Dataset Information

Socioeconomic disadvantage as a driver of non-urgent emergency department presentations: A retrospective data analysis.

ABSTRACT: BACKGROUND:Globally, emergency departments (EDs) are struggling to meet the service demands of their local communities. Across Australia, EDs routinely collect data for every presentation which is used to determine the ability of EDs to meet key performance indicators. This data can also be used to provide an overall picture of service demand and has been used by healthcare planners to identify local needs and inform service provision, thus, using ED presentations as a microcosm of the communities they serve. The aim of this study was to use ED presentation data to identify who, when and why people accessed a regional Australian ED with non-urgent conditions. METHOD AND MATERIALS:A retrospective data analysis of routinely collected ED data was undertaken. This included data obtained over a seven-year period (July 2009 to June 2016) in comparison with the Australian Bureau of Statistics census data. Analysis included descriptive statistics to identify the profile of non-urgent attendees and linear regression to identify trends in ED usage. RESULTS:This study revealed a consistently high demand for ED services by people with non-urgent conditions (54.1% of all presentations). People living in the most disadvantaged socioeconomic decile contributed to 36.8% of these non-urgent presentations while those under 25 years of age contributed to 41.1%. Diagnoses of mental health and behavioural issues and of non-specific symptoms significantly increased over the study period (p < 0.001) for both diagnostic groups. CONCLUSION:The over-representation by those from the most socioeconomically disadvantaged areas highlights an inequity in access to services. The over-representation by those younger in age indicates behavioural patterns based on age. These key issues faced by our local community and the disparity in current service provision will be used to inform future health policy and service planning.

SUBMITTER: Unwin M

PROVIDER: S-EPMC7153867 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Socioeconomic disadvantage as a driver of non-urgent emergency department presentations: A retrospective data analysis.

Unwin Maria M Crisp Elaine E Stankovich Jim J McCann Damhnat D Kinsman Leigh L

PloS one 20200413 4

<h4>Background</h4>Globally, emergency departments (EDs) are struggling to meet the service demands of their local communities. Across Australia, EDs routinely collect data for every presentation which is used to determine the ability of EDs to meet key performance indicators. This data can also be used to provide an overall picture of service demand and has been used by healthcare planners to identify local needs and inform service provision, thus, using ED presentations as a microcosm of the c ...[more]

PMID: 32282818

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Project description:BACKGROUND:Acute appendicitis is a global disease and a very common indication for emergency surgery worldwide. The need for hospital resources is therefore constantly high. The administration in Kanta-Häme Central Hospital, Southern Finland, called for an urgent reorganisation due to shortage of hospital beds at the department of general surgery. Postoperative treatment pathway of patients with nonperforated acute appendicitis was ordered to take place in the Emergency Department (ED). The aim of this study was to assess, whether this reorganisation was feasible and safe, i.e. did it affect the length of in-hospital stay (LOS) and the 30-day complication rate. METHODS:This is a retrospective pre- and post-intervention analysis. After the reorganisation, most patients with nonperforated appendicitis were followed postoperatively at the 24-h observation unit of the ED instead of surgical ward. Patients operated during the first 3 months after the reorganisation were compared to those operated during the 3 months before it. A case met inclusion criteria if there were no signs of appendiceal perforation during surgery. Exclusion criteria comprised age?<?18?years and perforated disease. RESULTS:Appendicectomy was performed on 112 patients, of whom 62 were adults with nonperforated appendicitis. Twenty-seven of the included patients were treated before the reorganisation, and 35 after it. Twenty of the latter were followed only at the ED. Postoperative LOS decreased significantly after the reorganisation. Median postoperative time till discharge was 15.7?h for all patients after the reorganisation compared to 24.4?h before the reorganisation (standard error 6.2?h, 95% confidence interval 2.3-15.2?h, p <?0.01). There were no more complications in the group treated postoperatively in the ED. CONCLUSIONS:Early discharge of patients with nonperforated appendicitis after enforced urgent reorganisation of the treatment pathway in the ED observation unit is safe and feasible. Shifting the postoperative monitoring and the discharge policy of such patients to the ED - instead of the surgical ward - occurred in the majority of the cases after the reorganisation. This change may spare resources as in our series it resulted in a significantly shorter LOS without any increase in the 30-day complication rate.

Dataset Information

Socioeconomic disadvantage as a driver of non-urgent emergency department presentations: A retrospective data analysis.

Publications

Socioeconomic disadvantage as a driver of non-urgent emergency department presentations: A retrospective data analysis.

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