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Multicenter Study
. 2023 Sep 18;23(1):1003.
doi: 10.1186/s12913-023-09760-6.

Clinician consensus on "Inappropriate" presentations to the Emergency Department in the Better Data, Better Planning (BDBP) census: a cross-sectional multi-centre study of emergency department utilisation in Ireland

Niamh M Cummins  1   2   3 , Louise A Barry  4   5   6 , Carrie Garavan  4   5   6 , Collette Devlin  4   5 , Gillian Corey  4   7 , Fergal Cummins  8   7 , Damien Ryan  8   7 , Emma Wallace  9 , Conor Deasy  10 , Mary Flynn  11 , Gerard McCarthy  10   11 ; BDBP Team; Rose Galvin  4   5
Collaborators, Affiliations
Multicenter Study

Clinician consensus on "Inappropriate" presentations to the Emergency Department in the Better Data, Better Planning (BDBP) census: a cross-sectional multi-centre study of emergency department utilisation in Ireland

Niamh M Cummins et al. BMC Health Serv Res. .

Erratum in

Abstract

Background: Utilisation of the Emergency Department (ED) for non-urgent care increases demand for services, therefore reducing inappropriate or avoidable attendances is an important area for intervention in prevention of ED crowding. This study aims to develop a consensus between clinicians across care settings about the "appropriateness" of attendances to the ED in Ireland.

Methods: The Better Data, Better Planning study was a multi-centre, cross-sectional study investigating factors influencing ED utilisation in Ireland. Data was compiled in patient summary files which were assessed for measures of appropriateness by an academic General Practitioner (GP) and academic Emergency Medicine Consultant (EMC) National Panel. In cases where consensus was not reached charts were assessed by an Independent Review Panel (IRP). At each site all files were autonomously assessed by local GP-EMC panels.

Results: The National Panel determined that 11% (GP) to 38% (EMC) of n = 306 lower acuity presentations could be treated by a GP within 24-48 h (k = 0.259; p < 0.001) and that 18% (GP) to 35% (EMC) of attendances could be considered "inappropriate" (k = 0.341; p < 0.001). For attendances deemed "appropriate" the admission rate was 47% compared to 0% for "inappropriate" attendees. There was no consensus on 45% of charts (n = 136). Subset analysis by the IRP determined that consensus for appropriate attendances ranged from 0 to 59% and for inappropriate attendances ranged from 0 to 29%. For the Local Panel review (n = 306) consensus on appropriateness ranged from 40 to 76% across ED sites.

Conclusions: Multidisciplinary clinicians agree that "inappropriate" use of the ED in Ireland is an issue. However, obtaining consensus on appropriateness of attendance is challenging and there was a significant cohort of complex heterogenous presentations where agreement could not be reached by clinicians in this study. This research again demonstrates the complexity of ED crowding, the introduction of evidence-based care pathways targeting avoidable presentations may serve to alleviate the problem in our EDs.

Keywords: Decision making; Emergency Department; General Practice; Health Services Research; Healthcare Quality Improvement.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Bland Altman Plot of Appropriateness Rating by the National GP-EMC Panel for Attendance to the ED in the BDBP Study (n = 306)
See this image and copyright information in PMC

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References

    1. Lucero A, Sokol K, Hyun J, Pan L, Labha J, Donn E, Kahwaji C, Miller G. Worsening of emergency department length of stay during the COVID-19 pandemic. J Am Coll Emerg Physicians Open. 2021;2(3):e12489. doi: 10.1002/emp2.12489. - DOI - PMC - PubMed
    1. Moskop JC, Sklar DP, Geiderman JM, Schears RM, Bookman KJ. Emergency department crowding, part 1–concept, causes, and moral consequences. Ann Emerg Med. 2009;53(5):605–11. doi: 10.1016/j.annemergmed.2008.09.019. - DOI - PubMed
    1. Ieraci S, Cunningham P, Talbot-Stern J, Walker S. Emergency medicine and “acute” general practice: comparing apples with oranges. Aust Health Rev. 2000;23(2):152–61. doi: 10.1071/AH000152. - DOI - PubMed
    1. Carter EJ, Pouch SM, Larson EL. The relationship between emergency department crowding and patient outcomes: a systematic review. J Nurs Scholarsh. 2014;46(2):106–15. doi: 10.1111/jnu.12055. - DOI - PMC - PubMed
    1. Hwang U, McCarthy ML, Aronsky D, Asplin B, Crane PW, Craven CK, Epstein SK, Fee C, Handel DA, Pines JM, et al. Measures of crowding in the emergency department: a systematic review. Acad Emerg Med. 2011;18(5):527–38. doi: 10.1111/j.1553-2712.2011.01054.x. - DOI - PubMed

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