Improving emergency care pathways: an action research approach.

Background Clinicians and managers across specialities are under pressure to review treatment and referral pathways to enable evidence-based practice, improve patient flow and provide a seamless service. This study outlines the processes and outcomes of an action research study conducted to reduce inappropriate attendances and unplanned pressures on Emergency Department (ED) staff in an English hospital during 2006–2008. Methods Action research, comprising three action/reflection cycles conducted with participants, was used. Data were collected using retrospective patient record review (n=35 200) interviews with staff members (n=28), observation of patient pathways (n=38 patients) and measurement of team climate (n=31) with literature reviews also informing each cycle of data collection. Results ED attendance and hospital emergency admission data were largely similar to the national picture with regards to time/day of attendance and seasonal variation. However, in the ‘adult majors’ subgroup, mean attendance on a Monday was significantly higher than the rest of the week (p Conclusions Study data suggest that inappropriate attendances decreased; however, data collection exposed gaps in the existing management information systems and inconsistencies in working practices in the ED. Action research can have a practical value besides contributing to knowledge.