results from the review suggest that triage is a complex process involving decision-making and interprofessional communication. Nurses need to make judgement, consider factors affecting service delivery, and engage in effective communication, which is central to triaging. Decision-making is contextual and requires judicious judgement. Effective communication with fellow healthcare personnel and with patients and their caregivers is paramount to optimise care delivery. Finally, more support is needed to empower the nurses to cope with the work involved in triaging.
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Rehan SM, Morris DS, Pedlar L, Sheen N, Shirodkar AL. Ophthalmic emergencies presenting to the emergency department at the University Hospital of Wales, Cardiff, UK. Clin Exp Optom 2020; 103:895-901. [PMID: 32066198 DOI: 10.1111/cxo.13050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 01/07/2020] [Accepted: 01/08/2020] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Community-based optometry services are increasingly used as a primary resource for patients with acute eye problems. The Eye Health Examination Wales (EHEW) is an example of one such established scheme. The aim of the project was to show how the aforementioned pathway has affected the presentation of ocular conditions to a general emergency department and the eye casualty department at the same hospital. METHODS Clinical data were collected prospectively over a one-month period. The records of 100 consecutive patients with ocular pathology presenting to a general emergency department were analysed. Numbers were also obtained for the number of patients seen under the EHEW scheme by community optometrists for the same period. The notes of patients referred to ophthalmology or back out to the community optometry scheme were followed to monitor for re-attendance in either setting. RESULTS Eighty-five per cent of patients were walk-in cases. The most common diagnosis made in the emergency department was 'no abnormality found' in 37 per cent. Eighty per cent of all conditions were discharged from the emergency department. Fifteen per cent of all cases, mainly foreign body-related, were followed up in the emergency eye clinic and 10 per cent were sent to EHEW for follow-up. No cases re-presented to a hospital service at a later date. CONCLUSION At least 37 per cent of emergency department cases could have been potentially avoided had the patient presented to the EHEW scheme. The pathway for patients to be sent from the emergency department to an EHEW optometrist does not appear to delay presentation to an ophthalmologist thereafter. Further promotion of the EHEW service is needed to change patient behaviours and reduce avoidable attendance to overstretched emergency departments.
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Affiliation(s)
- Shahzaib M Rehan
- Ophthalmology Department, University Hospital of Wales, Cardiff, UK
| | - Daniel S Morris
- Ophthalmology Department, University Hospital of Wales, Cardiff, UK
| | - Lee Pedlar
- Ophthalmology Department, University Hospital of Wales, Cardiff, UK
| | - Nik Sheen
- School of Optometry and Vision Sciences, Cardiff University, Cardiff, UK
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Bahadori M, Mousavi SM, Teymourzadeh E, Ravangard R. Non-urgent visits to emergency departments: a qualitative study in Iran exploring causes, consequences and solutions. BMJ Open 2020; 10:e028257. [PMID: 32051293 PMCID: PMC7045103 DOI: 10.1136/bmjopen-2018-028257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE To explore the causes and consequences of non-urgent visits to emergency departments in Iran and then suggest solutions from the healthcare providers' viewpoint. DESIGN Qualitative descriptive study with in-depth, open-ended, and semistructured interviews, which were inductively analysed using qualitative content analysis. SETTING A territorial, educational and military hospital in Iran. PARTICIPANTS Eleven healthcare providers including eight nurses, two emergency medicine specialists and one emergency medicine resident. RESULTS Three overarching themes of causes and consequences of non-urgent visits to the emergency department in addition to four suggested solutions were identified. The causes have encompassed the specialised services in emergency department, demand-side factors, and supply-side factors. The consequences have been categorised into three overarching themes including the negative consequences on patients, healthcare providers and emergency departments as well as the health system in general. The possible solutions for limiting and controlling non-urgent visits also involved regulatory plans, awareness-raising plans, reforms in payment mechanisms, and organisational arrangements. CONCLUSION We highlighted the need for special attention to the appropriate use of emergency departments in Iran as a middle-income country. According to the complex nature of emergency departments and in order to control and prevent non-urgent visits, it can be suggested that policy-makers should design and implement a combination of the possible solutions.
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Affiliation(s)
- Mohammadkarim Bahadori
- Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
- Research Center for Prevention of Oral and Dental Diseases, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Seyyed Meysam Mousavi
- Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Ehsan Teymourzadeh
- Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Ramin Ravangard
- Health Human Resources Research Center, School of Management and Medical Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
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Yazaki H, Nishiura H. Ambulance Transport of Patients with Mild Conditions in Hokkaido, Japan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17030919. [PMID: 32024234 PMCID: PMC7037900 DOI: 10.3390/ijerph17030919] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 01/25/2020] [Accepted: 02/01/2020] [Indexed: 11/16/2022]
Abstract
Understanding the epidemiological distributions of ambulance transport for patients with mild conditions according to age, disease, and geographic region could help in achieving optimal use of ambulance services. In the present study, we explored the descriptive epidemiology of ambulance transports in Hokkaido, the northernmost prefecture of Japan, identifying potential factors that determine the frequency of transports for mild diseases. Of the total 153,667 ambulance transports in Hokkaido during 2016, we found that two-thirds were for older people, of which about 60% resulted in hospital admission. There were 74,485 transports for mild cases, which were most commonly for psychiatric disorders among working-age adults (n = 4805), heart diseases among older people (n = 4246), and sensory organ diseases among older people (n = 3589). Examining the ecological correlations over 58 geographic units of ambulance services, the total unemployment rate and distance to the nearest tertiary care hospital were, respectively, positively and negatively correlated with the standardized transport ratio for multiple mild diseases. The proportion of working-age adults was uniquely identified as a possible positive predictor in mild cases of psychiatric disorders. As the identified potential predictors could be helpful in considering countermeasures, the causal links should be examined in future studies.
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Affiliation(s)
- Hiroshi Yazaki
- Graduate School of Medicine, Hokkaido University, Kita 15-Jo Nishi 7-Chome, Kita-ku, Sapporo-shi, Hokkaido 060-8638, Japan
- Hosanna Family Clinic, Miyanosawa 3 Jo 3-6-1, Nishiku, Sapporo 0630053, Japan
| | - Hiroshi Nishiura
- Graduate School of Medicine, Hokkaido University, Kita 15-Jo Nishi 7-Chome, Kita-ku, Sapporo-shi, Hokkaido 060-8638, Japan
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Succi MD, Yun BJ, Rao S, Rao S, Gottumukkala RV, Glover M, White BA, Lev MH, Raja AS, Prabhakar AM. Turning around cancer: Oncology imaging and implications for emergency department radiology workflow. Am J Emerg Med 2020; 38:317-320. [DOI: 10.1016/j.ajem.2019.158435] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 09/05/2019] [Accepted: 09/09/2019] [Indexed: 12/21/2022] Open
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Frank C, Elmqvist C. Staff strategies for dealing with care situations at an emergency department. Scand J Caring Sci 2019; 34:1038-1044. [PMID: 31865626 DOI: 10.1111/scs.12812] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 11/28/2019] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Overcrowding is a common international problem at Emergency Departments often due to those patients get recommendations or referrals from other health professionals to seek care at the emergency department. Crowding brings with it an amount of adverse consequences for both patients and staff, and knowledge about staff's strategies of dealing with this caring situation is limited. AIM The aim of the present study was thus to describe staffs' strategies to deal with the caring situations at an emergency department. METHOD Secondary analysis has been made of 18 qualitative interviews grounded in a lifeworld perspective. The interviews were analysed by qualitative content analysis. FINDINGS The results showed that the staff at the ED worked in twofold directions using both proactive and reactive strategies in order to deal with the care situation when caring for patients at ED. The proactive strategy is optimising conditions, controlling patient flow and being boundary. The reactive strategy is about customising the conversation and holding an open approach. CONCLUSION In conclusion, the proactive strategy is to make what you decided for unseen circumstances. The reactive strategy is then about less anticipation of the encounter, waiting for the patient to act and react to it. IMPLICATION The result can have implications with respect to developing and improving care at crowded Emergency departments. Knowledge about strategies creates a fundament for developing visible sustainable structure for patient flow in making work patient safety for patients, staff and organisation.
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Affiliation(s)
- Catharina Frank
- Centre of Interprofessional Cooperation and Coordination within Emergency Care (CICE), Department of Health and Caring Sciences, Linneaus University, Växjö, Sweden
| | - Carina Elmqvist
- Centre of Interprofessional Cooperation and Coordination within Emergency Care (CICE), Department of Health and Caring Sciences, Linneaus University, Växjö, Sweden
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Alhabdan N, Alhusain F, Alharbi A, Alsadhan M, Hakami M, Masuadi E. Exploring emergency department visits: factors influencing individuals' decisions, knowledge of triage systems and waiting times, and experiences during visits to a tertiary hospital in Saudi Arabia. Int J Emerg Med 2019; 12:35. [PMID: 31752662 PMCID: PMC6868738 DOI: 10.1186/s12245-019-0254-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 10/29/2019] [Indexed: 11/10/2022] Open
Abstract
Background In recent years, there has been an increased utilization of emergency departments (EDs) in many countries. Additionally, it is reported that there are major delays in delivering care to ED patients. Longer waiting times are associated with poor patient satisfaction, whereas an understanding of the triage process increases satisfaction. This study aimed to assess ED visitor’s awareness of the triage procedure and their preferences regarding delayed communication. Methods Cross-sectional study of King Abdulaziz Medical City – Emergency Department visitors using a previously validated questionnaire (Seibert 2014) which was translated to Arabic, piloted, and then used for this study. Results A total of 334 questionnaires were returned. The mean age of respondents was 33 years. Regarding primary care physicians, only 16% of respondents said that they have one. About 21% of those tried to communicate with them before coming to the ED. Even though only 11% of respondents knew exactly what triage is, 51% were able to correctly explain why some patients are seen before others. Statistical analysis did not show any factors that are associated with increased knowledge of triage. Most respondents (75%) want to hear updates regarding delays with 69% of them preferring to be updated every 30 min. Conclusions This study showed that the majority of patients do not know what triage means and that most of them want to know how the ED works. Moreover, a lot of respondents said that they do not have a primary care physician. These results support increasing patient awareness by education and involving them if any delay happens.
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Affiliation(s)
- Nawaf Alhabdan
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Faisal Alhusain
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia. .,Department of Emergency Medicine, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia.
| | - Abdulkareem Alharbi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Muatassem Alsadhan
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Moath Hakami
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Emad Masuadi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
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Bahadori M, Mousavi SM, Teymourzadeh E, Ravangard R. Emergency department visits for non-urgent conditions in Iran: a cross-sectional study. BMJ Open 2019; 9:e030927. [PMID: 31601591 PMCID: PMC6797411 DOI: 10.1136/bmjopen-2019-030927] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES To determine the percentage of non-urgent (NU) visits in an Iranian emergency department (ED), to explore why patients with NU conditions refer to EDs and also to assess the association between patients' characteristics and their visits. DESIGN A cross sectional study based on face to face survey. SETTING A territorial, teaching and military hospital in Tehran province, Iran. PARTICIPANTS AND DATA COLLECTION All patients who visited the ED during the 2-week period were recruited. Data were collected using a validated questionnaire. RESULTS Of 1884 patients who visited the ED, 1217 (64.6%) patients were triaged as NU while 667 (35.4%) were urgent and semiurgent visits cases. The most important reasons for NU visits were seeking prompt (36.6%) and less costly care (35.9%). We found that NU visits have increased with younger patients, during weekends and night shifts, and with patients suffering from recurrent symptoms lasting in 1 week or less. CONCLUSIONS EDs are a common source of care for NU problems in Iran. The most invaluable solution is building up special clinics for providing healthcare services to NU patients during the weekends and, in the busy and night shifts. Receiving higher fees from NU patients could also be adopted with caution. Promoting awareness and knowledge of both healthcare providers and patients about the main role of EDs will contribute in improving their performance. As a long-term solution, adopting the family physician programme and ameliorating the referral system are recommended.
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Affiliation(s)
- Mohammadkarim Bahadori
- Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Seyyed Meysam Mousavi
- Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Ehsan Teymourzadeh
- Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Ramin Ravangard
- Health Human Resources Research Center, School of Management & Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
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Baker B, Kessler K, Kaiser B, Waller R, Ingle M, Brambilla S, Viscardi E, Richards K, O'Sullivan P, Goucke R, Smith A, Yao F, Lin I. Non-traumatic musculoskeletal pain in Western Australian hospital emergency departments: A clinical audit of the prevalence, management practices and evidence-to-practice gaps. Emerg Med Australas 2019; 31:1037-1044. [PMID: 31090200 DOI: 10.1111/1742-6723.13305] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 04/02/2019] [Accepted: 04/03/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Musculoskeletal pain (MSP) conditions are a leading cause of morbidity worldwide and a common reason for ED presentation. Little is currently known about non-traumatic MSP (NTMSP) presenting to EDs. The present study described the prevalence and management practices of NTMSP in EDs. METHODS The design was a retrospective clinical audit in two hospital EDs in Western Australia covering 3 months beginning 1 January 2016. We defined NTMSP as pain of musculoskeletal origin occurring in the absence of external force or excessive physical loading. The outcomes measured included: patient, condition and hospital-episode characteristics, as well as management practices. Management practices were compared to recommended care derived from guideline recommendations. These included: assessment for red flags and psychosocial risk factors, appropriate use of diagnostic imaging, provision of patient education, administration and prescription of analgesic medication, and assessment of risk factors for opioid-related harm. RESULTS Eight hundred and eighty-eight patients were included in the present study. NTMSP accounted for 3.0% of all ED presentations. According to clinician documentation, red flag and psychosocial assessments were recorded in 73.3 and 10.5% of patients. Forty-one percent of patients were referred for imaging, of which 39.7% were inconsistent with guideline recommendations. Education was recorded 52.0% of the time. At least one opioid medication was administered to 55.3% of patients and there was no documented assessment of risk factors for opioid-related harm. CONCLUSIONS NTMSP is a relatively common reason for ED presentation. Documented management practices are discordant with guideline recommendations. Strategies to improve the concordance between management and guideline recommendations are needed.
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Affiliation(s)
- Briarley Baker
- Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.,School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| | - Kenny Kessler
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia.,St John of God Midland Hospital, Perth, Western Australia, Australia
| | - Bronwyn Kaiser
- Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Robert Waller
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| | - Michael Ingle
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| | - Simone Brambilla
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| | - Elena Viscardi
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| | - Karen Richards
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia.,St John of God Midland Hospital, Perth, Western Australia, Australia
| | - Peter O'Sullivan
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| | - Roger Goucke
- Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Anne Smith
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| | - Felix Yao
- St John of God Midland Hospital, Perth, Western Australia, Australia
| | - Ivan Lin
- Western Australian Centre for Rural Health, The University of Western Australia, Geraldton, Western Australia, Australia
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Anderson-James S, Marchant JM, Chang AB, Acworth JP, Phillips NT, Drescher BJ, Goyal V, O'Grady KAF. Burden and emergency department management of acute cough in children. J Paediatr Child Health 2019; 55:181-187. [PMID: 30066972 DOI: 10.1111/jpc.14146] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 07/03/2018] [Indexed: 11/30/2022]
Abstract
AIM In children presenting to an emergency department (ED) with an acute coughing illness, the aims of this study were to: (i) describe the frequency of doctor visits and medication use; and (ii) describe management and relate it to current evidence-based guidelines. METHODS This was a cross-sectional study in ED of a major teaching hospital (Royal Children's Hospital, Brisbane, Australia). Participants included 537 children (<15 years) presenting with acute (<2 weeks) cough, with a median age of 2.2 years (interquartile range 1.0-4.0); 61.5% were boys. Hospitalised children and those with asthma, pneumonia or chronic illnesses were excluded. Main outcome measures were: (i) frequency of pre-ED doctor visits and medication use; and (ii) comparison of management to current evidence-based recommendations related to four discharge diagnoses: bronchiolitis, 'wheeze/reactive airway disease (RAD)', croup and 'non-specific acute respiratory illness'. RESULTS A total of 300 children (55.9%) had seen a doctor prior to their ED presentation, and use of medications pre-ED was high (53.4%). While 93.4% of children with croup were treated in accordance with guidelines, concordance was lower for children with bronchiolitis or 'wheeze/RAD'. The majority of children with a discharge diagnosis of 'wheeze/RAD' (95.6%) received bronchodilators, and 72.7% also received oral corticosteroids but were not diagnosed with asthma. More than half (55.1%) of the children with non-specific acute respiratory illness received medication(s) either prior to or during their ED presentation. CONCLUSIONS The burden of acute cough-related illnesses in children is high, and there is a need for improved uptake of evidence-based guidelines. In addition, the large number of children diagnosed with 'wheeze/RAD' suggests asthma is likely under-diagnosed in this setting.
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Affiliation(s)
- Sophie Anderson-James
- Child Health Research Centre, University of Queensland, Brisbane, Queensland, Australia
| | - Julie M Marchant
- Child Health Research Centre, University of Queensland, Brisbane, Queensland, Australia.,Department of Respiratory and Sleep Medicine, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia
| | - Anne B Chang
- Department of Respiratory and Sleep Medicine, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia.,Institute of Health and Biomedical Innovation, Centre for Children's Health Research, Queensland University of Technology, Brisbane, Queensland, Australia.,Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Jason P Acworth
- Department of Emergency Medicine, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine and Biomedical Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Natalie T Phillips
- Department of Emergency Medicine, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine and Biomedical Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Benjamin J Drescher
- Institute of Health and Biomedical Innovation, Centre for Children's Health Research, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Vikas Goyal
- Child Health Research Centre, University of Queensland, Brisbane, Queensland, Australia.,Department of Respiratory and Sleep Medicine, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia
| | - Kerry-Ann F O'Grady
- Institute of Health and Biomedical Innovation, Centre for Children's Health Research, Queensland University of Technology, Brisbane, Queensland, Australia
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49
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Employment of Emergency Advanced Nurses of Turkey: A Discrete-Event Simulation Application. Processes (Basel) 2019. [DOI: 10.3390/pr7010048] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In the present study, problems in emergency services (ESs) were dealt with by analyzing the working system of ESs in Turkey. The purpose of this study was to reduce the waiting times spent in hospitals by employing advanced nurses (ANs) to treat patients who are not urgent, or who may be treated as outpatients in ESs. By applying discrete-event simulation on a 1/24 (daily) and 7/24 (weekly) basis, and by employing ANs, it was determined that the number of patients that were treated increased by 26.71% on a 1/24 basis, and by 15.13% on a 7/24 basis. The waiting time that was spent from the admission to the ES until the treatment time decreased by 38.67% on a 1/24 basis and 53.66% on a 24/7 basis. Similarly, the length of stay was reduced from 82.46 min to 53.97 min in the ES. Among the findings, it was observed that the efficiency rate of the resources was balanced by the employment of ANs, although it was not possible to obtain sufficient efficiency from the resources used in the ESs prior to the present study.
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50
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Scherer M, Lühmann D, Kazek A, Hansen H, Schäfer I. Patients Attending Emergency Departments. DEUTSCHES ARZTEBLATT INTERNATIONAL 2018; 114:645-652. [PMID: 29034865 DOI: 10.3238/arztebl.2017.0645] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 03/21/2017] [Accepted: 07/27/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND The number of patients in emergency departments has risen steadily in recent years, with a particular increase in patients not requiring urgent treatment. The aim of this study is to characterize this group of patients with respect to their sociodemographic features, health status, and reasons for attending an emergency department. METHODS PiNo Nord is a cross-sectional observational study representing two full working weeks in five different hospitals. Patients were questioned in personal interviews, and medical diagnoses were documented. The data were analyzed with multivariate logistic regressions in mixed multilevel models. Predictors for the subjectively perceived treatment urgency were identified by stepwise backward selection. RESULTS The 1175 patients questioned had an average age of 41.8 years and 52.9% were male. 54.7% said the degree of their treatment urgency was low. 41.3% had visited the emergency department on their own initiative, 17.0% on the advice or referral of their primary care physician, and 8.0% on the advice or referral of a specialist. The strongest predictors for low subjective treatment urgency were musculoskeletal trauma (odds ratio [OR] 2.18), skin conditions (OR 2.15), and the momentary unavailability of a primary care physician (OR 1.70). CONCLUSION More than half of the patients do not think their condition requires urgent treatment and thus do not meet the definition of a medical emergency. Patients' reasons for visiting the emergency department are varied; aside from the treatment urgency of the health condition itself, the reason may lie in perceived structural circumstances and individual preferences.
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Affiliation(s)
- Martin Scherer
- Department of General Practice/Primary Care, Hamburg University Medical School, Hamburg-Eppendorf
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