‘Emergency departments are as different as they are similar’

Friday, August 2, 2019

Research on 20 Emergency Departments (EDs) in Queensland shows considerable variability in models of care used to meet ever-increasing patient demand. The study has been published today in Australian Health Review, the peer-reviewed journal of the Australian Healthcare and Hospitals Association (AHHA).

A Queensland research team led by Dr Anthony Bell found that while many different models of care were used across intake, throughput and output stages, it was not clear how they reflected the needs of patients, nor how they related to each other or ED performance.

Innovations recorded by the researchers included physicians on triage or medical assessment teams, dividing caseloads into clinical streams according to likelihood of admission, and dedicated shift coordinators controlling patient flows rather than a Senior Medical Officer.

ED efficiency depended on the rest of the system working well to manage patient flow out of the ED, including short-stay units, ‘transit lounges’ and hospital-in-the-home facilities, as well as admission to the hospital itself.

The authors say that models of care targeting patients from aged care facilities or the frail elderly is ‘the next wave of implementation’ for EDs through hospital-in-the-nursing-home and other outreach options, and through supported discharge to primary place of residence.

In a second study published today, another research team investigated potentially preventable hospitalisations in regional Queensland.

They found that 11% of all admissions were potentially preventable, and that most of these were for chronic conditions such as chronic obstructive pulmonary disease (COPD), diabetes complications, congestive cardiac failure, angina, iron deficiency anaemia and asthma.

Potentially preventable hospitalisation rates for Aboriginal and Torres Strait Islander people were 3.4 times as high as for non-Indigenous Australians. 

The results suggest clear opportunities to improve local hospital and primary health services to reduce hospitalisations for common preventable conditions. In particular, community-level health services need to be more responsive to the needs of local Indigenous families.

A third paper published today, by a research team from Monash University and Monash Health, describes the missed opportunities so far for all parts of the health system to systematically learn from and make improvements following patient complaints and medico-legal claims.

Traditionally, the authors say, learning from medical errors has been achieved principally from reviews of adverse clinical outcomes. Learning in a systematic manner from patient complaints and legal action has been less well harnessed.

The authors suggest models for data sharing in order to achieve improvements but warn against superficial data reporting: ‘For example, it would be inadequate to simply report that obstetrics is a leading cause of medical litigation. Such a superficial level of reporting does not inform targeted improvements in care provision. In contrast, the finding that severe perineal trauma is an increasing cause of litigation affords clinicians and services an opportunity to focus on specific improvement initiatives and to measure the effects of those initiatives.’

Also included in AHR August 2019 is a policy reflection piece by prominent mental health expert Dr Ian HickieTime for structural reform in mental health: who is up for the challenge?

The August 2019 issue of Australian Health Review is available online. Some articles are freely available through open access, while others need a subscription or can be purchased individually.

The Australian Healthcare and Hospitals Association is the national peak body for public and not-for-profit hospitals, Primary Health Networks, and community and primary healthcare services.

Media enquiries:  Dr Sonĵ Hall, Editor in Chief, Australian Health Review

0427 613 587