Abstract
BackgroundAustralia’s only island state, Tasmania, experiences one of the nation’s highest incidences of non-urgent emergency department (ED) presentations in a healthcare system regularly faced with service demands that exceed resource availability. Service-demand mismatches are acknowledged to contribute to ED crowding which in turn, has been documented to have a correlation with poorer patient outcomes. Crowding within EDs is complex, non-urgent presentations alone are not the primary cause, but have been reported to be a contributing factor. In 2015–16 Tasmania recorded over 153,000 ED attendances, 55% of these fell into the two least urgent triage categories. Recent research in the State’s North established that 29% of non-urgent presentations were referred, formally or informally, from primary healthcare providers and that, for many patients (39%), the ED was not their first choice of service provider. This study aims to identify the service needs of patients referred to a regional Australian ED and subsequently triaged as non-urgent.MethodIn order to achieve this aim, three objectives have been identified. The first two objectives use an explanatory sequential mixed-method approach while the third objective will incorporate an implementation science approach. These three objectives are: first, a retrospective analysis of seven years of routinely collected hospital data to identify trends in referral of patients with non-urgent conditions; second, focus group interviews with patients and primary care providers to further understand perceived need and service requirements of those referred to the ED, and third, translation of findings into local health service recommendations.DiscussionIdentification of the needs of patients referred to the ED with non-urgent conditions will inform future service planning aiming to facilitate access to the right service at the right time and in the right place.
Highlights
IntroductionIn 2000, Derlet and Richards [1] identified a number of concerns held by emergency department (ED) physicians across the United States which included: increased risk to public safety; increased time to analgesia; extended waiting time; patient dissatisfaction; decreased physician satisfaction; increased violence; miscommunication; and negative impact on teaching
Australia’s only island state, Tasmania, experiences one of the nation’s highest incidences of non-urgent emergency department (ED) presentations in a healthcare system regularly faced with service demands that exceed resource availability
Identification of the needs of patients referred to the ED with non-urgent conditions will inform future service planning aiming to facilitate access to the right service at the right time and in the right place
Summary
In 2000, Derlet and Richards [1] identified a number of concerns held by ED physicians across the United States which included: increased risk to public safety; increased time to analgesia; extended waiting time; patient dissatisfaction; decreased physician satisfaction; increased violence; miscommunication; and negative impact on teaching. Since these themes have remained constant; with increased hospital length of stay, morbidity and mortality shown to be associated with ED crowding [2,3,4,5,6,7,8]. Recent studies have demonstrated a link between ED crowding and the presence of patients with non-urgent conditions in the ED and limited access to primary care services [10,11,12,13,14]
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