Right service, right place: optimising utilisation of a community nursing service to reduce planned re-presentations to the emergency department
2017
Background: Congruent with international rising
emergency department (ED) demand, a focus on strategies
and services to reduce burden on EDs and improve
patient outcomes is necessary. Planned re-presentations
of non-urgent patients at a regional Australian hospital
exceeded 1200 visits during the 2013–2014 financial year.
Planned re-presentations perpetuate demand and signify
a lack of alternative services for non-urgent patients.
The Community Nursing Enhanced Connections Service
(CoNECS) collaboratively evolved between acute care and
community services in 2014 to reduce planned ED representations. Objective: This study aimed to investigate the evolution and
impact of a community nursing service to reduce planned representations
to a regional Australian ED and identify enablers
and barriers to interventionist effectiveness. Methods: A mixed-methods approach evaluated the
impact of CoNECS. Data from hospital databases including
measured numbers of planned ED re-presentations by
month, time of day, age, gender and reason were used to
calculate referral rates to CoNECS. These results informed
two semistructured focus groups with ED and community
nurses. The researchers used a theoretical lens, ‘diffusion
of innovation’, to understand how this service could inform
future interventions. Results: Analyses showed that annual ED planned representations
decreased by 43% (527 presentations)
after implementation. Three themes emerged from the
focus groups. These were right service at the right time,
nursing uncertainty and system disconnect and medical
disengagement. Conclusions: CoNECS reduced overall ED planned representations
and was sustained longer than many complex
service-level interventions. Factors supporting the service
were endorsement from senior administration and strong
leadership to drive responsive quality improvement strategies.
This study identified a promising alternative service outside
the ED, highlighting possibilities for other hospital emergency
services aiming to reduce planned re-presentations.
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