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Right service, right place: optimising utilisation of a community nursing service to reduce planned re-presentations to the emergency department


Lawton, JK and Kinsman, L and Dalton, L and Walsh, F and Bryan, H and Williams, S, Right service, right place: optimising utilisation of a community nursing service to reduce planned re-presentations to the emergency department, BMJ Open Quality, 6 pp. 1-8. ISSN 2399-6641 (2017) [Refereed Article]


Copyright Statement

Copyright BMJ Publishing Group Limited. Licensed under Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)

DOI: doi:10.1136/bmjoq-2017-000150


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.

Item Details

Item Type:Refereed Article
Keywords:Emergency services, hospital; community nursing; evaluation
Research Division:Health Sciences
Research Group:Health services and systems
Research Field:Health services and systems not elsewhere classified
Objective Division:Health
Objective Group:Evaluation of health and support services
Objective Field:Evaluation of health and support services not elsewhere classified
UTAS Author:Lawton, JK (Ms Jessica Lawton)
UTAS Author:Kinsman, L (Professor Leigh Kinsman)
UTAS Author:Dalton, L (Associate Professor Lisa Dalton)
ID Code:122930
Year Published:2017
Deposited By:Health Sciences
Deposited On:2017-12-06
Last Modified:2018-09-13
Downloads:101 View Download Statistics

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