A paradigm shift in the nature of care provision in emergency departments
Abstract
OBJECTIVES: Access block to acute hospital inpatient beds has pressured emergency departments (EDs) to develop strategies to facilitate the management of patients in the community (new services) and to streamline ED care (facilitative initiatives). The aim of this study was to determine the nature and extent of those strategies introduced into the 17 public hospital EDs in Melbourne, Australia, since 1998.
METHODS: This was a cross sectional survey of ED directors and/or nurse unit managers undertaken in November and December, 2002. Face to face or telephone interviews were conducted using a researcher administered questionnaire.
RESULTS: All 17 EDs participated. A total of 15 strategies had been introduced into 15 (88.2%) EDs. New services included care coordination teams (12 ED, 70.6%), short stay units (10, 58.8%), psychiatric services (10, 58.8%), chest pain units (7, 41.2%), pharmacy services (3, 17.7%), sexual assault service (1, 5.9%), and hospital in the home within the ED (1, 5.9%). Facilitative initiatives included nurse initiated management (12, 70.6%), fast track processes (10, 58.8%), multidisciplinary triage (4, 23.5%), disposition nurses/communication clerks (3, 17.7%), and day treatment clinics (2, 11.8%).
CONCLUSIONS: Melbourne's EDs have adapted rapidly to external pressures of access block and increasing patient numbers. Many traditional inpatient services have now been incorporated into the EDs. These EDs now provide a different and expanded paradigm of…
How strong is the evidence?
Evidence Hub reads this as a cross-sectional, done in people. Its evidence level is 4 of 5 (Low · observational). Observational designs can show an association but not prove cause.
Read the paper
Related studies
- The Matrisome: In Silico Definition and In Vivo Characterization by Proteomics of Normal and Tumor Extracellular Matrices
- The Escherichia coli MG1655 in silico metabolic genotype: Its definition, characteristics, and capabilities
- In silico pharmacology for drug discovery: methods for virtual ligand screening and profiling
- In silico prediction of splice-altering single nucleotide variants in the human genome
- In silico clinical trials: how computer simulation will transform the biomedical industry
- In silico optimization of a guava antimicrobial peptide enables combinatorial exploration for peptide design
Go deeper in Evidence Hub
Evidence Hub adds a study data sheet (design, sample size, evidence level, key numbers), an AI summary and a chat grounded in the paper's text.