Harris, M, Fry, M & Fitzpatrick, L 2019, 'A clinical process redesign project to improve outcomes and reduce care variance for people with Parkinson's disease', Australasian Emergency Care, vol. 22, no. 2, pp. 107-112.View/Download from: UTS OPUS or Publisher's site
© 2019 College of Emergency Nursing Australasia Background: Redesigning clinical processes is an iterative process that seeks to reduce care variance and improve quality, safety and satisfaction for patients. The aim of this project was to optimise multidisciplinary collaboration, management and integration of clinical processes for people with Parkinson's Disease (PD) in one Emergency Department (ED). Methods: The retrospective evaluation study design explored the outcomes of a clinical process redesign project. The project included: a pre-post medical record audit, a nurse survey and patient and carer telephone interviews. Results: The pre-post ED medical record audit revealed in favour of the post group a median reduction of 175 minutes (IQR 0:40 - 19:40) in length of stay, a 21% improvement in timely PD medication administration and 13% improvement in correctly prescribed PD medications. Patients and carers (n = 47) were satisfied with their ED experience, clinicians' knowledge and management and healthcare decision engagement. Nurses (n = 30) reported improved knowledge, confidence and management in caring for PD patients. Conclusion: This project led to enhanced multidisciplinary engagement and positive patient, clinician and service outcomes. Redesign principles can provide a pragmatic approach to improve the integration of care, change clinician behaviour, and reduce adverse outcomes within any clinical setting.
Fry, M, Fitzpatrick, L, Considine, J, Shaban, RZ & Curtis, K 2018, 'Emergency department utilisation among older people with acute and/or chronic conditions: A multi-centre retrospective study.', International Emergency Nursing.View/Download from: UTS OPUS or Publisher's site
INTRODUCTION: Older persons aged over 65years represent up to 41% of Australian Emergency Department (ED) presentations. Older persons present with acute and/or chronic conditions, have more Emergency Department visits, hospital admissions and readmissions than other age groups. However, little is known about the characteristics and trends of acute illness and chronic presentations and whether frailty changes these dimensions within this cohort. METHODS: A 12-month retrospective medical record audit of persons over 65years presenting to four EDs. RESULTS: Data from 44,774 (26.6%) patients aged 65years and over were analysed. Patients with acute conditions presented more frequently (n=30,373; 67.8%), received more urgent triage categories (n=13,471; 30.1%) and had higher admission rates (n=18,332; 61%). Chronic conditions presented less frequently (n=14,396; 32.1%) and had higher discharge rates (n=9302; 65%). Patients over 80years were allocated more urgent triage categories and commonly presented with falls (n=3814; 8.5%). Patients between 65 and79years had a higher discharge rate (n=10,397; 46.1%). CONCLUSION: Older persons with acute illnesses were more likely to be admitted than those with chronic conditions and who were more likely to be discharged home. There is scope for further investigation of new models of care to better manage older persons with chronic conditions and ED discharge practices.