Reducing Avoidable Copd Emergency Room Presentations: An Integrated Cross-Health Service Utilisation Scoping Initiative In South Queensland

Moloney, C. ORCID: https://orcid.org/0000-0003-2520-1506 and Beccaria, G. ORCID: https://orcid.org/0000-0002-4341-804X and Sneath, E. and Mullens, A. and Issac, H. and King, A. and Gow, J. and Phillips, T. (2020) Reducing Avoidable Copd Emergency Room Presentations: An Integrated Cross-Health Service Utilisation Scoping Initiative In South Queensland. In: The Thoracic Society of Australia & New Zealand and the Australian and New Zealand Society of Respiratory Science Annual Scientific Meeting for Leaders in Lung Health & Respiratory Science (TSANZSRS 2020), 27-31 March, 2020, Melbourne, Australia.


Abstract

Introduction/Aim
Public Health Networks PHNs and The Australian Institute of Health and Welfare are calling for solutions that reduce COPD Emergency Department (ED) presentations, and decrease economic burden. The rationale for this multisite research project was to better establish the context of the situation facing EDs in South West Queensland with a focus on over-utilisation, and to provide some solutions.

Methods
1. Qualitative scoping exercise with 18 staff and 18 patients across 3 major Queensland Health (QH) sites. 2. Scoping review (International literature). 3. QH 2 year data systems summary of characteristics associated with avoidable COPD admissions. 4. Health economic analysis of actual costs for ED presentation.

Results
Thematic analysis from both staff and patient interviews reveals the following core concepts worthy of more in-depth exploration. 1. Integrated communication of patient assessment and history data. 2. A restructure of nurse led roles (Home Visits). 3. A failure to rescue. 4. Knowledge utilisation among ED clinicians. The Scoping Review confirms research should target ED avoidance and community management. Systems summary data confirm infective exacerbation, co-morbidities like Coronary heart disease, Depression, and Asthma as major contributors to presentation. Economic data reveals a total health service cost of $42, 142, 474 for ED presentations across all 3 sites. 41.1% of presentations assessed as category 3 or 4 in the EDs were transferred home on the same day. Targeting ED avoidance in this cohort reveals a cost saving of $533 per patient or $1,269,181 (as per, National Hospital Cost Data Collection estimates).

Conclusion
Innovative and targeted ED avoidance strategies are required that offer alternative COPD assessment points, ongoing support and monitoring, and earlier detection of deterioration, e.g. nurse led home visits. Clinician compliance with COPD X guidelines needs to be actively measured and reported.

Grant Support
Emergency Medicine Foundation: grant number EMSS-364R28-2017


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Item Type: Conference or Workshop Item (Commonwealth Reporting Category E) (Poster)
Refereed: Yes
Item Status: Live Archive
Faculty/School / Institute/Centre: Current - Faculty of Health, Engineering and Sciences - School of Nursing and Midwifery (1 Jan 2015 -)
Faculty/School / Institute/Centre: Current - Faculty of Health, Engineering and Sciences - School of Psychology and Counselling (1 Jan 2015 -)
Date Deposited: 14 Aug 2020 04:47
Last Modified: 09 Oct 2020 05:17
Uncontrolled Keywords: Chronic obstructive pulmonary disease (COPD); emergency department (ED) presentations; Queensland Health (QH); South West Queensland
Fields of Research (2008): 11 Medical and Health Sciences > 1110 Nursing > 111003 Clinical Nursing: Secondary (Acute Care)
Fields of Research (2020): 42 HEALTH SCIENCES > 4205 Nursing > 420501 Acute care
Socio-Economic Objectives (2008): E Expanding Knowledge > 97 Expanding Knowledge > 970111 Expanding Knowledge in the Medical and Health Sciences
Identification Number or DOI: https://doi.org/10.1111/resp.13778
URI: http://eprints.usq.edu.au/id/eprint/37846

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