RESUMEN
BACKGROUND: Congruent with international rising emergency department (ED) demand, a focus on strategies and services to reduce burden on EDs and improve patient outcomes is necessary. Planned re-presentations of non-urgent patients at a regional Australian hospital exceeded 1200 visits during the 2013-2014 financial year. Planned re-presentations perpetuate demand and signify a lack of alternative services for non-urgent patients. The Community Nursing Enhanced Connections Service (CoNECS) collaboratively evolved between acute care and community services in 2014 to reduce planned ED re-presentations. OBJECTIVE: This study aimed to investigate the evolution and impact of a community nursing service to reduce planned re-presentations to a regional Australian ED and identify enablers and barriers to interventionist effectiveness. METHODS: A mixed-methods approach evaluated the impact of CoNECS. Data from hospital databases including measured numbers of planned ED re-presentations by month, time of day, age, gender and reason were used to calculate referral rates to CoNECS. These results informed two semistructured focus groups with ED and community nurses. The researchers used a theoretical lens, 'diffusion of innovation', to understand how this service could inform future interventions. RESULTS: Analyses showed that annual ED planned re-presentations decreased by 43% (527 presentations) after implementation. Three themes emerged from the focus groups. These were right service at the right time, nursing uncertainty and system disconnect and medical disengagement. CONCLUSIONS: CoNECS reduced overall ED planned re-presentations and was sustained longer than many complex service-level interventions. Factors supporting the service were endorsement from senior administration and strong leadership to drive responsive quality improvement strategies. This study identified a promising alternative service outside the ED, highlighting possibilities for other hospital emergency services aiming to reduce planned re-presentations.
RESUMEN
OBJECTIVE: A more appropriate tool to measure the client experience of person-centred care is required to complement other existing measures of quality. A tool developed in the United Kingdom was trialled to determine its utility with a frail older Australian population. DESIGN: A random sample of clients recently discharged from a sub-acute setting over a 6-month period in 2005 were sent a questionnaire and invited to respond, a reply-paid envelope being provided for the return of the questionnaire. The questionnaire comprised the 20-item tool and space to provide additional qualitative comments. SETTING: The inpatient wards of a sub-acute facility in Melbourne. PARTICIPANTS: From the random sample of 144 discharged clients, 78 responded to the questionnaire. MAIN OUTCOME MEASURE: 20-item Patient-Centred Inpatient Scale (P-CIS) developed by Coyle and Williams (2001). RESULTS: Overall, there was a fundamental core of person-centredness as demonstrated by a ratio score of 0.68. Personalisation and respect dimensions are the main strengths of person-centred care in the health care setting in which the P-CIS was trialled, with personalisation scoring 0.75 and respect scoring 0.77. The miscellaneous components scored 0.69. The findings show that areas of the client experience warranting priority quality improvement effort are specific to the dimensions of empowerment (0.58), information (0.58) and approachability/availability (0.43). CONCLUSIONS: The P-CIS demonstrates the potential to be a contributing component that informs the monitoring and improvement of quality person-centred care in Australian inpatient health care settings.