Does distance to hospital affect emergency department presentations and hospital length of stay among chronic obstructive pulmonary disease patients?

Rana, Rezwanul Hasan; Gow, Jeff; Moloney, Clint; King, Alex; Keijzers, Gerben; Beccaria, Gavin; Mullens, Amy B.

doi:10.1111/imj.15014

Cited by 7 publications

(9 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…5 , 6 Economic data from an Australian review of three major tertiary hospitals revealed a total annual health service cost of 20 million AUD for ED presentations across three major health service districts. 7 That study reported that 41.1% of ED presentations assessed as Australian Triage Scale category 3 (urgent) or 4 (semi-urgent) were discharged home on the same day. 7 A lack of integrated care and discharge planning from the ED is associated with COPD readmissions and exacerbations resulting in breathlessness, reduced activity levels, malnutrition, social isolation, a loss of independence, and depression which all lead to a reduced health-related quality of life (HRQoL).…”

Section: Introductionmentioning

confidence: 98%

“… 18–20 Developing relevant ED-focussed quality indicators have been noted as important in improving care outcomes. 7 , 13 , 21 Appropriate delegation and handover of chronic care referrals potentially can reduce ED COPD readmissions and improve HRQoL for these patients. 7 , 15 This study aimed to develop a proforma for ED departments to improve guideline adherence amongst ED interdisciplinary clinicians.…”

Section: Introductionmentioning

confidence: 99%

“… 7 , 13 , 21 Appropriate delegation and handover of chronic care referrals potentially can reduce ED COPD readmissions and improve HRQoL for these patients. 7 , 15 This study aimed to develop a proforma for ED departments to improve guideline adherence amongst ED interdisciplinary clinicians. The imperative perspective here is from ED interdisciplinary staff verified and validated by respiratory interdisciplinary staff.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Development of an Electronic Interdisciplinary Chronic Obstructive Pulmonary Disease (COPD) Proforma (E-ICP) to Improve Interdisciplinary Guideline Adherence in the Emergency Department: Modified Delphi Study

Issac¹,

Keijzers²,

Yang³

et al. 2022

COPD

Self Cite

View full text Add to dashboard Cite

Introduction Chronic obstructive pulmonary disease guideline non-adherence is associated with a reduction in health-related quality of life in patients (HRQoL). Improving guideline adherence has the potential to mitigate fragmented care thereby sustaining pulmonary function, preventing acute exacerbations, reducing economic health burdens, and enhancing HRQoL. The development of an electronic proforma stemming from expert consensus, including digital guideline resources and direct interdisciplinary referrals is hypothesised to improve guideline adherence and patient outcomes for emergency department (ED) patients with COPD. Aim The aim of this study was to develop consensus among ED and respiratory staff for the correct composition of a COPD electronic proforma that aids in guideline adherence and management in the ED. Methods This study adopted a mixed-method design to develop the most important indicators of care in the ED. The study involved three phases: (1) a systematic literature review and qualitative interdisciplinary staff interviews to assess barriers and solutions for guideline adherence and qualitative interdisciplinary staff interviews, (2) a modified Delphi panel to select interventions for the proforma, and (3) a consensus process through three rounds of scoring through a quantitative survey (ED and Respiratory consensus) and qualitative thematic analysis on each indicator. Results The electronic proforma achieved acceptable and good internal consistency through all iterations from national emergency department and respiratory department interdisciplinary experts. Cronbach’s alpha score for internal consistency (α) in iteration 1 emergency department cohort (EDC) (α = 0.80 [CI = 0.89%]), respiratory department cohort (RDC) (α = 0.95 [CI = 0.98%]). Iteration 2 reported EDC (α = 0.85 [CI = 0.97%]) and RDC (α = 0.86 [CI = 0.97%]). Iteration 3 revealed EDC (α = 0.73 [CI = 0.91%]) and RDC (α = 0.86 [CI = 0.95%]), respectively. Conclusion Electronic proformas have the potential to facilitate direct referrals from the ED leading to reduced hospital admissions, reduced length of hospital stays, holistic care, improved health care and quality of life and improved interdisciplinary guideline adherence.

show abstract

Section: Introductionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Development of an Electronic Interdisciplinary Chronic Obstructive Pulmonary Disease (COPD) Proforma (E-ICP) to Improve Interdisciplinary Guideline Adherence in the Emergency Department: Modified Delphi Study

Issac¹,

Keijzers²,

Yang³

et al. 2022

COPD

Self Cite

View full text Add to dashboard Cite

show abstract

“… 3 Economic research data in three Southern Queensland Hospitals reveal a total health service cost of AUD $ 42, 142, 474 for COPD ED presentations across all 3 sites where 41.1% of presentations were assessed as emergency triage category 3 or 4 in the EDs and were transferred home on the same day. 11 , 12 The Australian triage scale outlines five categories from Category-1, an immediately life-threatening condition involving prompt assessment and treatment to Category-5, a chronic or minor condition to be assessed and treated within 2 hours. 13 The estimated cost savings of reduced COPD-related admission is around AUD $533 per patient in these ED’s.…”

Section: Introductionmentioning

confidence: 99%

“…Implications of this practice often lead to repetitive readmissions of COPD exacerbations, increased economic burden, and poor optimisation of patient lung function and overall health. 11 , 12 , 14 , 15 …”

Section: Introductionmentioning

confidence: 99%

Exploring Factors Contributing to Chronic Obstructive Pulmonary Disease (COPD) Guideline Non-Adherence and Potential Solutions in the Emergency Department: Interdisciplinary Staff Perspective

Issac¹,

Taylor²,

Moloney³

et al. 2021

JMDH

Self Cite

View full text Add to dashboard Cite

Purpose Acute exacerbations of chronic obstructive pulmonary disease (COPD) have a significant and prolonged impact on health-related quality of life, patient outcomes, and escalation of pulmonary function decline. COPD-X guidelines published in 2003 subsist to facilitate a shift from the emphasis on pharmacological treatment to a more holistic multi-disciplinary interventions approach. Despite the existing comprehensive recommendations, readmission rates have increased in the last decade. Evidence to date has reported sub-optimal COPD guidelines adherence in emergency departments. This qualitative study explored contributing factors to interdisciplinary staff non-adherence and utilisation of COPD-X guidelines in a major Southern Queensland Emergency Department. Methods Semi-structured qualitative interviews with interdisciplinary staff were conducted in an emergency department. A purposive sample of doctors, nurses, physiotherapists, pharmacist and a social worker were recruited. Interviews were digitally recorded, de-identified and transcribed verbatim. Data analysis followed a coding process against the Theoretical Domains Framework (TDF) to examine implementation barriers and potential solutions. Identified factors affecting non-adherence and underutilisation of guidelines were then mapped to the capability, opportunity, motivation, behaviour model (COM-B) and behaviour change wheel (BCW) to inform future implementation recommendations. Results Prominent barriers influencing the clinical uptake of COPD guidelines were identified using TDF analysis and included knowledge, professional role clarity, clinical behaviour regulation, memory, attention, and decision process, beliefs about departmental capabilities, environmental context and resources. Potential interventions included education, training, staffing, funding and time-efficient digitalised referrals and systems management reminders to prevent COPD readmissions, remissions and improve patient health-related quality of life. Conclusion Implementation strategies such as electronic interdisciplinary COPD proforma that facilitates a multimodal approach with appropriate patient/staff resources and referrals prior to discharge from an ED require further exploration. Greater clarity around which components of the COPD X guidelines must be applied in ED settings needs to stem from future research.

show abstract

Factors Associated with Extended Length of Stay for Paediatric Mental Health Presentations to Emergency Departments in South Western Sydney, Australia

Khan¹,

John²,

Middleton³

et al. 2023

Preprint

View full text Add to dashboard Cite

Background: Evidence suggests that children and young people (CYP) who present to the emergency department (ED) for mental health (MH) difficulties may have extended lengths of stay (LOS); however, there is a paucity of research in Australia regarding the factors associated with extended LOS. This study aimed to determine the factors associated with extended LOS for paediatric MH-related presentations to the EDs in South Western Sydney (SWS), a multicultural community in Australia. Methods: We analysed electronic medical records (eMR) of 7,409 MH-related ED encounters of CYP aged 0 up to 18 years from all six public hospitals in SWS from January 2016 to April 2022. Extended LOS was defined as encounters of more than 4 hours. We assessed factors associated with extended LOS using a multilevel logistic regression model, accounting for hospital-level clustering. Results: Approximately 57.6% of all ED presentations for paediatric MH involved extended LOS. ED presentations by adolescents (adjusted odds ratio (AOR) 2.23, 95% CI 1.20-4.17 for 12-14 years and AOR 2.69, 95% CI 1.44-5.00 for 15-17 years), and patients with a preferred language other than English (AOR 1.47, 95% CI 1.15-1.89) had increased odds of extended LOS compared to their counterparts. Deliberate self-harm related presentations, the most commonly presented MH condition, had higher odds of extended LOS than other MH-related presentations (AOR 1.77, 95% CI 1.59-1.98). Patients with MH presentations that required urgent evaluation (triage levels 1-2) had higher odds of extended LOS (AOR 1.38, 95% CI 1.15-1.65) compared to triage level 3, whereas those with triage levels 4-5 had lower odds (AOR 0.66, 95% CI 0.58-0.74). Further, patients with MH-related presentations that came by ambulance (compared to other mode of presentations) and presentations that happened at night and late at night (compared to early morning and daytime presentations). The odds of extended LOS were considerably lower during the COVID-19 period compared to the pre-COVID-19 period (AOR 0.74, 95% CI 0.67-0.82). Additionally, extended paediatric LOS for MH issues in the ED showed notable hospital-level heterogeneity. Conclusion: A large proportion of extended LOS in ED and sociodemographic disparities reflect inequality in access to paediatric MH care. Our findings highlight the need for equitable distribution of resources directed towards at-risk CYP to improve MH outcomes and reduce health system burden.

show abstract

Does distance to hospital affect emergency department presentations and hospital length of stay among chronic obstructive pulmonary disease patients?

Abstract: This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process which may lead to differences between this version and the Version of Record. Please cite this article as

Cited by 7 publications

References 17 publications

Development of an Electronic Interdisciplinary Chronic Obstructive Pulmonary Disease (COPD) Proforma (E-ICP) to Improve Interdisciplinary Guideline Adherence in the Emergency Department: Modified Delphi Study

Development of an Electronic Interdisciplinary Chronic Obstructive Pulmonary Disease (COPD) Proforma (E-ICP) to Improve Interdisciplinary Guideline Adherence in the Emergency Department: Modified Delphi Study

Exploring Factors Contributing to Chronic Obstructive Pulmonary Disease (COPD) Guideline Non-Adherence and Potential Solutions in the Emergency Department: Interdisciplinary Staff Perspective

Factors Associated with Extended Length of Stay for Paediatric Mental Health Presentations to Emergency Departments in South Western Sydney, Australia

Contact Info

Product

Resources

About