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Osman AD, Yeak D, Ben-Meir M, Braitberg G. Emergency department staff opinion on newly introduced phlebotomy services in the department. A cross-sectional study incorporating thematic analysis. Emerg Med Australas 2024. [PMID: 39091123 DOI: 10.1111/1742-6723.14476] [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: 03/24/2024] [Revised: 06/26/2024] [Accepted: 07/18/2024] [Indexed: 08/04/2024]
Abstract
OBJECTIVES The demand for ED services, both in terms of patient numbers and complexity has risen over the past decades. According to reports, there has been an increase in the ED patient presentation rate from 330 per 1000 to 334 per 1000 between 2018-2019 and 2022-2023. Consequently, new care models have been introduced to address this surge in demand, mitigate associated risks and improve overall safety. Among these models is the concept of 'front loading' clinical care, involving the initiation of interventions at the point of arrival. The present study evaluates the impact of introducing phlebotomists at triage. METHODS We conducted a cross-sectional survey using purposive sampling at a single quaternary metropolitan ED with an annual census of greater than 90 000, encompassing all clinical staff in the ED. The survey data were analysed quantitatively and complemented by a thematic analysis. RESULTS The response rate for the questionnaire was 61% (n = 207), with good representation from all ED craft groups. Nearly all the staff (99.5%) reported being aware of the presence of phlebotomists in the ED, whereas only 57% of the staff reported working in triage (P = 0.05, 0.00 to 0.04). 'Valuable/vital resource' featured as a common response. Early decision-making, patient safety, staff and patient satisfaction emerged as consistent themes. CONCLUSIONS Staff expressed satisfaction that patient care now begins in the waiting room, especially after extended waiting periods prior to cubicle allocation. They assert that this improvement significantly enhances timely treatment and disposition decisions, as well as overall patient satisfaction.
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Affiliation(s)
- Abdi D Osman
- Emergency Department, Austin Health, Melbourne, Victoria, Australia
- Department of Critical Care, University of Melbourne, Melbourne, Victoria, Australia
- Nursing and Midwifery Discipline, College of Sports, Health and Engineering, Victoria University, Melbourne, Victoria, Australia
| | - Daryl Yeak
- Emergency Department, Austin Health, Melbourne, Victoria, Australia
| | - Michael Ben-Meir
- Department of Critical Care, University of Melbourne, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - George Braitberg
- Emergency Department, Austin Health, Melbourne, Victoria, Australia
- Department of Critical Care, University of Melbourne, Melbourne, Victoria, Australia
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2
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Han CY, Lin CC, Chen LC, Liu SH, Goopy S, Chang W. Family Caregivers' Experiences of Preventing Harm to Older People during Hospitalization: A Phenomenographic Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15375. [PMID: 36430089 PMCID: PMC9693274 DOI: 10.3390/ijerph192215375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 11/15/2022] [Accepted: 11/19/2022] [Indexed: 06/16/2023]
Abstract
Hospital admission is associated with a high risk of harm, particularly for older people, and family members play a critical role in providing care. The aim of this study was to explore family caregivers' experiences in preventing harm to older people during hospitalization. The phenomenographic approach was applied. Thirty family caregivers were asked to describe their experiences of preventing harm to older people. Semi-structured interviews were audiotaped and transcribed. Participants described preventing harm as "essential care", "an important step toward recovery", "a load off the mind", "outcomes of collaboration among caregivers and health professionals", and "improvement in the quality of life after discharge". The core theme was to achieve the goal of integrated care for older people. The results can help improve caregiving processes and prevent harm to older people during hospitalizations. They can assist in developing strategies for the delivery of safe care for older people.
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Affiliation(s)
- Chin-Yen Han
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan 33303, Taiwan
- New Taipei Municipal TuCheng Hospital, Chang Gung Medical Foundation, New Taipei City 236017, Taiwan
| | - Chun-Chih Lin
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan 33303, Taiwan
- New Taipei Municipal TuCheng Hospital, Chang Gung Medical Foundation, New Taipei City 236017, Taiwan
| | - Li-Chin Chen
- New Taipei Municipal TuCheng Hospital, Chang Gung Medical Foundation, New Taipei City 236017, Taiwan
| | - Shou-Hsuan Liu
- Department of Nephrology, Chang Gung Memorial Hospital at Linkou, Taoyuan 33303, Taiwan
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan 33303, Taiwan
| | - Suzanne Goopy
- Usher Institute, University of Edinburgh, Edinburgh EH8 9YL, UK
| | - Wen Chang
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan 33303, Taiwan
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3
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Williamson M, Barr ML, Kabir A, Comino EJ, Goodger B, Harris‐Roxas BF, Crozier A, Jackson T, Finch J, Harris MF. Frequent users of health services among community‐based older Australians: Characteristics and association with mortality. Australas J Ageing 2022; 41:e328-e338. [PMID: 35761510 PMCID: PMC10084303 DOI: 10.1111/ajag.13110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 05/29/2022] [Accepted: 06/01/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To investigate characteristics of frequent users of general practice (GP; ≥21 visits in a year), medical specialist (≥10 visits), emergency department (ED; ≥2 presentations) and hospital services (≥2 overnight hospitalisations) and the association with mortality for people aged over 75 years. METHODS The study included residents from Central and Eastern Sydney, Australia, aged over 75 years who participated in a large community-dwelling cohort study. Demographic, social and health characteristics data were extracted from the 45 and Up Study survey. Health service (GP, medical specialist, ED and hospitalisations) use and mortality data were extracted from linked administrative data. We calculated adjusted prevalence ratios to identify independent characteristics associated with frequent users of services at baseline (approx. 2008) and adjusted hazard ratios to assess the association between frequent users of services and mortality. RESULTS Frequent users of services (GPs, medical specialists, EDs and hospitals) were more likely to be associated with ever having had heart disease and less likely to be associated with reporting good quality of life. Characteristics varied by service type. Frequent users of services were 1.5-2.0 times more likely to die within 7 years compared to those who were less frequent service users after controlling for all significant factors. CONCLUSIONS Our analysis found that frequent service users aged over 75 years had poorer quality of life, more complex health conditions and higher mortality and so their health service use was not inappropriate. However, better management of these frequent service users may lead to better health outcomes.
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Affiliation(s)
- Margaret Williamson
- Faculty of Medicine, Centre for Primary Health Care and EquityUniversity of New South WalesSydneyNSWAustralia
| | - Margo Linn Barr
- Faculty of Medicine, Centre for Primary Health Care and EquityUniversity of New South WalesSydneyNSWAustralia
| | - Alamgir Kabir
- Faculty of Medicine, Centre for Primary Health Care and EquityUniversity of New South WalesSydneyNSWAustralia
| | - Elizabeth Jane Comino
- Faculty of Medicine, Centre for Primary Health Care and EquityUniversity of New South WalesSydneyNSWAustralia
| | - Brendan Goodger
- Central and Eastern Sydney Primary Health NetworkSydneyNSWAustralia
| | - Ben F. Harris‐Roxas
- Faculty of Medicine, School of Population HealthUniversity of New South WalesSydneyNSWAustralia
| | - Ann‐Marie Crozier
- Sydney Local Health District, New South Wales HealthSydneyNSWAustralia
| | - Tony Jackson
- South Eastern Sydney Local Health District, New South Wales HealthSydneyNSWAustralia
| | - Julie Finch
- Sydney Local Health District, New South Wales HealthSydneyNSWAustralia
| | - Mark Fort Harris
- Faculty of Medicine, Centre for Primary Health Care and EquityUniversity of New South WalesSydneyNSWAustralia
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4
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Baskaran R, Gonski PN, Metz C. Preventable presentations of older adults to emergency departments: General practitioners' perspectives. Emerg Med Australas 2022; 34:725-730. [DOI: 10.1111/1742-6723.13965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 01/26/2022] [Accepted: 03/03/2022] [Indexed: 11/24/2022]
Affiliation(s)
- Radheshan Baskaran
- Rehabilitation and Aged Care Services Hornsby Ku‐ring‐gai Hospital Sydney New South Wales Australia
| | - Peter N Gonski
- Aged Care and Rehabilitation The Sutherland Hospital Sydney New South Wales Australia
| | - Colin Metz
- Albemarle Medical Practice Sydney New South Wales Australia
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Nouvenne A, Ticinesi A, Cerundolo N, Prati B, Parise A, Chiussi G, Frosio L, Guerra A, Brianti E, Fabi M, Meschi T. Implementing a multidisciplinary rapid geriatric observation unit for non-critical older patients referred to hospital: observational study on real-world data. Aging Clin Exp Res 2022; 34:599-609. [PMID: 34472045 DOI: 10.1007/s40520-021-01967-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 08/17/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Geriatric rapid observation units may represent an alternative to hospitalization in older patients with non-critical acute illness. AIMS To describe the characteristics and outcomes of patients admitted to a geriatric observation unit called URGe (Unità Geriatrica Rapida), implemented in an Italian hospital and characterized by multidisciplinary medical staff with geriatric expertise, fast-track access to diagnostic resources, regular use of point-of-care ultrasound and predicted length of stay (LOS) < 72 h. METHODS The medical records of patients admitted to URGe during a 3-month period (452 subjects, 247 F and 205 M, median age 82 years, IQR 77-87) were retrospectively examined. The primary study endpoint was transferral from URGe to regular wards. Baseline covariates included demographics, comprehensive geriatric assessment, acute illnesses, comorbidities, vital signs and routine laboratory tests. RESULTS Despite elevated burden of multimorbidity (median number of chronic diseases 4, IQR 2-5) and frailty (median Rockwood Clinical Frailty Scale score 4, IQR 3-6), only 137 patients (30.3%) required transferral from URGe to regular wards. The main factors positively associated with this outcome were Rockwood score, fever, cancer and red cell distribution width (P < 0.05 on multivariate logistic regression model). The rate of complications (mortality, delirium, and falls) during URGe stay was low (0.5%, 7% and 2%, respectively). Overall duration of hospital stay was lower than that of a group of historical controls matched by age, sex, main diagnosis, multimorbidity and frailty. CONCLUSIONS The URGe model of acute geriatric care is feasible, safe and has the potential of reducing unnecessary hospitalizations of older patients.
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Affiliation(s)
- Antonio Nouvenne
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria Di Parma, Via Antonio Gramsci 14, 43126, Parma, Italy
| | - Andrea Ticinesi
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria Di Parma, Via Antonio Gramsci 14, 43126, Parma, Italy.
- Department of Medicine and Surgery, University of Parma, Parma, Italy.
| | - Nicoletta Cerundolo
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria Di Parma, Via Antonio Gramsci 14, 43126, Parma, Italy
| | - Beatrice Prati
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria Di Parma, Via Antonio Gramsci 14, 43126, Parma, Italy
| | - Alberto Parise
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria Di Parma, Via Antonio Gramsci 14, 43126, Parma, Italy
| | - Giulia Chiussi
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria Di Parma, Via Antonio Gramsci 14, 43126, Parma, Italy
| | - Laura Frosio
- Post-Graduate Specialization Course in Emergency-Urgency Medicine, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Angela Guerra
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria Di Parma, Via Antonio Gramsci 14, 43126, Parma, Italy
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Ettore Brianti
- General Management, Azienda Ospedaliero-Universitaria Di Parma, Parma, Italy
| | - Massimo Fabi
- General Management, Azienda Ospedaliero-Universitaria Di Parma, Parma, Italy
| | - Tiziana Meschi
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria Di Parma, Via Antonio Gramsci 14, 43126, Parma, Italy
- Department of Medicine and Surgery, University of Parma, Parma, Italy
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6
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Han CY, Redley B, Lin CC, Chen LC, Ng CJ, Wang LH. Standard risk assessment forms help reduce preventable harm in older adult inpatients: A retrospective chart review study. J Adv Nurs 2021; 77:4439-4450. [PMID: 34133782 DOI: 10.1111/jan.14931] [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: 12/10/2020] [Revised: 04/16/2021] [Accepted: 05/24/2021] [Indexed: 11/29/2022]
Abstract
AIMS To examine nurse documentation of assessments using standard risk assessment forms in older inpatients, and to determine the value of such assessment. DESIGN Cross-sectional retrospective chart review. METHODS This retrospective review of risk evaluation documentation in patients' medical records focused on skin, continence, medical complications, nutrition, cognition, mobility, medications and pain. RESULTS A total of 1000 medical records from Taiwan hospitals were reviewed from January 2016 to December 2017, and 379 from Australian hospitals were reviewed from March 2011 to February 2012. Taiwanese patients with documented assessment of skin (aOR =2.94, 95%CI =1.88-4.54), nutrition (aOR =3.22, 95%CI =1.08-9.59), cognition (aOR =2.61, 95%CI =1.32-5.16) and pain (aOR =5.01, 95%CI=1.63-15.38) had significantly higher odds of developing new problems; while Australian patients with documented assessments of continence (aOR =11.55, 95%CI =1.48-90.45) and nutrition (aOR =12.90, 95%CI =1.67-99.06) had significantly higher odds of developing new problems. DISCUSSION Nursing assessments and interventions documented in standard risk assessment forms help clinical nurses detect new preventable problems and prevent harm in older hospital inpatients across geographic locations and hospital types. Standard nursing forms can be used in clinical practice to guide proactive care by nurses to prevent harm during hospitalisation. IMPACT Older inpatients are at risk of preventable harm and new health problems. The present study found that incorporating eight factors sensitive to nursing care into standard risk assessment forms can help reduce preventable harm in older inpatients. In addition, these forms guide assessment and intervention effectively in different countries.
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Affiliation(s)
- Chin-Yen Han
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan City, Taiwan.,Clinical Competency Center, Chang Gung University of Science and Technology, Taoyuan City, Taiwan.,Department of Nursing, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan
| | - Bernice Redley
- Centre for Quality and Patient Safety Research-Monash Health Partnership, School of Nursing and Midwifery, Deakin University, Waurn Ponds, VIC, Australia
| | - Chun-Chih Lin
- Department of Nursing, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan.,Department of Nursing, Chang Gung University of Science and Technology, Puzi City, Chiayi County, Taiwan
| | - Li-Chin Chen
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan City, Taiwan.,Department of Nursing, New Taipei Municipal TuCheng Hospital, Chang Gung Memorial Hospital, New Taipei City, Taiwan
| | - Chip Jin Ng
- Department of Emergency Medicine, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Li-Hsiang Wang
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan City, Taiwan.,Department of Nursing, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan
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7
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Gomes JCP, Dias RD, de Barros JV, Velasco IT, Jacob Filho W. The growing impact of older patients in the emergency department: a 5-year retrospective analysis in Brazil. BMC Emerg Med 2020; 20:47. [PMID: 32527325 PMCID: PMC7291438 DOI: 10.1186/s12873-020-00341-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 05/25/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The average age of the global population is rising at an increasing rate. There is a disproportional increase in Emergency Department (ED) visits by older people worldwide. In the Brazilian health system, complex and severely ill patients and those requiring specialized urgent procedures are referred to tertiary level care. As far as we know, no other study in Latin America has analyzed the impact of demographic changes in tertiary ED attendance. AIM To describe the sociodemographic characteristics and outcomes of tertiary Brazilian ED users. METHODS Design: Observational cross-sectional analytic study. SETTING Emergency Department, tertiary university hospital, São Paulo, Brazil. PARTICIPANTS patients aged 18 years or older attending a tertiary ED (2009-2013). The primary outcomes were hospitalization and mortality; the secondary outcome was ICU admission. Age was categorized as 'young adults' (18-39y), 'adults' (40-59y), 'young-older adults' (60-79y), and 'old-older adults' (80-109y). Other variables included sex, reason for attendance, time of ED visit, mode of presentation, type of hospitalization, main procedure, length of hospital stay (LOS) and length of ICU stay (ICU-LOS). We calculated descriptive statistics, built generalized linear mixed models for each outcome and estimated Odds Ratios (95% CI) for the independent categorical variables. The significance level was 5% with Bonferroni correction. RESULTS Older age-groups represented 26.6% of 333,028 ED visits, 40.7% of admissions, 42.7% of ICU admissions and 58% of all deaths. Old-older patients accounted for 5.1% of ED visits, 9.5% of admissions and 10.1% of ICU admissions. Hospitalization, ICU admission and mortality rates increased with older age in both sexes. LOS and ICU-LOS were similar across age-groups. The proportions of visits and admissions attributed to young adults decreased annually, while those of people aged 60 or over increased. The ORs for hospitalization, ICU admission and mortality associated with the old-older group were 3.49 (95% CI = 3.15-3.87), 1.27 (1.15-1.39) and 5.93 (5.29-6.66) respectively, with young adults as the reference. CONCLUSIONS In tertiary ED, age is an important risk factor for hospitalization and mortality, but not for ICU admission. Old-older people are at the greatest risk and demand further subgroup stratification.
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Affiliation(s)
- João Carlos Pereira Gomes
- Emergency Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av Dr. Enéas Carvalho de Aguiar, 255, 5° andar, s.5023, São Paulo, SP, CEP: 05403-010, Brazil.
| | - Roger Daglius Dias
- Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA
- STRATUS Center for Medical Simulation, Brigham and Women's Hospital, Boston, MA, USA
| | - Jacson Venancio de Barros
- Department of Information Technology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Irineu Tadeu Velasco
- Emergency Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av Dr. Enéas Carvalho de Aguiar, 255, 5° andar, s.5023, São Paulo, SP, CEP: 05403-010, Brazil
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Wilson Jacob Filho
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
- Division of Geriatrics, Department of Internal Medicine, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
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Trivedi S, Dick A, Beckett S, Hartmann RJ, Roberts C, Lyster K, Stempien J. An Assessment of Handover Culture and Preferred Information in the Transitions of Care of Elderly Patients. Cureus 2019; 11:e5267. [PMID: 31576260 PMCID: PMC6764648 DOI: 10.7759/cureus.5267] [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: 11/05/2022] Open
Abstract
Introduction Transitions of care for elderly patients in long term care (LTC) to the emergency department (ED) is fraught with communication challenges. Information preferred during these transitions has not been agreed upon. We sought to understand our local handover culture and identify what information is preferred in the transitions of care of these patients. Methods We performed a cross-sectional electronic survey that was distributed to 1470 healthcare providers (HCPs) and 82 patient and family advocates (PFAs) in two Canadian cities. The HCP group consisted of physicians and nurses in ED and LTC settings as well as paramedics. The survey was open for a period of one month with formal reminders sent weekly. Results A total of 12.9% of HCPs and 26.8% of PFAs responded to the survey. Only 41.3% of HCP respondents were aware of existing handover protocols and 83.2% indicated a desire for a single page handover form. HCPs identified concerns over handover culture surrounding workplace inefficiencies and increased demands to their time. Several preferred items of information in the transitions of care for the institutionalized elderly patient were also identified across both HCP and PFA groups. Conclusions Our study identified a need for improved local handover culture in transitions of care for the institutionalized elderly patient. We also identified the preferred elements of information during bilateral communication between LTC and the ED. Our results will be used to design a patient-centred handover form for future use in this population.
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Affiliation(s)
- Sachin Trivedi
- Emergency Medicine, University of Saskatchewan, Saskatoon, CAN
| | - Alixe Dick
- Emergency Medicine, University of Saskatchewan, Regina, CAN
| | | | | | | | - Kish Lyster
- Internal Medicine, Regina Qu'appelle Health Region, Regina, CAN
| | - James Stempien
- Emergency Medicine, University of Saskatchewan, Saskatoon, CAN
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9
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Trivedi S, Roberts C, Karreman E, Lyster K. Characterizing the Long-term Care and Community-dwelling Elderly Patients' Use of the Emergency Department. Cureus 2018; 10:e3642. [PMID: 30705794 PMCID: PMC6349572 DOI: 10.7759/cureus.3642] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Introduction Elderly patients, particularly those in long-term care (LTC), are a growing proportion of patients who present to the emergency department (ED). This population is medically complex, with high burdens on ED resources and patient flow. This study sought to characterize how elderly LTC and community-dwelling (CD) patients use ED services. Materials and methods This was a retrospective cohort study that assessed approximately 200 senior (age>65) ED visits. These patients were either residing in LTC facilities or they were CD. All participants lived in the same, medium-sized Canadian city. Data indicating demographic information, acuity of presentation, and administrative parameters (such as disposition status or length of stay) were collected and analyzed. Results A few statistically significant differences between the populations were noted. This included mean age, which was 82.6 years in the LTC population and 77.3 for the CD group (p<0.001). There were 27 repeat visits among patients in the LTC group, compared to six from the CD patients (p<0.001). In the LTC population, 75 patients required transport from emergency medical services (EMS) compared to 41 from the control group (p<0.001). Conclusion LTC patients re-present to the ED and use EMS services more frequently than their CD counterparts. This difference indicates potential areas to target for future quality improvement work to help enhance care to this vulnerable population.
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Affiliation(s)
- Sachin Trivedi
- Emergency Medicine, University of Saskatchewan, Saskatoon, CAN
| | | | - Erwin Karreman
- Miscellaneous, Regina Qu'appelle Health Region, Regina, CAN
| | - Kish Lyster
- Internal Medicine, Regina Qu'appelle Health Region, Regina, CAN
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10
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Reyes JF, Wood JG, Beutels P, Macartney K, McIntyre P, Menzies R, Mealing N, Newall AT. Beyond expectations: Post-implementation data shows rotavirus vaccination is likely cost-saving in Australia. Vaccine 2017; 35:345-352. [PMID: 27916411 DOI: 10.1016/j.vaccine.2016.11.056] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 11/08/2016] [Accepted: 11/10/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Universal vaccination against rotavirus was included in the funded Australian National Immunisation Program in July 2007. Predictive cost-effectiveness models assessed the program before introduction. METHODS We conducted a retrospective economic evaluation of the Australian rotavirus program using national level post-implementation data on vaccine uptake, before-after measures of program impact and published estimates of excess intussusception cases. These data were used as inputs into a multi-cohort compartmental model which assigned cost and quality of life estimates to relevant health states, adopting a healthcare payer perspective. The primary outcome was discounted cost per quality adjusted life year gained, including or excluding unspecified acute gastroenteritis (AGE) hospitalisations. RESULTS Relative to the baseline period (1997-2006), over the 6years (2007-2012) after implementation of the rotavirus program, we estimated that ∼77,000 hospitalisations (17,000 coded rotavirus and 60,000 unspecified AGE) and ∼3 deaths were prevented, compared with an estimated excess of 78 cases of intussusception. Approximately 90% of hospitalisations prevented were in children <5years, with evidence of herd protection in older age groups. The program was cost-saving when observed changes (declines) in both hospitalisations coded as rotavirus and as unspecified AGE were attributed to the rotavirus vaccine program. The adverse impact of estimated excess cases of intussusception was far outweighed by the benefits of the program. CONCLUSION The inclusion of herd impact and declines in unspecified AGE hospitalisations resulted in the value for money achieved by the Australian rotavirus immunisation program being substantially greater than predicted bypre-implementation models, despite the potential increased cases of intussusception. This Australian experience is likely to be relevant to high-income countries yet to implement rotavirus vaccination programs.
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Affiliation(s)
- J F Reyes
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia.
| | - J G Wood
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | - P Beutels
- Centre for Health Economics Research and Modelling Infectious Diseases (CHERMID), Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - K Macartney
- Discipline of Child and Adolescent Health, University of Sydney, NSW, Australia; National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), Kids Research Institute, Children's Hospital at Westmead, NSW, Australia
| | - P McIntyre
- Discipline of Child and Adolescent Health and School of Public Health, University of Sydney, NSW, Australia; National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), Kids Research Institute, Children's Hospital at Westmead, NSW, Australia
| | - R Menzies
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | - N Mealing
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | - A T Newall
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
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11
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Rawson H, Bennett PN, Ockerby C, Hutchinson AM, Considine J. Emergency nurses' knowledge and self-rated practice skills when caring for older patients in the Emergency Department. ACTA ACUST UNITED AC 2017; 20:174-180. [PMID: 28923236 DOI: 10.1016/j.aenj.2017.08.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 08/02/2017] [Accepted: 08/08/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Older adults are high users of emergency department services and their care requirements can present challenges for emergency nurses. Although clinical outcomes for older patients improve when they are cared for by nurses with specialist training, emergency nurses' knowledge and self-assessment of care for older patients is poorly understood. AIM To assess emergency nurses' knowledge and self-rating of practice when caring for older patients. METHODS A cross-sectional self-report survey of emergency nurses (n=101) in Melbourne, Australia. RESULTS Mean scores were 12.7 (SD 2.66) for the 25-item knowledge of older persons questionnaire, and 9.04 (SD 1.80) for the 15-item gerontic health related questions. Scores were unaffected by years of experience as a registered nurse or emergency nurse. More than 80% of nurses rated themselves as 'very good' or 'good' in assessing pain (94.9%), identifying delirium (87.8%), and identifying dementia (82.8%). Areas with a 'poor' ratings were identifying depression (46.5%), assessing polypharmacy (46.5%) and assessing nutrition (37.8%). CONCLUSIONS There was variation in knowledge and self-rating of practice related to care of older patients. The relationship between knowledge and self-ratings of practice in relation to actual emergency nursing care of older people and patient outcomes warrants further exploration.
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Affiliation(s)
- Helen Rawson
- Deakin University, Geelong, School of Nursing and Midwifery,75 Pigdons Road, Waurn Ponds, VIC 3126, Australia; Deakin University, Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, 221 Burwood Highway, Burwood, VIC 3125, Australia; Centre for Quality and Patient Safety Research, Monash Health Partnership, Clayton, VIC, Australia.
| | - Paul N Bennett
- Deakin University, Geelong, School of Nursing and Midwifery,75 Pigdons Road, Waurn Ponds, VIC 3126, Australia; Satellite Healthcare Inc, San Jose, CA, USA
| | - Cherene Ockerby
- Centre for Quality and Patient Safety Research, Monash Health Partnership, Clayton, VIC, Australia
| | - Alison M Hutchinson
- Deakin University, Geelong, School of Nursing and Midwifery,75 Pigdons Road, Waurn Ponds, VIC 3126, Australia; Deakin University, Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, 221 Burwood Highway, Burwood, VIC 3125, Australia; Centre for Quality and Patient Safety Research, Monash Health Partnership, Clayton, VIC, Australia
| | - Julie Considine
- Deakin University, Geelong, School of Nursing and Midwifery,75 Pigdons Road, Waurn Ponds, VIC 3126, Australia; Deakin University, Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, 221 Burwood Highway, Burwood, VIC 3125, Australia; Centre for Quality and Patient Safety Research, Eastern Health Partnership, Box Hill, VIC, Australia
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Coster JE, Turner JK, Bradbury D, Cantrell A. Why Do People Choose Emergency and Urgent Care Services? A Rapid Review Utilizing a Systematic Literature Search and Narrative Synthesis. Acad Emerg Med 2017; 24:1137-1149. [PMID: 28493626 PMCID: PMC5599959 DOI: 10.1111/acem.13220] [Citation(s) in RCA: 186] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 03/31/2017] [Accepted: 04/04/2017] [Indexed: 01/03/2023]
Abstract
OBJECTIVES Rising demand for emergency and urgent care services is well documented, as are the consequences, for example, emergency department (ED) crowding, increased costs, pressure on services, and waiting times. Multiple factors have been suggested to explain why demand is increasing, including an aging population, rising number of people with multiple chronic conditions, and behavioral changes relating to how people choose to access health services. The aim of this systematic mapping review was to bring together published research from urgent and emergency care settings to identify drivers that underpin patient decisions to access urgent and emergency care. METHODS Systematic searches were conducted across Medline (via Ovid SP), EMBASE (via Ovid), The Cochrane Library (via Wiley Online Library), Web of Science (via the Web of Knowledge), and the Cumulative Index to Nursing and Allied Health Literature (CINAHL; via EBSCOhost). Peer-reviewed studies written in English that reported reasons for accessing or choosing emergency or urgent care services and were published between 1995 and 2016 were included. Data were extracted and reasons for choosing emergency and urgent care were identified and mapped. Thematic analysis was used to identify themes and findings were reported qualitatively using framework-based narrative synthesis. RESULTS Thirty-eight studies were identified that met the inclusion criteria. Most studies were set in the United Kingdom (39.4%) or the United States (34.2%) and reported results relating to ED (68.4%). Thirty-nine percent of studies utilized qualitative or mixed research designs. Our thematic analysis identified six broad themes that summarized reasons why patients chose to access ED or urgent care. These were access to and confidence in primary care; perceived urgency, anxiety, and the value of reassurance from emergency-based services; views of family, friends, or healthcare professionals; convenience (location, not having to make appointment, and opening hours); individual patient factors (e.g., cost); and perceived need for emergency medical services or hospital care, treatment, or investigations. CONCLUSIONS We identified six distinct reasons explaining why patients choose to access emergency and urgent care services: limited access to or confidence in primary care; patient perceived urgency; convenience; views of family, friends, or other health professionals; and a belief that their condition required the resources and facilities offered by a particular healthcare provider. There is a need to examine demand from a whole system perspective to gain better understanding of demand for different parts of the emergency and urgent care system and the characteristics of patients within each sector.
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Affiliation(s)
- Joanne E. Coster
- School for Health and Related Research (ScHARR)University of SheffieldSheffield
| | - Janette K. Turner
- School for Health and Related Research (ScHARR)University of SheffieldSheffield
| | - Daniel Bradbury
- School for Health and Related Research (ScHARR)University of SheffieldSheffield
- Northampton General Hospital NHS TrustNorthamptonUK
| | - Anna Cantrell
- School for Health and Related Research (ScHARR)University of SheffieldSheffield
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Tran DT, Gibson A, Randall D, Havard A, Byrne M, Robinson M, Lawler A, Jorm LR. Compliance with telephone triage advice among adults aged 45 years and older: an Australian data linkage study. BMC Health Serv Res 2017; 17:512. [PMID: 28764695 PMCID: PMC5539620 DOI: 10.1186/s12913-017-2458-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 07/18/2017] [Indexed: 11/25/2022] Open
Abstract
Background Middle-aged and older patients are prominent users of telephone triage services for timely access to health information and appropriate referrals. Non-compliance with advice to seek appropriate care could potentially lead to poorer health outcomes among those patients. It is imperative to assess the extent to which middle-aged and older patients follow triage advice and how this varies according to their socio-demographic, lifestyle and health characteristics as well as features of the call. Methods Records of calls to the Australian healthdirect helpline (July 2008–December 2011) were linked to baseline questionnaire data from the 45 and Up Study (participants age ≥ 45 years), records of emergency department (ED) presentations, hospital admissions, and medical consultation claims. Outcomes of the call included compliance with the advice “Attend ED immediately”; “See a doctor (immediately, within 4 hours, or within 24 hours)”; “Self-care”; and self-referral to ED or hospital within 24 h when given a self-care or low-urgency care advice. Multivariable logistic regression was used to investigate associations between call outcomes and patient and call characteristics. Results This study included 8406 adults (age ≥ 45 years) who were subjects of 11,088 calls to the healthdirect helpline. Rates of compliance with the advices “Attend ED immediately”, “See a doctor” and “Self-care” were 68.6%, 64.6% and 77.5% respectively, while self-referral to ED within 24 h followed 7.0% of calls. Compliance with the advice “Attend ED immediately” was higher among patients who had three or more positive lifestyle behaviours, called after-hours, or stated that their original intention was to attend ED, while it was lower among those who lived in rural and remote areas or reported high or very high levels of psychological distress. Compliance with the advice “See a doctor” was higher in patients who were aged ≥65 years, worked full-time, or lived in socio-economically advantaged areas, when another person made the call on the patient’s behalf, and when the original intention was to seek care from an ED or a doctor. It was lower among patients in rural and remote areas and those taking five medications or more. Patients aged ≥65 years were less likely to comply with the advice “Self-care”. The rates of self-referral to ED within 24 h were greater in patients from disadvantaged areas, among calls made after-hours or by another person, and when the original intention was to attend ED. Patients who were given a self-care or low-urgency care advice, whose calls concerned bleeding, cardiac, gastrointestinal, head and facial injury symptoms, were more likely to self-refer to ED. Conclusions Compliance with telephone triage advice among middle-age and older patients varied substantially according to both patient- and call-related factors. Knowledge about the patients who are less likely to comply with telephone triage advice, and about characteristics of calls that may influence compliance, will assist in refining patient triage protocols and referral pathways, training staff and tailoring service design and delivery to achieve optimal patient compliance. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2458-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Duong Thuy Tran
- Centre for Big Data Research in Health-Faculty of Medicine, UNSW Sydney (The University of New South Wales), Sydney, NSW, 2052, Australia.
| | - Amy Gibson
- Centre for Big Data Research in Health-Faculty of Medicine, UNSW Sydney (The University of New South Wales), Sydney, NSW, 2052, Australia
| | - Deborah Randall
- Centre for Big Data Research in Health-Faculty of Medicine, UNSW Sydney (The University of New South Wales), Sydney, NSW, 2052, Australia
| | - Alys Havard
- Centre for Big Data Research in Health-Faculty of Medicine, UNSW Sydney (The University of New South Wales), Sydney, NSW, 2052, Australia
| | - Mary Byrne
- Healthdirect Australia, 133 Castlereagh Street, Sydney, NSW, 2000, Australia
| | - Maureen Robinson
- Healthdirect Australia, 133 Castlereagh Street, Sydney, NSW, 2000, Australia
| | - Anthony Lawler
- School of Medicine, University of Tasmania and Healthdirect Australia, Department of Health and Human Services, Level 2, 22 Elizabeth Street, Hobart, TAS, 7000, Australia
| | - Louisa R Jorm
- Centre for Big Data Research in Health-Faculty of Medicine, UNSW Sydney (The University of New South Wales), Sydney, NSW, 2052, Australia
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15
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Franchi C, Cartabia M, Santalucia P, Baviera M, Mannucci PM, Fortino I, Bortolotti A, Merlino L, Monzani V, Clavenna A, Roncaglioni MC, Nobili A. Emergency department visits in older people: pattern of use, contributing factors, geographical differences and outcomes. Aging Clin Exp Res 2017; 29:319-326. [PMID: 26931325 DOI: 10.1007/s40520-016-0550-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 02/09/2016] [Indexed: 11/28/2022]
Abstract
AIMS To assess the pattern of use of Emergency Departments (EDs), factors contributing to the visits, geographical distribution and outcomes in people aged 65 years or more living in the Italian Lombardy Region in 2012. METHODS Based on an administrative database the study population was divided into groups according to the number of ED visits. A multinomial logistic regression model was performed to compare the characteristics of each group. The Getis-Ord's G statistic was used to evaluate the clusters of high and low visit prevalence odd ratios (OR) at district level. To estimate the severity of the disease leading to ED attendance, visits were stratified based on the level of emergency and outcome. RESULTS About 2 million older people were included in the analyses: 78 % had no ED visit, 15 % only 1, 7 % 2 or more. Male sex, age 85 years or more, high number of drugs, ED visits and hospital admissions in the previous year and the location of an ED within 10 km from the patient's place were all factors associated with a higher risk to have more ED visits. Clusters of high and low prevalence of visits were found for occasional users. Overall, 83 % of ED visit with a low emergency triage code at admission had as visit outcome discharge at home. CONCLUSIONS In older people several variables were associated with an increased risk to have a high number of ED visits. Most of the visits were done for non-urgent problems and significant geographic differences were observed for occasional users.
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Affiliation(s)
- Carlotta Franchi
- Laboratory for Quality Assessment of Geriatric Therapies and Services, IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Via Giuseppe La Masa, 19, 20156, Milan, Italy.
| | - Massimo Cartabia
- Laboratory of Mother and Child Health, IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - Paola Santalucia
- Scientific Direction, IRCCS-Maggiore Hospital Foundation, Milan, Italy
| | - Marta Baviera
- Laboratory of General Practice Research, IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - Pier Mannuccio Mannucci
- A. Bianchi Bonomi Hemophilia and Thrombosis Center, IRCCS-Maggiore Hospital Foundation, Milan, Italy
| | - Ida Fortino
- Regional Health Ministry, Lombardy Region, Milan, Italy
| | | | - Luca Merlino
- Regional Health Ministry, Lombardy Region, Milan, Italy
| | - Valter Monzani
- Emergency Division, IRCCS Fondazione Policlinico, Mangiagalli e Regina Elena, Milan, Italy
| | - Antonio Clavenna
- Laboratory of Mother and Child Health, IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - Maria Carla Roncaglioni
- Laboratory of General Practice Research, IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - Alessandro Nobili
- Laboratory for Quality Assessment of Geriatric Therapies and Services, IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Via Giuseppe La Masa, 19, 20156, Milan, Italy
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Xu F, Sullivan EA, Forero R, Homer CSE. The association of Emergency Department presentations in pregnancy with hospital admissions for postnatal depression (PND): a cohort study based on linked population data. BMC Emerg Med 2017; 17:12. [PMID: 28335736 PMCID: PMC5364622 DOI: 10.1186/s12873-017-0123-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 03/11/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To investigate the impact of presenting to an Emergency Department (ED) during pregnancy on postnatal depression (PND) in women in New South Wales (NSW), Australia. METHOD An epidemiological population-based study using linked data from the NSW Emergency Department Data Collection (EDDC), the NSW Perinatal Data Collection (PDC) and the NSW Admitted Patients Data Collection (APDC) was conducted. Women who gave birth to their first child in NSW between 1 January 2006 and 31 December 2010 were followed up from pregnancy to the end of the first year after birth. RESULTS The study population includes 154,328 women who gave birth to their first child in NSW between 2006 and 2010. Of these, 31,764 women (20.58%) presented to ED during pregnancy (95%CI = 20.38-20.78). Women who presented to ED during pregnancy were more likely to be admitted to hospital for the diagnosis of unipolar depression (the adjusted relative risk (RR) =1.86, 95%CI = 1.49-2.31) and the diagnosis of mild mental and behavioural disorders associated with the puerperium (the adjusted RR = 1.55, 95%CI = 1.29-1.87) than those without ED presentation. CONCLUSION Women's hospital admissions for postnatal depression were associated with frequent ED presentations during pregnancy.
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Affiliation(s)
- Fenglian Xu
- Faculty of Health, University of Technology Sydney, Ultimo, 2007, Australia.
| | | | - Roberto Forero
- Simpson Centre for Health Service Research, SWS Clinical School and Ingham Institute for Applied Medical Research, University of New South Wales, Liverpool, NSW, 2017, Australia
| | - Caroline S E Homer
- Faculty of Health, University of Technology Sydney, Ultimo, 2007, Australia
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Dinh MM, Russell SB, Bein KJ, Vallmuur K, Muscatello D, Chalkley D, Ivers R. Age-related trends in injury and injury severity presenting to emergency departments in New South Wales Australia: Implications for major injury surveillance and trauma systems. Injury 2017; 48:171-176. [PMID: 27542554 DOI: 10.1016/j.injury.2016.08.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 08/06/2016] [Accepted: 08/11/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To describe population based trends and clinical characteristics of injury related presentations to Emergency Departments (EDs). DESIGN AND SETTING A retrospective, descriptive analysis of de-identified linked ED data across New South Wales, Australia over five calendar years, from 2010 to 2014. PARTICIPANTS Patients were included in this analysis if they presented to an Emergency Department and had an injury related diagnosis. Injury severity was categorised into critical (triage category 1-2 and admitted to ICU or operating theatre, or died in ED), serious (admitted as an in-patient, excluding above critical injuries) and minor injuries (discharged from ED). MAIN OUTCOME MEASURES The outcomes of interest were rates of injury related presentations to EDs by age groups and injury severity. RESULTS A total of 2.09 million injury related ED presentations were analysed. Minor injuries comprised 85.0%, and 14.1% and 1.0% were serious and critical injuries respectively. There was a 15.8% per annum increase in the rate of critical injuries per 1000 population in those 80 years and over, with the most common diagnosis being head injuries. Around 40% of those with critical injuries presented directly to a major trauma centre. CONCLUSION Critical injuries in the elderly have risen dramatically in recent years. A minority of critical injuries present directly to major trauma centres. Trauma service provision models need revision to ensure appropriate patient care. Injury surveillance is needed to understand the external causes of injury presenting to hospital.
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Affiliation(s)
- Michael M Dinh
- Royal Prince Alfred Hospital, Australia; Discipline of Emergency Medicine, The University of Sydney, Australia.
| | | | | | | | - David Muscatello
- School of Public Health and Community Medicine, University of New South Wales, Australia
| | | | - Rebecca Ivers
- The George Institute for Global Health, The University of Sydney, Australia; School of Nursing and Midwifery, Flinders University, Australia
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Turner J, Coster J, Chambers D, Cantrell A, Phung VH, Knowles E, Bradbury D, Goyder E. What evidence is there on the effectiveness of different models of delivering urgent care? A rapid review. HEALTH SERVICES AND DELIVERY RESEARCH 2015. [DOI: 10.3310/hsdr03430] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundIn 2013 NHS England set out its strategy for the development of an emergency and urgent care system that is more responsive to patients’ needs, improves outcomes and delivers clinically excellent and safe care. Knowledge about the current evidence base on models for provision of safe and effective urgent care, and the gaps in evidence that need to be addressed, can support this process.ObjectiveThe purpose of the evidence synthesis is to assess the nature and quality of the existing evidence base on delivery of emergency and urgent care services and identify gaps that require further primary research or evidence synthesis.Data sourcesMEDLINE, EMBASE, The Cochrane Library, the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and the Web of Science.MethodsWe have conducted a rapid, framework-based, evidence synthesis approach. Five separate reviews linked to themes in the NHS England review were conducted. One general and five theme-specific database searches were conducted for the years 1995–2014. Relevant systematic reviews and additional primary research papers were included and narrative assessment of evidence quality was conducted for each review.ResultsThe review was completed in 6 months. In total, 45 systematic reviews and 102 primary research studies have been included across all five reviews. The key findings for each review are as follows: (1) demand – there is little empirical evidence to explain increases in demand for urgent care; (2) telephone triage – overall, these services provide appropriate and safe decision-making with high patient satisfaction, but the required clinical skill mix and effectiveness in a system is unclear; (3) extended paramedic roles have been implemented in various health settings and appear to be successful at reducing the number of transports to hospital, making safe decisions about the need for transport and delivering acceptable, cost-effective care out of hospital; (4) emergency department (ED) – the evidence on co-location of general practitioner services with EDs indicates that there is potential to improve care. The attempt to summarise the evidence about wider ED operations proved to be too complex and further focused reviews are needed; and (5) there is no empirical evidence to support the design and development of urgent care networks.LimitationsAlthough there is a large body of evidence on relevant interventions, much of it is weak, with only very small numbers of randomised controlled trials identified. Evidence is dominated by single-site studies, many of which were uncontrolled.ConclusionsThe evidence gaps of most relevance to the delivery of services are (1) a requirement for more detailed understanding and mapping of the characteristics of demand to inform service planning; (2) assessment of the current state of urgent care network development and evaluation of the effectiveness of different models; and (3) expanding the current evidence base on existing interventions that are viewed as central to delivery of the NHS England plan by assessing the implications of increasing interventions at scale and measuring costs and system impact. It would be prudent to develop a national picture of existing pilot projects or interventions in development to support decisions about research commissioning.FundingThe National Institute for Health Research Health Services and Delivery Research Programme.
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Affiliation(s)
- Janette Turner
- School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Joanne Coster
- School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Duncan Chambers
- School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Anna Cantrell
- School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Viet-Hai Phung
- College of Social Science, University of Lincoln, Lincoln, UK
| | - Emma Knowles
- School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Daniel Bradbury
- School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Elizabeth Goyder
- School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
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Dinh MM, Bein KJ, Latt M, Chalkley D, Muscatello D. Age before acuity: the drivers of demand for emergency department services in the Greater Sydney Area. Emerg Med J 2014; 32:708-11. [PMID: 25532104 DOI: 10.1136/emermed-2014-204174] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 11/26/2014] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To contrast long-term population-based trends in general practice (GP) presentations and acute inpatient admissions from the emergency department (ED) in the elderly population within the Greater Sydney Area. METHODS This was a retrospective analysis of population-based ED presentation data over 11 years, between January 2001 and December 2011, conducted within the Greater Sydney Area in Australia. De-identified data were obtained from the New South Wales Emergency Department Data Collection database on all patients presenting to 30 public hospital EDs located within the Greater Sydney Area. The outcomes of interest were GP presentations to ED (triage category 4 or 5, self-referred and discharged from ED) and of acute inpatient admissions from ED per 1000 population. RESULTS Over 11 million presentations were identified. Around 40% of presentations were classified as a GP presentation and 23% were classified as acute inpatient admissions. There was a 2.9% per annum increase in acute inpatient admissions per 1000 population in those ≥80 years of age and no appreciable change in other age groups. Rates of GP presentations were higher in those <65 years of age. GP presentations increased 1.9% per annum in those aged <65 years of age. CONCLUSIONS The increase in ED demand appears to be driven by the elderly presenting with acute problems requiring inpatient admission. There has been a modest increase in the rate of GP presentations to ED.
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Affiliation(s)
- Michael M Dinh
- Discipline of Emergency Medicine, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Kendall J Bein
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Mark Latt
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Dane Chalkley
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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