Why do patients seek primary medical care in emergency departments?

MacKichan, F. (2017) BMJ Open. 7:e013816

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Objectives: To describe how processes of primary care access influence decisions to seek help at the emergency department (ED).

Conclusions: This study provides important insight into the implicit role of primary care access on the use of ED. Discourses around ‘inappropriate’ patient demand neglect to recognise that decisions about where to seek urgent care are based on experiential knowledge. Simply speeding up access to primary care or increasing its volume is unlikely to alleviate rising ED use. Systems for accessing care need to be transparent, perceptibly fair and appropriate to the needs of diverse patient groups.

Read the full article here

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Emergency departments under pressure

The Institute of Health Care Management has published The Winter’s Tale: leadership lessons from emergency departments under pressure.

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Image source: ihm.org.uk/

The report focuses on the processes and behaviours of the emergency teams that are managing to deliver outstanding results despite the ever increasing challenges.

This report highlights the importance of using data to identify and shape solutions to the pressures in emergency departments.  It identifies key lessons for managers working in or with emergency departments.

The full report can be read online here.

The Impact of Walk-in Centres and GP Co-operatives on Emergency Department Presentations

Crawford, J. et al. International Emergency Nursing | Published online: 18 April 2017

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Image source: Kake – Flickr // CC BY-NC-SA 2.0

Highlights:

  • Workload and resource pressures on EDs require the development of applicable minor illness and injury pathways.
  • Walk-in-centres have the potential to reduce ED workloads but more work is required to substantiate this pathway.
  • GP cooperatives can reduce ED workloads but further evidence is required to be confident of the efficacy of this care pathway.

Read the full abstract here

Winter Insight: NHS 111

An analysis of how NHS 111 has fared, especially over the winter period | Nuffield Trust

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Image source: Nuffield Trust

Key Points:

  • The proportion of callers being dispatched from NHS 111 to emergency services over the last three years has risen. There has been a particular rise in the share of people who are passed to ambulances.
  • There is great variability between different areas in how likely NHS 111 is to send people to A&E or the ambulance service. This might suggest that some areas are too likely, or not likely enough, to send people to emergency services. NHS 111 is also more likely to dispatch an ambulance than to simply send people to A&E – which is the reverse of the usual pattern of NHS use. This lends credence to claims that the service is too risk-averse in some cases.
  • However, contrary to criticism that it adds to the pressure on A&E, the service overall seems to steer people away from emergency services. Patient surveys suggest as many as 8 million more people would have gone to A&E and the ambulance service over the last three years without 111. The call line also soaks up extra demand during winter, when it becomes less likely to refer people to urgent services.
  • NHS 111 still answers the vast majority of calls within a minute, and few people hang up after having to hold for more than 30 seconds. However, it has not met its target of answering 95 per cent of calls within 60 seconds for two-and-a-half years, and it seems prone to serious under-performance when calls spike after Christmas and the New Year.

Read the full report here

Community-Based Palliative Care & Reduced Emergency Department Visits

Spilsbury, K. Annals of Emergency Medicine. Published online: 3 February 2017

Historically, palliative care evolved to meet the end-of-life needs of cancer patients. It has since become apparent that it benefits noncancer terminal conditions such as renal failure, heart failure, chronic obstructive pulmonary disease, and liver failure, although access to and quality of palliative care for these conditions could be improved. In Australia, there has been evidence of this improved access to palliative care in noncancer conditions during the last 10 years.

The objective of this study was to describe patterns of use of EDs by people in their last year of life and how this varied when they received community-based palliative care. We also investigated whether any patient health, social, and demographic factors modified the rates of ED visits while patients were receiving community-based palliative care.

Read the full article here