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Right service, right place: optimising utilisation of a community nursing service to reduce planned re-presentations to the emergency department

Lawton, JK, Kinsman, L ORCID: 0000-0002-0790-5887, Dalton, L ORCID: 0000-0003-4470-5814, Walsh, F, Bryan, H and Williams, S 2017 , 'Right service, right place: optimising utilisation of a community nursing service to reduce planned re-presentations to the emergency department' , BMJ Open Quality, vol. 6 , pp. 1-8 , doi:

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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:
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Copyright BMJ Publishing Group Limited. Licensed under Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)

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