Streamlining care of older people in residential aged care: Nurse practitioner candidate and emergency department care coordination

Craswell, Alison; Coates, Kaye; Taylor, Andrea; Marsden, Elizabeth; Crilly, Julia; Glenwright, Amanda; Wallis, Marianne

doi:10.1016/j.nurpra.2017.05.057

Cited by 1 publication

(1 citation statement)

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“…24 It would appear that MOC targeting patients from aged care facilities or the frail elderly could provide the next wave of implementation for Queensland EDs, with only one-quarter reporting a Hospital in the Nursing Home program. From the literature concerning residents from aged care facilities, these programs serve to define goals of care, 27 reduce ED attendance, 28,29 reduce ED LOS, 27,28 reduce hospital admission, 27,29 reduce hospital LOS, 28 increase rates of comprehensive geriatric assessment and facilitate supported discharge in the primary place of residence 30 with an option of outreach into the aged care facility. 31 A comprehensive evaluation of an ED-based service for all older people, whether from the community or aged care facilities, presenting to the ED is under way.…”

Section: Discussionmentioning

confidence: 99%

Emergency department models of care in Queensland: a multisite cross-sectional study

Bell

Toloo²,

Crilly

et al. 2019

Aust. Health Review

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The acuity and number of presentations being made to emergency departments (EDs) is increasing. In an effort to safely and efficiently manage this increase and optimise patient outcomes, innovative models of care (MOC) have been implemented. What is not clear is how these MOC reflect the needs of patients or relate to each other or to ED performance. The aim of this study was to describe ED MOC in Queensland, Australia. Situated within a larger mixed-methods study, the present study was a cross-sectional study. In early 2015, leaders (medical directors and nurse managers) from public hospital EDs in Queensland were invited to complete a survey detailing ED activity, staffing profiles, treatment space, MOC and National Emergency Access Target (NEAT) performance. Routinely collected ED information system data was also used. Twenty of the 27 EDs invited participated in the study (response rate 74%). An extensive array of MOC were identified that were categorised into those that facilitate input, throughput and output from the ED. There was no consistent evidence as to the relative effectiveness of these MOC in achieving ED performance benchmarks, such as NEAT performance. There is considerable variability in the MOC used throughout EDs in Queensland. A more complete analysis of the relative effectiveness of different MOC either in isolation or as part of a comprehensive approach would help inform more consistent MOC in Queensland EDs. MOC in any given ED are implemented in response to factors such as the geographical location of the hospital, hospital-specific characteristics and service profile, staffing profile and patient demographic profile. In the era of time-based targets, they may also serve to address a particular aspect of flow in the face of rising ED demand. Although many of the MOC attempt to deal with flow in a linear fashion, target specific phases of the ED journey or address particular patient cohorts, what is clear is that not all EDs are shaped and formed the same. The study provides a comprehensive description of the varied models of care operating within Queensland public hospital EDs and how they relate to ED performance. A basic taxonomy of contemporary ED MOC is necessary to allow comparison between departments and inform decisions regarding safety, efficiency and cost-effectiveness. A contemporary understanding of the presence and profile of ED MOC that currently exist within a network of hospitals and health services is important for managers, clinicians and patients to inform decision-making regarding the safety, clinical effectiveness and cost-effectiveness of these models. This understanding can also inform where and how further improvements in care delivery can progress.

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