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Clinician consensus on "inappropriate" presentations to the Emergency Department in the Better Data, Better Planning (BDBP) census: a cross-sectional multi-centre study of Emergency Department utilisation in Ireland

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posted on 2023-10-06, 15:53 authored by Niamh M Cummins, Louise A Barry, Carrie Garavan, Collette Devlin, Gillian Corey, Fergal Cummins, Damien Ryan, Emma WallaceEmma Wallace, Conor Deasy, Mary FlynnMary Flynn, Gerard McCarthy, BDBP Team, Rose Galvin

Background: Utilisation of the Emergency Department (ED) for non-urgent care increases demand for services, therefore reducing inappropriate or avoidable attendances is an important area for intervention in prevention of ED crowding. This study aims to develop a consensus between clinicians across care settings about the "appropriateness" of attendances to the ED in Ireland.

Methods: The Better Data, Better Planning study was a multi-centre, cross-sectional study investigating factors influencing ED utilisation in Ireland. Data was compiled in patient summary files which were assessed for measures of appropriateness by an academic General Practitioner (GP) and academic Emergency Medicine Consultant (EMC) National Panel. In cases where consensus was not reached charts were assessed by an Independent Review Panel (IRP). At each site all files were autonomously assessed by local GP-EMC panels.

Results: The National Panel determined that 11% (GP) to 38% (EMC) of n = 306 lower acuity presentations could be treated by a GP within 24-48 h (k = 0.259; p < 0.001) and that 18% (GP) to 35% (EMC) of attendances could be considered "inappropriate" (k = 0.341; p < 0.001). For attendances deemed "appropriate" the admission rate was 47% compared to 0% for "inappropriate" attendees. There was no consensus on 45% of charts (n = 136). Subset analysis by the IRP determined that consensus for appropriate attendances ranged from 0 to 59% and for inappropriate attendances ranged from 0 to 29%. For the Local Panel review (n = 306) consensus on appropriateness ranged from 40 to 76% across ED sites.

Conclusions: Multidisciplinary clinicians agree that "inappropriate" use of the ED in Ireland is an issue. However, obtaining consensus on appropriateness of attendance is challenging and there was a significant cohort of complex heterogenous presentations where agreement could not be reached by clinicians in this study. This research again demonstrates the complexity of ED crowding, the introduction of evidence-based care pathways targeting avoidable presentations may serve to alleviate the problem in our EDs.

Funding

Health Service Executive Clinical Design and Innovation Office (2019–2021)

History

Comments

The original article is available at https://bmchealthservres.biomedcentral.com/

Published Citation

Cummins NM. et al. Clinician consensus on "inappropriate" presentations to the Emergency Department in the Better Data, Better Planning (BDBP) census: a cross-sectional multi-centre study of Emergency Department utilisation in Ireland. BMC Health Serv Res. 2023;23(1):1003

Publication Date

18 September 2023

PubMed ID

37723478

Department/Unit

  • HRB Centre for Primary Care Research
  • Surgical Affairs
  • General Practice

Publisher

BioMed Central

Version

  • Published Version (Version of Record)