Nurse Discharge Planning in the Emergency Department: A Toowoomba, Australia, Study

Hegney, Desley, Buikstra, Elizabeth, Chamberlain, Chris, March, Judy, McKay, Michelle, Cope, Gail and Fallon, Tony (2005) Nurse Discharge Planning in the Emergency Department: A Toowoomba, Australia, Study. Journal of Clinical Nursing, 15 8: 1033-1044. doi:10.1111/j.1365-2702.2006.01405.x

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Author Hegney, Desley
Buikstra, Elizabeth
Chamberlain, Chris
March, Judy
McKay, Michelle
Cope, Gail
Fallon, Tony
Title Nurse Discharge Planning in the Emergency Department: A Toowoomba, Australia, Study
Journal name Journal of Clinical Nursing   Check publisher's open access policy
ISSN 0962-1067
1365-2702
Publication date 2005-06-01
Sub-type Article (original research)
DOI 10.1111/j.1365-2702.2006.01405.x
Open Access Status File (Author Post-print)
Volume 15
Issue 8
Start page 1033
End page 1044
Total pages 12
Editor R. Watson
Place of publication United Kingdom
Publisher John Wiley & Sons, Inc.
Language eng
Subject 321100 Nursing
Abstract Aim. This study aimed to ascertain whether a model of risk screening carried out by an experienced community nurse was effective in decreasing re-presentations and readmissions and the length of stay of older people presenting to an Australian emergency department. Objectives. The objectives of the study were to (i) identify all older people who presented to the emergency department of an Australian regional hospital; (ii) identify the proportion of re-presentations and readmissions within this cohort of patients; and (iii) risk-screen all older patients and provide referrals when necessary to community services. Design. The study involved the application of a risk screening tool to 2139 men and women over 70 years of age from October 2002 to June 2003. Of these, 1102 (51.5%) were admitted and 246 (11.5%) were re-presentations with the same illness. Patients presenting from Monday to Friday from 08:00 to 16:00 hours were risk-screened face to face in the emergency department. Outside of these hours, but within 72 hours of presentation, risk screening was carried out by telephone if the patient was discharged or within the ward if the patient had been admitted. Results. There was a 16% decrease in the re-presentation rate of people over 70 years of age to the emergency department. Additionally during this time there was a 5.5% decrease in the readmission rate (this decrease did not reach significance). There was a decrease in the average length of stay in hospital from 6.17 days per patient in October 2002 to 5.37 days per patient in June 2003. An unexpected finding was the decrease in re-presentations in people who represented to the emergency department three or more times per month (known as 'frequent flyers'). Conclusions. Risk screening of older people in the emergency department by a specialist community nurse resulted in a decrease of re-presentations to the emergency department. There was some evidence of a decreased length of stay. It is suggested that the decrease in re-presentations was the result of increased referral and use of community services. It appears that the use of a specialist community nurse to undertake risk screening rather than the triage nurse may impact on service utilization. Relevance to clinical practice. It is apparent that older people presenting to the emergency department have complex care needs. Undertaking risk screening using an experienced community nurse to ascertain the correct level of community assistance required and ensuring speedy referral to appropriate community services has positive outcomes for both the hospital and the patient.
Keyword emergency department
length of stay
nurse risk screening
older people
re-presentations
readmissions
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ
Additional Notes This is an author version of an article originally published as : Desley Hegney, Elizabeth Buikstra, Chris Chamberlain, Judy March, Michelle McKay, Gail Cope and Tony Fallon (2006) Nurse Discharge Planning in the Emergency Department: A Toowoomba, Australia, Study, Journal of Clinical Nursing (2006) 15 (8): 1033-1044. doi:10.1111/j.1365-2702.2006.01405.x Copyright 2006 Blackwell Publishing. All rights reserved.

 
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Created: Tue, 19 Sep 2006, 10:00:00 EST by Vicki Percival on behalf of School of Nursing, Midwifery and Social Work