Project 150 – Nursing Honours Scholarship – Jessica Lawson

01 Feb 2017

Scholarship Holder – Jessica Lawson – Research Project – Right service, right place: optimising utilisation of a community nursing program to reduce ED attendances

It is known that many people attend emergency departments (ED) with complaints and concerns that are considered non-urgent/emergent. The Launceston General Hospital ED suffers the consequences of overcrowding, which can have a significant negative impact on patient outcomes, patient satisfaction, staff burnout and adverse events. In 2013, planned return visits by non-urgent patients to the emergency department (ED) in Launceston reached an all-time high, an issue also recognised across Tasmanian EDs. As EDs are meant for acutely unwell patients who have urgent and emergency care needs, questions are constantly raised as to whether the ED is the right place for non-urgent cases to access the care they need.

In 2014, the Department of Health and Human Services (DHHS) work collaborative with Tasmanian Health Service (THS) to design a community-nursing service for these non-urgent patients. The Community Nursing Enhances Connections Service (CoNECS) was planned and implemented to offer patients a service for treatment and follow-up care after an ED visit where they could book in and attend a clinic instead. This would, in-turn, reduce the number of planned visits to the ED for non-urgent patients. The CoNECS successfully reduced planned visits to the ED by 50%. Through focus groups with ED and Community Nursing staff, we identified that the factors contributing to the success of the program were backing from senior hospital administration and commitment to improving the service, for example, improving the referral process. Further improvement led to a redesign of a key nursing role to support the CoNECS. Participants also identified that there were risks to the sustainability of the CoNECS. Issues included having medical staff on board and use of locum doctors. Staff knowledge and inclusion of the CoNECS into regular practice and ongoing unrest within the ED were also key issues. The ED is extremely busy, high-pressure working environment for staff, this makes changes, like new services, challenging to implement and sustain. This study found that the CoNECS provides a promising model of care outside the ED, which could be helpful in guiding other hospitals that aim to reduce planned visits to the ED.

The results of this study were published in the BMJ Quality Improvement reports 2017 – Right person, right place: optimising use of community nursing program to reduce planned re-presentations to the emergency department.