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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-center Study of Emergency Department Utilization in Ireland

Published online by Cambridge University Press:  13 July 2023

Niamh Cummins ,
Louise Barry ,
Carrie Garavan ,
Collette Devlin ,
Gillian Corey ,
Fergal Cummins ,
Damien Ryan ,
Conor Deasy ,
Gerald McCarthy  and
Rose Galvin
Niamh Cummins
Affiliation:
School of Medicine, Faculty of Education and Health Sciences, SLÁINTE Research and Education Alliance in General Practice, Primary Healthcare and Public Health, Health Research Institute, University of Limerick, Limerick, Ireland Department of Paramedicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
Louise Barry
Affiliation:
Department of Nursing and Midwifery, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
Carrie Garavan
Affiliation:
Department of Nursing and Midwifery, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
Collette Devlin
Affiliation:
School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
Gillian Corey
Affiliation:
ALERT Limerick EM Education Research Training, Emergency Department, University Hospital Limerick, Limerick, Ireland
Fergal Cummins
Affiliation:
School of Medicine, Faculty of Education and Health Sciences, SLÁINTE Research and Education Alliance in General Practice, Primary Healthcare and Public Health, Health Research Institute, University of Limerick, Limerick, Ireland ALERT Limerick EM Education Research Training, Emergency Department, University Hospital Limerick, Limerick, Ireland
Damien Ryan
Affiliation:
School of Medicine, Faculty of Education and Health Sciences, SLÁINTE Research and Education Alliance in General Practice, Primary Healthcare and Public Health, Health Research Institute, University of Limerick, Limerick, Ireland ALERT Limerick EM Education Research Training, Emergency Department, University Hospital Limerick, Limerick, Ireland
Conor Deasy
Affiliation:
Emergency Department, Cork University Hospital, Cork, Ireland
Gerald McCarthy
Affiliation:
Emergency Medicine Programme, Royal College of Surgeons in Ireland, Dublin, Ireland
Rose Galvin
Affiliation:
School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
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Abstract

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Introduction:

Utilization of the Emergency Department (ED) for non-urgent care increases demand for services, therefore reducing avoidable attendance is an important area for intervention in the prevention of ED crowding. This study aims to develop a consensus among clinicians across care settings about the “appropriateness” of attendance at the ED in Ireland.

Method:

The Better Data, Better Planning study was a multi-center, cross-sectional study investigating factors influencing ED utilization in Ireland. Following ethical approval, 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 24-48h (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 0-59% and for inappropriate attendances ranged from 0-29%. For the Local Panel review (n=306) consensus on appropriateness ranged from 40-76% across sites.

Conclusion:

Multidisciplinary clinicians agree that “inappropriate” use of Irish EDs is an issue. However, obtaining consensus on appropriateness of attendance is challenging and there was a significant cohort of complex heterogeneous 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.

Type
Lightning and Oral Presentations
Information
Prehospital and Disaster Medicine , Volume 38 , Supplement S1: 22nd Congress on Disaster and Emergency Medicine , May 2023 , pp. s51 - s52
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Copyright
© The Author(s), 2023. Published by Cambridge University Press on behalf of World Association for Disaster and Emergency Medicine