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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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2
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Fatima Y, Hays R, Knight S, Neilson A, Fleming R, Panaretto K, Jatrana S, Skinner I. Drivers of general practice-type presentations to the emergency department in a remote outback community. Aust J Rural Health 2021; 29:391-398. [PMID: 34051017 DOI: 10.1111/ajr.12706] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/23/2020] [Accepted: 11/25/2020] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To estimate the number of general practice-appropriate attendances in a remote emergency department and explore the reasons for patients' choice of service. DESIGN A four-step case study approach was adopted, focusing on hospital emergency department (ED) attendances that were potentially manageable in general practice. SETTING A large, remote community with substantial populations of Indigenous peoples and fly-in, fly-out mining industry workers. The ED is experiencing rapid growth in demand for services for lower urgency. PARTICIPANTS Patients attending the emergency department with lower urgency problems. INTERVENTIONS ED attendance data for 2016 were reviewed to identify lower urgency presentations. Patient records for 400 randomly selected presentations were subject to deeper analysis. A prospective survey was conducted over 6 months of 369 ED patients with lower urgency presentations. MAIN OUTCOME MEASURES The proportion of patients attending the ED with GP-appropriate problems and influences on their decisions to attend the ED. RESULTS About 48% of all attendances met the agreed definition of GP-appropriate problems. About half of presentations were during the normal work hours and about half of patients stated that GP services were unavailable. Younger age, lack of information about local GP services, and perceptions of convenience contributed significantly to seeking ED care. CONCLUSION Increasing the availability of GP services alone is unlikely to be sufficient to change service utilisation. Strategies should include raising community awareness of how and when to utilise the appropriate service, understanding different models of care, and the need to register with a general practice.
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Affiliation(s)
- Yaqoot Fatima
- Centre for Rural and Remote Health, James Cook University, Mount Isa, QLD, Australia.,Institute for Social Science Research, University of Queensland, Brisbane, QLD, Australia
| | - Richard Hays
- Centre for Rural and Remote Health, James Cook University, Mount Isa, QLD, Australia
| | - Sabina Knight
- Centre for Rural and Remote Health, James Cook University, Mount Isa, QLD, Australia
| | - Anne Neilson
- Darling Downs Hospital and Health Service, Kingaroy, QLD, Australia
| | - Rhonda Fleming
- Western Queensland Primary Health Network, Mount Isa, QLD, Australia
| | - Kathryn Panaretto
- Gidgee Healing, Mount Isa, QLD, Australia.,University of Queensland, Brisbane, QLD, Australia
| | - Santosh Jatrana
- Centre for Rural and Remote Health, James Cook University, Mount Isa, QLD, Australia
| | - Isabelle Skinner
- Centre for Rural and Remote Health, James Cook University, Mount Isa, QLD, Australia
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Gurung A, Broadbent M, Bakon S, Hocking J, Glenwright A, Shaw C, Tweddell S, Clark S. Understanding registered nurse decision-making, communication and care delivery between emergency departments and residential aged care facilities: A research protocol. Australas J Ageing 2019; 39:277-282. [PMID: 31782254 DOI: 10.1111/ajag.12758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 10/23/2019] [Accepted: 10/24/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Nursing staff in residential aged care facilities (RACF)s often make decisions about the transfer of residents to the emergency department (ED). This paper describes the protocol of a study that aims to understand decision-making process utilised by RACF registered nurses (RNs) and to explore the perceptions of RNs about the decision and communication process between RACF and ED. METHODS The proposed mixed-method study will survey and interview RACF RNs to understand their decision to transfer a resident and collect information about older people referred to the ED. Data collection will involve telephone survey, ED information system (EDIS) data and semistructured interviews. RESULTS The project outcomes will provide an understanding of existing ED service provision, communication between facilities and the reasons for transfer of older person to ED. This may inform redesign in communication processes between the ED and local RACFs and outreach care from the ED to RACFs.
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Affiliation(s)
- Apil Gurung
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Caboolture, Queensland, Australia
| | - Marc Broadbent
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Caboolture, Queensland, Australia
| | - Shannon Bakon
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Caboolture, Queensland, Australia
| | - Julia Hocking
- Griffith University, Brisbane, Queensland, Australia
| | - Amanda Glenwright
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Caboolture, Queensland, Australia
| | - Christine Shaw
- Emergency Department, Caboolture Hospital, Caboolture, Queensland, Australia
| | - Sheryl Tweddell
- Emergency Department, Caboolture Hospital, Caboolture, Queensland, Australia
| | - Sean Clark
- Emergency Department, Caboolture Hospital, Caboolture, Queensland, Australia
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Unwin M, Crisp E, Rigby S, Kinsman L. Investigating the referral of patients with non-urgent conditions to a regional Australian emergency department: a study protocol. BMC Health Serv Res 2018; 18:647. [PMID: 30126396 PMCID: PMC6102868 DOI: 10.1186/s12913-018-3411-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 07/23/2018] [Indexed: 11/10/2022] Open
Abstract
Background Australia’s only island state, Tasmania, experiences one of the nation’s highest incidences of non-urgent emergency department (ED) presentations in a healthcare system regularly faced with service demands that exceed resource availability. Service-demand mismatches are acknowledged to contribute to ED crowding which in turn, has been documented to have a correlation with poorer patient outcomes. Crowding within EDs is complex, non-urgent presentations alone are not the primary cause, but have been reported to be a contributing factor. In 2015–16 Tasmania recorded over 153,000 ED attendances, 55% of these fell into the two least urgent triage categories. Recent research in the State’s North established that 29% of non-urgent presentations were referred, formally or informally, from primary healthcare providers and that, for many patients (39%), the ED was not their first choice of service provider. This study aims to identify the service needs of patients referred to a regional Australian ED and subsequently triaged as non-urgent. Method In order to achieve this aim, three objectives have been identified. The first two objectives use an explanatory sequential mixed-method approach while the third objective will incorporate an implementation science approach. These three objectives are: first, a retrospective analysis of seven years of routinely collected hospital data to identify trends in referral of patients with non-urgent conditions; second, focus group interviews with patients and primary care providers to further understand perceived need and service requirements of those referred to the ED, and third, translation of findings into local health service recommendations. Discussion Identification of the needs of patients referred to the ED with non-urgent conditions will inform future service planning aiming to facilitate access to the right service at the right time and in the right place.
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Affiliation(s)
- Maria Unwin
- College of Health and Medicine, University of Tasmania c/- Level 2, Northern Integrated Care Services, 41 Frankland St, Launceston, TAS, 7250, Australia. .,Emergency Department, Launceston General Hospital, Tasmanian Health Service, 274-280 Charles St, Launceston, Tasmania, Australia.
| | - Elaine Crisp
- College of Health and Medicine, University of Tasmania, 1 Newham Close, Newnham, Tasmania, 7248, Australia
| | - Scott Rigby
- Emergency Department, Launceston General Hospital, Tasmanian Health Service, 274-280 Charles St, Launceston, Tasmania, Australia
| | - Leigh Kinsman
- College of Health and Medicine, University of Tasmania c/- Level 2, Northern Integrated Care Services, 41 Frankland St, Launceston, TAS, 7250, Australia.,Tasmanian Health Service c/-Level 2, Northern Integrated Care Services, 41 Frankland St, Launceston, Tasmania, 7250, Australia
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Freed GL, Bingham A, Allen AR, Freed M, Sanci LA, Spike N. Actual availability of general practice appointments for mildly ill children. Med J Aust 2015. [DOI: 10.5694/mja14.01724] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Nagree Y, Gosbell A, McCarthy S, Moore K, Mountain D. Determining the true burden of general practice patients in the emergency department: getting closer. Emerg Med Australas 2014; 25:487-90. [PMID: 24308612 DOI: 10.1111/1742-6723.12163] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Yusuf Nagree
- Emergency, Fremantle Hospital, Fremantle, Western Australia, Australia; School of Primary, Aboriginal and Rural Health Care, University of Western Australia, Nedlands, Western Australia, Australia
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van der Linden MC, Lindeboom R, van der Linden N, van den Brand CL, Lam RC, Lucas C, de Haan R, Goslings JC. Self-referring patients at the emergency department: appropriateness of ED use and motives for self-referral. Int J Emerg Med 2014; 7:28. [PMID: 25097670 PMCID: PMC4110705 DOI: 10.1186/s12245-014-0028-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 06/19/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Nearly all Dutch citizens have a general practitioner (GP), acting as a gatekeeper to secondary care. Some patients bypass the GP and present to the emergency department (ED). To make best use of existing emergency care, Dutch health policy makers and insurance companies have proposed the integration of EDs and GP cooperatives (GPCs) into one facility. In this study, we examined ED use and assessed the characteristics of self-referrals and non-self-referrals, their need for hospital emergency care and self-referrals' motives for presenting at the ED. METHODS A descriptive cohort study was conducted in a Dutch level 1 trauma centre. Differences in patient characteristics, time of presentation and need for hospital emergency care were analysed using χ (2) tests and t tests. A patient was considered to need hospital emergency care when he/she was admitted to the hospital, had an extremity fracture and/or when diagnostic tests were performed. Main determinants of self-referral were identified via logistic regression. RESULTS Of the 5,003 consecutive ED patients registering within the 5-week study period, 3,028 (60.5%) were self-referrals. Thirty-nine percent of the self-referrals had urgent acuity levels, as opposed to 65% of the non-self-referrals. Self-referrals more often suffered from injuries (49 vs. 20%). One third of the self-referrals presented during office hours. Of all self-referrals, 51% needed hospital emergency care. Younger age; non-urgent acuity level; chest pain, ear, nose or throat problems; and injuries were independent predictors for self-referral. Most cited motives for self-referring were 'accessibility and convenience' and perceived 'medical necessity'. CONCLUSIONS A substantial part of the self-referrals needed hospital emergency care. The 49% self-referrals who were eligible for GP care presented during out-of-hours as well as during office hours. This calls for an integrative approach to this health care problem.
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Affiliation(s)
| | - Robert Lindeboom
- Division of Clinical Methods and Public Health, Master Evidence Based Practice, Academic Medical Centre, University of Amsterdam, Amsterdam 1100 DD, The Netherlands
| | - Naomi van der Linden
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, P.O. Box 1738, Rotterdam 3000 DR, The Netherlands
| | - Crispijn L van den Brand
- Accident and Emergency Department, Medical Centre Haaglanden, The Hague 2501 CK, The Netherlands
| | - Rianne C Lam
- Accident and Emergency Department, Medical Centre Haaglanden, The Hague 2501 CK, The Netherlands
| | - Cees Lucas
- Division of Clinical Methods and Public Health, Master Evidence Based Practice, Academic Medical Centre, University of Amsterdam, Amsterdam 1100 DD, The Netherlands
| | - Rob de Haan
- Clinical Research Unit, Academic Medical Centre, University of Amsterdam, J1b-118, Amsterdam 1100 DD, The Netherlands
| | - J Carel Goslings
- Trauma Unit, Department of Surgery, Academic Medical Centre, University of Amsterdam, Amsterdam 1100 DD, The Netherlands
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Harris T, McDonald K. Is the case-mix of patients who self-present to ED similar to general practice and other acute-care facilities? Emerg Med J 2013; 31:970-4. [PMID: 23985339 DOI: 10.1136/emermed-2013-202845] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To benchmark walk-in presentations to emergency departments (ED) with those presenting to other local acute healthcare facilities. SETTING A large teaching hospital with an annual ED census of 140, 000 adult patients and surrounding associated acute healthcare providers. METHODS A random sample of 384 patients who self-presented to the ED was obtained. Benchmarking data were drawn from two general practices; the Tower Hamlets Community Services walk-in centre (co-located on-site with the ED) and the GP-run out-of-hours service. RESULTS The case-mix presenting to the ED was characterised by a higher proportion of injuries and chest pain, but fewer simple infections and non-traumatic musculoskeletal conditions as compared to other acute care facilities in our region. CONCLUSIONS Patients with injuries and possible cardiac chest pain were more likely to attend the ED, and those with infection or musculoskeletal problems less likely, as compared with other acute healthcare facilities. The population presenting to the ED is distinct from that presenting to general practice, out-of-hours clinics, or walk-in centres.
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Affiliation(s)
- Tim Harris
- Emergency Department, The Royal London Hospital, London, UK
| | - Keith McDonald
- GP Health E1 Homeless Medical Centre and Clinical Lead GP Streaming Service, Barts Health NHS Trust, London, UK
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9
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Nagree Y, Camarda VJ, Fatovich DM, Cameron PA, Dey I, Gosbell AD, McCarthy SM, Mountain D. Quantifying the proportion of general practice and low‐acuity patients in the emergency department. Med J Aust 2013; 198:612-5. [DOI: 10.5694/mja12.11754] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Accepted: 05/02/2013] [Indexed: 11/17/2022]
Affiliation(s)
- Yusuf Nagree
- School of Primary, Aboriginal and Rural Health Care, University of Western Australia, Perth, WA
- Fremantle Hospital, Fremantle, WA
| | | | - Daniel M Fatovich
- School of Primary, Aboriginal and Rural Health Care, University of Western Australia, Perth, WA
- Royal Perth Hospital, Perth, WA
| | | | - Ian Dey
- Fremantle Hospital, Fremantle, WA
| | | | - Sally M McCarthy
- Emergency Care Institute, NSW Agency for Clinical Innovation, Sydney, NSW
| | - David Mountain
- School of Primary, Aboriginal and Rural Health Care, University of Western Australia, Perth, WA
- Sir Charles Gairdner Hospital, Perth, WA
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10
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Nagree Y, Gosbell AD, Fatovich DM, Cameron PA, McCarthy SM, Mountain D. General practice patients form an insignificant part of the emergency department workload. Med J Aust 2013; 197:619. [PMID: 23230922 DOI: 10.5694/mja12.11571] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Accepted: 11/06/2012] [Indexed: 11/17/2022]
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Nagree Y, Cameron P, Gosbell A, Mountain D. Telephone triage is not the answer to ED overcrowding. Emerg Med Australas 2012; 24:123-6. [PMID: 22487660 DOI: 10.1111/j.1742-6723.2012.01547.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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12
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Estella A. Emergency overcrowding: an incurable disease? CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2011; 15:428; author reply 428. [PMID: 21635705 PMCID: PMC3218977 DOI: 10.1186/cc10223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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