You are here

  • Home
  • Archive
  • Volume 6, Issue 2
  • Right service, right place: optimising utilisation of a community nursing service to reduce planned re-presentations to the emergency department

Article Text

Article menu

Download PDFPDF

Original article
Right service, right place: optimising utilisation of a community nursing service to reduce planned re-presentations to the emergency department
  1. Jessica Kirsten Lawton1,
  2. Leigh Kinsman1,2,
  3. Lisa Dalton1,
  4. Fay Walsh3,
  5. Helen Bryan2,
  6. Sharon Williams3
  1. 1 University of Tasmania, Launceston, Tasmania, Australia
  2. 2 Tasmanian Health Service, Department of Health and Human Services, Launceston, Tasmania, Australia
  3. 3 Primary Health Tasmania, Department of Health and Human Services, Tasmania, Australia
  1. Correspondence to Jessica Kirsten Lawton; Jessica.Lawton{at}utas.edu.au

Abstract

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 re-presentations.

Objective This study aimed to investigate the evolution and impact of a community nursing service to reduce planned re-presentations 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 re-presentations 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 re-presentations 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.

  • emergency department
  • complexity
  • evaluation methodology
  • health services research

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjoq-2017-000150

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    View Full Text

    Footnotes

    • Contributors JKL, LK, LD, FW, HB and SW were involved in the development of the research proposal. JKL and LK collected and analysed the data. JKL, LK, LD, FW, HB and SW contributed to the writing of the manuscript.

    • Funding The Clifford Craig Foundation supported this project through a $A5000 student scholarship for JKL.

    • Competing interests None declared.

    • Ethics approval Ethical approval for this research was approved and deemed low risk by the Tasmanian Health and Medical Human Research Ethics Committee on 11 March 2016: H001574.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement There is no unpublished data available to share at this time.