Nurse discharge planning in the emergency department: a Toowoomba, Australia, study

Abstract

Aim. This study aimed to ascertain whether a model of risk screening carried out by an experienced community nurse was effective in decreasing re-presentations and readmissions and the length of stay of older people presenting to an Australian emergency department. Objectives. The objectives of the study were to (i) identify all older people who presented to the emergency department of an Australian regional hospital; (ii) identify the proportion of representations and readmissions within this cohort of patients; and (iii) risk-screen all older patients and provide referrals when necessary to community services. Design. The study involved the application of a risk screening tool to 2139 men and women over 70 years of age from October 2002 to June 2003. Of these, 1102 ( 5 1 . 5 % ) were admitted and 246 ( 1 1 . 5 % ) were re-presentations with the same illness. Patients presenting from Monday to Friday from 08:00 to 16:00 hours were risk-screened face to face in the emergency department. Outside of these hours, but within 72 hours of presentation, risk screening was carried out by telephone if the patient was discharged or within the ward if the patient had been admitted. Results. There was a 16% decrease in the re-presentation rate of people over 70 years of age to the emergency department. Additionally during this time there was a 5. 5 % decrease in the readmission rate (this decrease did not reach significance). There was a decrease in the average length of stay in hospital from 6. 17 days per patient in October 2002 to 5 . 37 days per patient in June 2003. An unexpected finding was the decrease in re-presentations in people who represented to the emergency department three or more times per month (known as 'frequent flyers'). Conclusions. Risk screening of older people in the emergency department by a specialist community nurse resulted in a decrease of re-presentations to the emergency department. There was some evidence of a decreased length of stay. It is suggested that the decrease in re-presentations was the result of increased referral and use of community services. It appears that the use of a Journal of Clinical Nursing (2006Nursing ( ) 15 (8): 1033Nursing ( -1044Nursing ( . doi:10.1111Nursing ( /j.1365Nursing ( -2702Nursing ( .2006 specialist community nurse to undertake risk screening rather than the triage nurse may impact on service utilization. Relevance to clinical practice. It is apparent that older people presenting to the emergency department have complex care needs. Undertaking risk screening using an experienced community nurse to ascertain the correct level of community assistance required and ensuring speedy referral to appropriate community services has positive outcomes for both the hospital and the patient.

A New Model for Dealing with Patients Who Frequently Arrive Spontaneously at Hospital Emergency Departments Requiring Health Care: A Pilot Study

“…Although the literature review presented beneficial outcomes in providing intensive CM at somatic hospital based ED, the authors concluded that there was a need for further studies covering how best to take care of frequent visitors to ED. This is a conclusion which is supported by other researchers [8,[19][20][21]. In Sweden and, to our knowledge, no intervention study covering models for reducing costs and frequent visits at ED has been published.…”

Interventions targeting the elderly population to reduce emergency department utilisation: a literature review

“…Of them, only five studies demonstrated statistical significance in lowering ED use or ED length of stay (LOS) 27 31 32 36 37. None of them used RCTs.…”

Expansion of nursing role in general practice: studies suggest patients think that nurses can manage simple conditions but have some concerns about knowledge and competence in some areas

“…Although the findings did raise issues in these areas, it is not clear why these were selected as conclusions of the review. There has been some work previously undertaken around consumer perceptions of practice nurse roles in the international context which may have provided more insight in this area 5–7…”