Patients' Psychological and Practical Reasons for Attending the Cairns Hospital Emergency Department: a mixed methods study (P3ED)
Mills, Jane, Watt, Kerrianne, Beaton, Neil, Wilson, Michael, Neighbour, Nicky, Davis, Scott, Panzera, Annette, Stone, Richard, Rose, Ben, Brose, Jarred, Cant, Robyn, Towne, Murray, Hitchins, Marnie, and Groth, Anna (2014) Patients' Psychological and Practical Reasons for Attending the Cairns Hospital Emergency Department: a mixed methods study (P3ED). Report. James Cook University, Cairns, QLD, Australia.
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Abstract
This mixed methods research study provides an analysis of patients' psychological and practical reasons for attending the Cairns Hospital Emergency Department (ED) (P3ED study). The research has four main aims: to provide an analysis of current and recent trends in utilisation of the Cairns Hospital ED; to estimate the rate of GP-type patients presenting to the Cairns Hospital ED; to identify the psychological and practical reasons for people attending the Cairns Hospital ED; and to consider alternative models of care to potentially reduce presentations to the ED. The study was undertaken by the Centre of Nursing and Midwifery Research, James Cook University in collaboration with both the Cairns and Hinterland Hospital and Health Service and the Far North Queensland Medicare Local (the research funders). The principle rationale for the study was the increasing number of ED presentations at the Cairns Hospital, above Queensland average per annum increases, and an interest in investigating consumers' motivations in attending the Cairns Hospital ED.
The research study has multiple datasets. Firstly, survey data form study participants, defined as consenting patients presenting to the Cairns Hospital Emergency Department from 13 March - 11 April 2014. Consenting patients undertook a 52 item survey instrument administered via iPads, with the assistance of research assistants (3rd/4th year nursing students and 4th/5th/6th year medical students). Secondly, focus groups were held post-ED presentation providing data from 16 focus group participants in total. Willing participants left contact details for follow up to participate in focus groups which were held in April-May 2014 at Smithfield, Cairns North, and Edmonton Community Health Centres. Thirdly, Emergency Department Information System (EDIS) data from 2010-2014, including the period of the survey administration represents the third dataset. This data provided a range of data items for all ED presentations over the period, notably age, gender, postcode, triage category, length of stay, mode of arrival, referral status, ICD code. For the one month survey period the EDIS data was matched to the survey data via Medical Record Number (MRNs). MRNs were collected in a log casebook at the time of the iPad survey and were later matched to the MRNs provided with the EDIS data for the survey month only and for those survey participants that consented to have their medical record accessed (relating to that visit only). This created a fourth dataset - a matched dataset of EDIS and survey data for consenting survey participants only, for the period 13 March - 11 April 2014.
Key findings of the study were the following:
1. The most significant increase in ED presentations in the past four years has occurred among adults (16-74yrs);
2. Lack of consumer confidence in primary health care services based on the public perception that many health conditions are "too complicated" for such services is potentiating ED presentations;
3. The increase in ED presentations can be partially linked to acute exacerbations of chronic disease;
4. While parents of young children have good access to GP services, the ED is often considered the 'best place' for medical care.
Analysis of the data gathered in the P3ED project has highlighted a number of 'red flag' issues around ED use in the Cairns and Hinterland Hospital and Health Service district. Further work is needed to provide a targeted and more detailed analysis of the existing dataset and an expansion of the dataset to include other sources of information, with a view to supporting projects, people and services that will ease pressure on the ED and strengthen current models of service delivery. Three additional areas are recommended for further investigation: the establishment of a minor injuries clinic, the development of an electronic patient decision making support system, and strategies to prevent exacerbations of chronic disease that lead patients to present to the ED.
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