Dr Melanie Jessup1, Professor Paul Fulbrook2,3, Dr Frances Kinnear1,3
1University Of Queensland, Wynnum , Australia, 2Australian Catholic University, Chermside, Australia, 3The Prince Charles Hospital, Chermside, Australia
Background: Integrating ambulance and emergency department (ED) activity is an ongoing issue. Targets for timely ambulance transfer of patients to the appropriate ED are not always met, with delays in admission to ED being a continued concern, and timely throughput targets (POST/NEAT) also falling short. This project investigated the decision-making around ambulance destination from the user’s perspective.
Aim: To gather in-depth data about destination decision making processes, resources and impacts.
Method: Utilising a case study design, data were collected from individual interviews with 30 purposively selected patients and the relatives associated with their episode of care, representing diverse diagnoses and triage categories. A van Manen (1990) approach to thematic analysis of the interview data was used.
Results: Patients and relatives recounted their episode, the reasons they called an ambulance, and their input into ED destination. Analysis of the data revealed notions of convenience and manipulation of the system on the part of patients, these dynamics often competing with the integral system drivers of capacity, catchment and continuity of care.
Conclusion: Various systems of decision-making, augmented by professional expertise and supporting information and communication technologies, have been devised to facilitate ambulance destination. However, these can be subtly driven by extraneous human input/factors. Awareness of these can inform the capability to make delivery of patients to ED more efficient. Ensuring patients are taken to the most suitable ED for their condition can help to reduce morbidity and mortality, easing their journey through the system due to enhanced effectiveness from pickup point, through their ambulance trip, to the ED. Findings will be used to inform a larger study to develop a decision-making framework that will enable optimal ED destinations to be determined, focused primarily on the patient in terms of needs and timeliness of treatment.
Melanie is a lecturer at the University of Queensland, where she lectures in the Master of Nursing Studies programme and supervises research higher degree candidates. Her research focuses on working with multi-disciplinary teams in her two distinct areas of interest: emergency medical care – patient and system flow and workforce issues, and in chronic conditions – patient self-management in respiratory conditions. Melanie enjoys collaborative links with colleagues in emergency care, in paediatric and adult respiratory, and the CSIRO’s Australian e-Health Research Centre.