Primary care professionals providing non-urgent care in hospital emergency departments

Gonçalves‐Bradley, Daniela C; Khangura, Jaspreet; Flodgren, Gerd; Perera, Rafael; Rowe, Brian H.; Shepperd, Sasha

doi:10.1002/14651858.cd002097.pub4

Cited by 75 publications

(68 citation statements)

References 52 publications

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“…It is necessary to further explore the patient's perspective of the decision‐making process and to define the nature and scope of primary care that would be required. A better understanding of the factors affecting patient's decisions and how this may affect demand is important to develop evidence‐based policies and management strategies …”

Section: Resultsmentioning

confidence: 99%

General practitioner‐type patients in emergency departments in metro North Brisbane, Queensland: A multisite study

Toloo

Bahl

Lim

et al. 2019

Emerg Medicine Australasia

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Objective: To estimate the proportion of ED patients in urban Queensland who are potentially suitable for general practitioner (GP) care. Methods: A retrospective analysis was conducted using ED Information System data from Metro North Hospital and Health Service in Brisbane, Australia for three consecutive financial years (2014-2015 to 2016-2017). The hospitals included two Principal Referral and two Public Acute hospitals. GP-type patients were calculated using the Australian Institute of Health and Welfare (AIHW), Australasian College for Emergency Medicine (ACEM) and the validated Sprivulis methods. Results: Of the 822 841 ED presentations, 219 567 (27%) were potentially GP-type patients by AIHW, 49 307 (6%) by ACEM and 61 836 (8%) by Sprivulis methods. The higher proportion of GP-type presentations were during 08.00 to 17.00 hours by AIHW and ACEM methods. Of the loweracuity triage categories of 4 (286 154 presentations) and 5 (5658 presentations), AIHW estimated that 62% and 80% of the patients were GP-type patients, as compared to 9% and 22% by ACEM, and 9% and 0.3% by Sprivulis method. The mean costs of adult GP-type patients is $345 by the AIHW and $406 by the ACEM method, lower than non-GP type patients ($706 and $622, respectively). Conclusions: There is considerable variation in what is considered GPtype ED presentations based on the three methods employed and this variation may have fuelled the debate surrounding what is 'avoidable' ED utilisation. Regardless, the study findings provide an interesting addition to defining and addressing appropriate utilisation of ED services.

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Section: Resultsmentioning

confidence: 99%

General practitioner‐type patients in emergency departments in metro North Brisbane, Queensland: A multisite study

Toloo

Bahl

Lim

et al. 2019

Emerg Medicine Australasia

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“…Emergency departments (EDs) are designed to provide rapid, high-quality, continuously accessible, and unscheduled care to emergency cases 1 2. It means that EDs are not ideal place for caring the non-urgent (NU) conditions 3.…”

Section: Introductionmentioning

confidence: 99%

Non-urgent visits to emergency departments: a qualitative study in Iran exploring causes, consequences and solutions

et al. 2020

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ObjectiveTo explore the causes and consequences of non-urgent visits to emergency departments in Iran and then suggest solutions from the healthcare providers’ viewpoint.DesignQualitative descriptive study with in-depth, open-ended, and semistructured interviews, which were inductively analysed using qualitative content analysis.SettingA territorial, educational and military hospital in Iran.ParticipantsEleven healthcare providers including eight nurses, two emergency medicine specialists and one emergency medicine resident.ResultsThree overarching themes of causes and consequences of non-urgent visits to the emergency department in addition to four suggested solutions were identified. The causes have encompassed the specialised services in emergency department, demand-side factors, and supply-side factors. The consequences have been categorised into three overarching themes including the negative consequences on patients, healthcare providers and emergency departments as well as the health system in general. The possible solutions for limiting and controlling non-urgent visits also involved regulatory plans, awareness-raising plans, reforms in payment mechanisms, and organisational arrangements.ConclusionWe highlighted the need for special attention to the appropriate use of emergency departments in Iran as a middle-income country. According to the complex nature of emergency departments and in order to control and prevent non-urgent visits, it can be suggested that policy-makers should design and implement a combination of the possible solutions.

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“…After the introduction of a 4‐h time‐based ED performance target in the UK, it was modified and introduced in Western Australia (WA) in 2009, and then across Australia in 2012 . The Four‐Hour Rule/National Emergency Access Target (4HR/NEAT) requires that most patients presenting to an ED should be seen, admitted or discharged within 4 h, when appropriate …”

Section: Introductionmentioning

confidence: 99%

“…[7][8][9][10] The Four-Hour Rule/National Emergency Access Target (4HR/NEAT) requires that most patients presenting to an ED should be seen, admitted or discharged within 4 h, when appropriate. 7,11,12 The 4HR/NEAT policy has had an impact with modest to major improvements in access block, excess mortality 9,[13][14][15][16][17] and other patient flow and outcome measures. 7,[9][10][11]13,14,[18][19][20] However, our previous studies have also shown complex effects at the ED, hospital and health system level such as effects on quality and safety, education and training, as well as the direct impact on ED overcrowding and access block.…”

Section: Introductionmentioning

confidence: 99%

“…7,11,12 The 4HR/NEAT policy has had an impact with modest to major improvements in access block, excess mortality 9,[13][14][15][16][17] and other patient flow and outcome measures. 7,[9][10][11]13,14,[18][19][20] However, our previous studies have also shown complex effects at the ED, hospital and health system level such as effects on quality and safety, education and training, as well as the direct impact on ED overcrowding and access block. [21][22][23] This study is based on the hypothesis that hospital performance is determined by multifactorial conditions that are not discernible by quantitative measures alone.…”

Section: Introductionmentioning

confidence: 99%

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When a health policy cuts both ways: Impact of the National Emergency Access Target policy on staff and emergency department performance

Forero

Man

Nahidi

et al. 2019

Emerg Medicine Australasia

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Objective To explore the impact of the Four‐Hour Rule/National Emergency Access Target (4HR/NEAT) on staff and ED performance. Methods A mixed‐methods study design was used to link performance data from 16 participating hospitals with the experiences reported by 119 ED staff during policy implementation. Quantitative and qualitative measures were triangulated to identify the staff and organisational effects on hospital performance. An overall score was developed to categorise hospitals into: high, moderate and low performers, then compared with four qualitative themes: social factors, ED management, ED outcomes and 4HR/NEAT compliance. Results Key factors identified were stress and morale; intergroup dynamics; interaction with patients; resource management; education and training; financial incentives; impact on quality and safety; perceived improvements on access block and overcrowding. High performing hospitals reported increased stress and decreased morale, decreased staff–patient communication and staff shortages; significant changes in ED management and effective use of the whole‐of‐hospital approach. Moderate performing hospitals reported similar characteristics to a lesser degree, and the perception that 4HR/NEAT did not impact ED practice. Low performing hospitals also reported increased stress and low morale and a less effective whole‐of‐hospital approach. ED staff also reported a reduction in communication with patients. Conclusions There was strong evidence of an association between high stress and low morale and the implementation of the 4HR/NEAT across all levels of performance. These adverse consequences of the 4HR/NEAT implementation indicate that a more nuanced approach to efficiency improvements is required. This would balance processes measured by 4HR/NEAT against a range of other clinical and organisational performance measures.

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Primary care professionals providing non-urgent care in hospital emergency departments

Abstract: Primary care professionals providing non-urgent care in hospital emergency departments.

Cited by 75 publications

References 52 publications

General practitioner‐type patients in emergency departments in metro North Brisbane, Queensland: A multisite study

General practitioner‐type patients in emergency departments in metro North Brisbane, Queensland: A multisite study

Non-urgent visits to emergency departments: a qualitative study in Iran exploring causes, consequences and solutions

When a health policy cuts both ways: Impact of the National Emergency Access Target policy on staff and emergency department performance

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