Latest AHHA-published research on unplanned readmissions, GP registrar referrals to EDs, mental illness impact, and nurse practitioners

Monday, February 4, 2019

Unplanned readmissions, GP registrar referrals to emergency departments, the impact of mental illness, and privately practising nurse practitioners are among the topics investigated in the February 2019 edition of the Australian Healthcare and Hospitals Association’s peer-reviewed academic journal Australian Health Review (AHR).

Unplanned hospital readmissions

A Deakin University/Eastern Health research team led by Professor Julie Considine analysed unplanned hospital readmissions within 28 days (a safety and quality indicator) in Victoria’s Eastern Health region. The team found that:

  • 1 in 7 discharges resulted in an unplanned readmission. One in 10 readmissions occurred within one day. Around one-half of all readmissions occurred by Day 8.
  • The factors associated with increased risk in admission varied between patient groups—any ‘one-size-fits-all’ attempt to reduce readmissions therefore might not work.
  • A longer length of stay with the original admission was associated with a higher chance of readmission, as was age, and ED attendances within the preceding 6 months. All are markers of more complex cases.
  • There is not enough information to show if readmissions were due to not adequately addressing complex conditions during the original stay, or due to typical disease progression or a combination of both.

GP registrar referrals to emergency departments

A five-state combined research team led by Nigel Catzirikis and Amanda Tapley from GP Synergy and the University of Newcastle examined GP registrar referral patterns to emergency departments compared with those of established GPs. (A GP registrar is a fully qualified and registered doctor currently on a 3-year GP registration course.)

Around 8% of all emergency department presentations are referred from general practice.

The team found that GP registrar ED referral rates were nearly double those of established GPs. Likely contributing factors included that GP registrars were more likely to be seeing new patients, with more serious acute illnesses or injuries.

Economic impact of mental illness

A Central Queensland University research team led by Professor Christopher Doran conducted a literature review of 45 studies from around the world looking at the economic impact and cost of mental illness.

The studies highlight the significant burden mental illness places on individuals, families, workplaces and the wider economy. Mental illness results in a greater chance of leaving school early, less chance of full-time employment and a reduced quality of life.

Although no estimates of current and projected costs yet exist for Australia, overseas studies suggest mental illness costs will rise six-fold over the next 30 years.

Privately practising nurse practitioners

A Sydney Nursing School research team led by Jane Currie found that while MBS and PBS subsidisation of private nurse practitioner services had been in place since 2010 to take the load off GPs, the Medicare item numbers unnecessarily restricted nurse practitioners from operating to their full scope of practice, from referring patients to diagnostic services or allied health professionals, or from providing complete episodes of care. This often resulted in unnecessary duplication and costs through forcing patients to see a GP for necessary referrals. Also, MBS revenue alone was not enough to make nurse practitioner services viable. The study suggests policy changes and restructuring of the nurse practitioner MBS and PBS items are needed to maximise community access to nurse practitioner care.

The February 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:  Prof. Sonĵ Hall, Editor in Chief, Australian Health Review

0427 613 587