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Abstract

Background:Congruent with international risingemergency department (ED) demand, a focus on strategiesand services to reduce burden on EDs and improvepatient outcomes is necessary. Planned re-presentationsof non-urgent patients at a regional Australian hospitalexceeded 1200 visits during the 2013–2014 financial year.Planned re-presentations perpetuate demand and signifya lack of alternative services for non-urgent patients.The Community Nursing Enhanced Connections Service(CoNECS) collaboratively evolved between acute care andcommunity services in 2014 to reduce planned ED representations.Objective: This study aimed to investigate the evolution andimpact of a community nursing service to reduce planned representationsto a regional Australian ED and identify enablersand barriers to interventionist effectiveness.Methods: A mixed-methods approach evaluated theimpact of CoNECS. Data from hospital databases includingmeasured numbers of planned ED re-presentations bymonth, time of day, age, gender and reason were used tocalculate referral rates to CoNECS. These results informedtwo semistructured focus groups with ED and communitynurses. The researchers used a theoretical lens, ‘diffusionof innovation’, to understand how this service could informfuture interventions.Results:Analyses showed that annual ED planned representationsdecreased by 43% (527 presentations)after implementation. Three themes emerged from thefocus groups. These were right service at the right time,nursing uncertainty and system disconnect and medicaldisengagement.Conclusions: CoNECS reduced overall ED planned representationsand was sustained longer than many complexservice-level interventions. Factors supporting the servicewere endorsement from senior administration and strongleadership to drive responsive quality improvement strategies.This study identified a promising alternative service outsidethe ED, highlighting possibilities for other hospital emergencyservices aiming to reduce planned re-presentations.

Item Type:	Article
Authors/Creators:	Lawton, JK and Kinsman, L and Dalton, L and Walsh, F and Bryan, H and Williams, S
Keywords:	Emergency services, hospital; community nursing; evaluation
Journal or Publication Title:	BMJ Open Quality
Publisher:	BMJ Open Quality
ISSN:	2399-6641
DOI / ID Number:	https://doi.org/10.1136/bmjoq-2017-000150
Copyright Information:	Copyright BMJ Publishing Group Limited. Licensed under Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) https://creativecommons.org/licenses/by-nc/4.0/
Related URLs:	Google Scholar: Kinsman, L UTAS Profile: Kinsman, L Google Scholar: Dalton, L UTAS Profile: Dalton, L
Item Statistics:	View statistics for this item

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