Trends and characteristics of short‐term and frequent representations to emergency departments: A population‐based study from New South Wales, Australia

Dinh, Michael; Russell, Saartje Berendsen; Bein, Kendall J; Chalkley, Dane; Muscatello, David; Paoloni, Richard; Ivers, Rebecca

doi:10.1111/1742-6723.12582

Cited by 33 publications

(29 citation statements)

References 16 publications

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“…), and those with AOD misuse and mental illness are most likely to become very frequent (>30 presentations/year) presenters to the ED (Dinh et al . ). Although there did not appear to be a difference in the re‐presentation rate between the cohorts in the present study, other work has shown that screening, brief intervention, referral, and treatment (SBIRT) in the ED have reduced the harmful use of AOD in this population (Cherpitel et al .…”

Section: Discussionmentioning

confidence: 97%

“…However, we hypothesized that patients presenting involuntarily with or without an AOD issue might in itself be a risk factor for re-presentation to the ED. Previous work in Australia has shown that re-admissions are highest when patients have unmet psychosocial needs upon leaving the department (Moore et al 2012), and those with AOD misuse and mental illness are most likely to become very frequent (>30 presentations/year) presenters to the ED (Dinh et al 2016). Although there did not appear to be a difference in the re-presentation rate between the cohorts in the present study, other work has shown that screening, brief intervention, referral, and treatment (SBIRT) in the ED have reduced the harmful use of AOD in this population (Cherpitel et al 2009;Cunningham et al 2009;D'Onofrio et al 2012;Daeppen et al 2007;D esy & Perhats 2008;InSight Project Research Group 2009;Madras et al 2009;Woodruff et al 2013).…”

Section: Discussionmentioning

confidence: 99%

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Treatment and outcomes of patients presenting to an adult emergency department involuntarily with substance misuse

Hughes

Sheehan

Evans

2017

Int J Mental Health Nurs

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Alcohol and other drug (AOD) use is common in our society. The use of these substances flow throughout all areas of healthcare, and is especially prevalent in patients presenting to the emergency department with signs of mental illness. At the extreme end of these presentations patients present involuntarily with either police or ambulance officers. The aim of this study was to identify and describe the population presenting to the ED involuntarily with and without substance misuse as a precipitating factor. Quantitative descriptive analysis was used to describe this population between April and June 2015. In patients presenting to one large inner city emergency department involuntarily, 30% had alcohol or other drug misuse as a precipitating factor. Patients who involuntarily presented with alcohol and other misuse stay longer in the emergency department then others that do not have alcohol or other drug misuse. These patients represent frequently, with over 50% representing at 90 days however this was not associated with alcohol or other drug misuse. Almost all patients who present involuntarily are discharged home post review by a mental health team. Significant improvements in care can be made in this population if the opportunistic treatment of both mental illness and AOD misuse is completed in the emergency department.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Treatment and outcomes of patients presenting to an adult emergency department involuntarily with substance misuse

Hughes

Sheehan

Evans

2017

Int J Mental Health Nurs

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“…Internationally, the rates of ED re‐presentations within 72 h range between 1% and 5% . In Australia, one New South Wales (NSW) population study and one single centre study from Sydney both demonstrated a re‐presentation rate of 4.9% . This local rate is at the higher end of the range compared to international studies and may represent a greater burden.…”

Section: Introductionmentioning

confidence: 97%

“…The rate of 72 h ED re‐presentations is used as a key performance indicator and is often regarded as a measure of the quality of care provided to patients along with the presence and adequacy of follow‐up healthcare options . Information about these 72 h re‐presentations allows for comparison between healthcare districts with regards to differences in ED use and access to additional primary or specialised care …”

Section: Introductionmentioning

confidence: 99%

Characteristics of short‐term re‐presentations to a regional emergency department

Millhouse

Davies

Tankel

2019

Emerg Medicine Australasia

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Objective: The present study aims to describe the characteristics of early ED re-presentations in a regional hospital in New South Wales, Australia. Methods: This was a retrospective review of all patients re-presenting within 72 h of discharge from Coffs Harbour Base Hospital ED, a regional ED, for the 2016-2017 financial year. Presentations were categorised according to their diagnosis and cause for re-presentation. Results: Of the 38 986 presentations to the ED within the study period, 2125 patients met re-presentation inclusion criteria (5.45%). Diagnoses most likely to re-present were injury/trauma (18.8%), gastrointestinal (14.8%) and psychiatric (12.5%). The most common cause for re-presentation was disease progression (32.7%). Patients aged over 66 were the most likely to be admitted on re-presentation (35.8%) followed by the 17-65 age group (24.2%) and the <16 age group (18.7%).Conclusions: Re-presentations were common, but did not lead to increased admissions. The regional hospital in the present study had a higher 72 h ED re-presentation rate than the comparative major city hospital. In particular, paediatric and psychiatric re-presentations were a greater burden to the regional ED. This may be secondary to a lack of alternative services, particularly for these patient groups. Improving these outpatient services may help to reduce the burden of 72 h ED representations.

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“…Despite these complexities, management of the frail older adult continues to be caught up in the ‘one size fits all’ model of care currently seen in many EDs . This often leads to unnecessary invasive investigations, high rates of admission and re‐admission, delayed and fragmented care and longer ED LoS . If admitted, RACF residents suffer high rates of iatrogenic hospital acquired complications such as falls, urosepsis and delirium .…”

Section: Introductionmentioning

confidence: 99%

Effect of the Geriatric Emergency Department Intervention on outcomes of care for residents of aged care facilities: A non‐randomised trial

Marsden

Taylor

Wallis

et al. 2019

Emerg Medicine Australasia

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Objective: As the population of Australia ages, EDs will experience an increasing frequency of presentations of older adults from residential aged care facilities (RACFs). These presentations are often complex and time consuming in the chaotic and potentially hazardous ED environment. The Geriatric Emergency Department Intervention (GEDI) model was developed to optimise the care of frail older adults, especially RACF residents, in the ED. The aim of the present study was to evaluate the effectiveness of the GEDI model on the primary outcomes of disposition (admission, discharge or death) and ED length of stay for residents of RACFs, presenting to an ED in regional Queensland, Australia. Methods: GEDI is a nurse-led, physician-championed, innovative model delivered by advanced practice nurses with expertise in gerontology. This quasi-experimental pragmatic study compared outcomes for RACF residents who presented to a regional Queensland ED during three time periods: pre-GEDI, interim GEDI and post-GEDI implementation of the GEDI model. Outcomes included disposition, ED length of stay, ED representation and mortality. Results: A significant increase in the likelihood of discharge from ED (hazard ratio 1.15, 95% confidence interval 1.05-1.26) and reductions in ED length of stay (hazard ratio 1.49, 95% confidence interval 1.24-1.78) were evident for RACF residents following the implementation of the GEDI intervention. There were no differences in mortality, ED re-presentation or in-hospital length of stay between the three time periods. Conclusion: There is a paucity of evidence to support the implementation of nurse-led teams in EDs designed to target older adults living in RACFs. The GEDI model was effective in reducing ED length of stay while increasing the likelihood of safe discharge for RACF residents. Key findings• The GEDI is a physicianchampioned, nurse-led model designed to improve care and reduce unnecessary hospitalisation of frail older adults. • The GEDI model decreases the ED length of stay for RACF residents. • The GEDI model increased the likelihood of safe ED discharge for RACF residents.

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Trends and characteristics of short‐term and frequent representations to emergency departments: A population‐based study from New South Wales, Australia

Cited by 33 publications

References 16 publications

Treatment and outcomes of patients presenting to an adult emergency department involuntarily with substance misuse

Treatment and outcomes of patients presenting to an adult emergency department involuntarily with substance misuse

Characteristics of short‐term re‐presentations to a regional emergency department

Effect of the Geriatric Emergency Department Intervention on outcomes of care for residents of aged care facilities: A non‐randomised trial

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