Understanding the patient journey to the Emergency Department - A South Australian study.

BACKGROUND: To determine patients' points of contact prior to or decision making processes before presenting to an Emergency Department for treatment. To obtain data that may inform future exploration of targeted Emergency Department avoidance strategies. METHOD: All patients presenting to two metropolitan Emergency Departments over a 24h period were surveyed. Where information was unattainable, it was sought from computerised Patient Administration Systems used by each Emergency Department. A descriptive analysis of the results was undertaken. RESULTS: Three hundred and thirty two patients presented over the 48 h survey period. Results showed that 200 (60.2%) were self-referred, 65 patients (19.6%) contacted their general practitioner, 22 (6.6%) were transferred from other hospitals and 3 patients (0.9%) contacted the National Healthdirect Australia triage hotline prior to presenting to the Emergency Department. CONCLUSION: The study showed 39.8% had sought advice from other health care professionals prior to presenting to the Emergency Department and that 60.2% of patients were self-referred. This study has not revealed any new pathways that warrant targeting for Emergency Department avoidance strategies. The focus still needs to target primary care referrals, ambulance service transports and smaller hospital transfers.

A multidisciplinary Care Coordination Team improves emergency department discharge planning practice.

In response to difficulties meeting the demand for hospital services ("access block") at Royal Melbourne Hospital, a major metropolitan tertiary referral hospital, an audit of patient needs revealed a shortage of aged-care beds and a need for post-acute care. A multidisciplinary Care Coordination Team (CCT) was formed at the end of July 2000 to ensure that emergency department patients were provided with services that would facilitate their return to, or maintenance in, the community. The target population included the frail elderly, those living alone, the homeless, frequent emergency department attenders, and those with complex medical or drug and alcohol problems. As part of routine emergency department care, a risk screen was implemented to determine referral to the CCT. In the first 12 months, the CCT saw 2532 patients (5.8% of all emergency department attendances). Nearly half of these patients were discharged home with referrals to community service providers. The rate of hospital admission from the emergency department fell significantly compared with the 12-month period before implementation of the CCT (13 420 patients, 30.9% [95% CI, 30.5-31.3] v 14 217 patients, 32.6% [95% CI, 32.2-33.0]; P < 0.001). Surveys of staff, patients and carers, as well as community service providers, showed a high level of satisfaction with the CCT.