Development and evaluation of a code frame to identify potential primary care presentations in the hospital emergency department
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
University of Wollongong Research Online Australian Health Services Research Institute Faculty of Business 2019 Development and evaluation of a code frame to identify potential primary care presentations in the hospital emergency department Heike Schutze University of Wollongong, hschutze@uow.edu.au Rhyannan Rees University of Wollongong, St. George Hospital Stephen Asha St George Hospital, University of New South Wales Kathy Eagar University of Wollongong, keagar@uow.edu.au Publication Details H. Schutze, R. Rees, S. Asha & K. Eagar, "Development and evaluation of a code frame to identify potential primary care presentations in the hospital emergency department", Emergency Medicine Australasia Online First (2019) 1-7. Research Online is the open access institutional repository for the University of Wollongong. For further information contact the UOW Library: research-pubs@uow.edu.au
Development and evaluation of a code frame to identify potential primary
care presentations in the hospital emergency department
Abstract
Objective: A major challenge in evaluating the appropriateness of ED presentations is the lack of a universal
and workable definition of patients who could have received primary care instead. Our objective was to
develop a standardised code frame to identify potential primary care patients in the ED.
Methods: A standardised code frame to identify which patients could potentially be treated in a primary care
setting was developed and tested on all patient episodes of care who presented to the ED of the St George
Hospital, Sydney, between December 2016 and February 2017. Sensitivity and specificity of the code frame
were performed. The code frame was then tested on all presentations from 2011 to 2016 in the St George
Hospital and The Sutherland Hospital in Sydney.
Results: Of 19 916 ED presentations, 5810 (29%) were potential primary care presentations. The code frame
had a sensitivity of 99.9% and a specificity of 49.0%. Results were consistent (28%) when applied to 5 years of
presentations (601 168 presentations).
Conclusion: This standardised code frame enables accurate retrospective local and national data estimations.
The code frame could be used prospectively to evaluate interventions such as diverting patients to primary
care settings, and to identify populations for specifically targeted interventions. The conservative nature of the
code frame ensures that only those that can safely receive care in a primary care setting are identified as
potential primary care.
Publication Details
H. Schutze, R. Rees, S. Asha & K. Eagar, "Development and evaluation of a code frame to identify potential
primary care presentations in the hospital emergency department", Emergency Medicine Australasia Online
First (2019) 1-7.
This journal article is available at Research Online: https://ro.uow.edu.au/ahsri/974Emergency Medicine Australasia (2019) doi: 10.1111/1742-6723.13293
ORIGINAL RESEARCH
Development and evaluation of a code frame to identify
potential primary care presentations in the hospital
emergency department
Heike SCHÜTZE ,1,2,3 Rhyannan REES,1,3 Stephen ASHA 3,4
and Kathy EAGAR2
1
School of Health and Society, University of Wollongong, Wollongong, New South Wales, Australia, 2Australian Health Services Research
Institute, University of Wollongong, Wollongong, New South Wales, Australia, 3St George Hospital, Sydney, New South Wales, Australia, and
4
St George Clinical School, The University of New South Wales, Sydney, New South Wales, Australia
Abstract 5 years of presentations (601 168
Key findings
presentations).
Objective: A major challenge in Conclusion: This standardised code • A major challenge in evaluating
evaluating the appropriateness of ED frame enables accurate retrospective the burden of patients who pre-
presentations is the lack of a univer- local and national data estimations. sent to the ED who could have
sal and workable definition of The code frame could be used pro- been equally treated in primary
patients who could have received spectively to evaluate interventions care, is the lack of a universal
primary care instead. Our objective such as diverting patients to primary and workable definition to
was to develop a standardised code care settings, and to identify
frame to identify potential primary identify these patients.
populations for specifically targeted • We developed a workable
care patients in the ED.
interventions. The conservative standardised code frame that
Methods: A standardised code frame
nature of the code frame ensures that can be used retrospectively or
to identify which patients could poten-
tially be treated in a primary care set- only those that can safely receive prospectively, to identify
ting was developed and tested on all care in a primary care setting are
which patients could have
patient episodes of care who presented identified as potential primary care.
been seen in primary care. This
to the ED of the St George Hospital, robust tool will enable more
Sydney, between December 2016 and Key words: ED, general practice,
hospital emergency service, pri- accurate data estimations of
February 2017. Sensitivity and speci-
mary care. primary care appropriate pre-
ficity of the code frame were per-
sentations in the ED, which
formed. The code frame was then
tested on all presentations from 2011
Introduction have not been previously pos-
to 2016 in the St George Hospital and Presentations to the hospital ED are sible. This will help planning
The Sutherland Hospital in Sydney. consistently increasing worldwide and policy efforts.
Results: Of 19 916 ED presenta- and significantly outweigh population
tions, 5810 (29%) were potential growth in Australia.1,2 The diversion increased patient waiting times and
primary care presentations. The code of specialist resources to presenta- increased length of stay.3 Conversely,
frame had a sensitivity of 99.9% and tions that could be better treated in improved access to primary care
a specificity of 49.0%. Results were primary care adversely affects the effi- results in better use of health dollars,
consistent (28%) when applied to cient performance of EDs, resulting in continuity of patient care, reduced
waiting times and reduced pressure
on hospital acute services.4,5
Correspondence: Dr Heike Schütze, School of Health and Society, University of Wollon- There is no standardised definition
gong, Northfields Avenue, Wollongong, NSW 2522, Australia. Email: hschutze@uow. of what constitutes a primary care
edu.au appropriate presentation either in
Heike Schütze, BSc (Biomed), MPH, PhD, Lecturer, Research Fellow; Rhyannan Rees, Australia or abroad. A systematic
RN, Registered Nurse; Stephen Asha, BSc, MBBS (Hons), FACEM, MMed (ClinEpi), review of the literature6 found a sig-
Associate Professor; Kathy Eagar, BA, MA (Psych), PhD, FAFRM (Hon), Senior nificant variation in the calculation
Professor. methods used to report non-urgent
This is an open access article under the terms of the Creative Commons Attribution- visits to the ED with rates ranging
NonCommercial-NoDerivs License, which permits use and distribution in any from 4.8% to 90%, indicating that
medium, provided the original work is properly cited, the use is non-commercial and there is no standard method for
no modifications or adaptations are made. identifying or reporting primary care
Accepted 15 March 2019 appropriate patients in the ED.
© 2019 The Authors. Emergency Medicine Australasia published by John Wiley & Sons Australia, Ltd on behalf of Australasian College
for Emergency Medicine2 H SCHÜTZE ET AL.
Patients who present to the ED in Hospital, a major trauma hospital in The code frame was then tested on
Australia are classified according to Sydney, Australia. all ED presentations from December
the urgency in which they must be 2016 to February 2017 (19 916 epi-
seen using the Australasian Triage sodes of care). The criteria were
Scale (ATS):7
Ethics approval applied as an algorithm in the order
• ATS 1 Resuscitation – seen The study was approved by the listed in Table 1, for example, first all
immediately South Eastern Sydney Local Health ATS category 1–3 presentations were
• ATS 2 Emergency – within 10 min District Ethics Committee, HREC excluded as being considered a poten-
• ATS 3 Urgent – within 30 min 17/053 (LNR/17/POWH/146). Site- tial primary care patient, then all
• ATS 4 Semi-urgent – within 60 min specific approval was also obtained patients who arrived by ambulance
• ATS 5 Non-urgent – within from the participating hospitals. were excluded, and so on. Sensitivity
120 min. (the ability to detect true positives)
This method has commonly been and specificity (the ability to detect
used to calculate non-urgent presenta-
Data collection true negatives) testing were per-
tions considered to be appropriate for ED presentations were reviewed for formed.13 The hospital admission
primary care. The Australian Institute the period December 2016 to code (that is, the code stating whether
of Health and Welfare (AIHW) February 2017 (19 916 records). De- the patient was ultimately discharged
reported a primary care appropriate identified medical record data were from the ED or admitted into hospi-
presentation to be any patient allo- provided in electronic form by the tal) was considered to be the ‘gold
cated as an ATS 4 or ATS 5 category, Electronic Medical Records Data standard’ to assess whether a patient
who did not arrive by ambulance, Manager. was potentially suitable to be seen in
police or correctional services, was not primary care. Therefore, any patient
admitted to hospital and was not who was admitted to hospital was
referred to another hospital.8 How-
Code frame development considered an ED appropriate presen-
ever, the ATS scale is an urgency scale, An Advisory Committee was formed tation (true positive) and those who
not a scale of the complexity of the consisting of expert clinicians and departed from the ED were consid-
case, which must also be taken into researchers. The Committee com- ered a potential primary care presen-
consideration, and the AIHW method prised a Professor of Health Services tation (true negative).
was shown to overestimate primary Research, a Professor of General
care appropriate presentations.9 The Practice, a General Practitioner, an
AIHW ceased reporting this statistic in Associate Professor of Emergency
Results
2013 and stated that they would Services Research, a Registered Table 2 shows that 29% (5810 of
resume reporting primary care appro- Nurse and a Research Fellow. The 19 916 episodes of care) were found
priate presentations if the estimation Advisory Committee reviewed the to be potential primary care
method was improved in the future.10 existing code frame for a primary presentations.
The lack of reliable and reproduc- care presentation developed by The code frame had very high sensi-
ible criteria and methods for classify- Bezzina et al.,12 who defined primary tivity (99.9%) in that it identified
ing primary care presentations in the care presentations as: patients who were ultimately admitted
ED results in unreliable estimations of • ATS 4 or ATS 5 category to hospital and therefore not a primary
the true burden of these • Self-referred care appropriate presentation, and the
presentations,6,9,11 and the need for a • Presenting for a new episode specificity was 49% it correctly identi-
robust workable method has been of care fied those patients who departed and
highlighted.9 A standard definition of • Unlikely to be admitted or ulti- were therefore potential primary care
a primary care presentation is required mately not admitted. patients (Table 3), when tested against
to achieve consistency in the interpre- Next, the committee reviewed the the hospital admission code.
tation of data and to provide a tool code frame by Siminski et al.11 who The code frame was then tested on
for identifying patients for targeted added to this definition by including: larger data sets to establish if results
interventions in the future. The aim of • Did not arrive by ambulance would be consistent. The code frame
the present paper is therefore to • Presenting problem. was applied to all ED presentations
develop a code frame to identify However, Siminski et al. did not from 2011 to 2016 at the St George
potential primary care presentations in specify what the presenting Hospital (356 027 patient episodes
the hospital ED for these purposes. problem(s) was/were, which did not of care) and to The Sutherland Hos-
lend the code frame to broader uni- pital, Sydney (245 141 patient epi-
versal application. sodes of care); 28.7% and 28.4% of
The Advisory Committee reviewed presentations respectively were con-
Methods all ED presentations during February sidered to be potential primary care
2017 (6313 presentations) and presentations. These results were
Study design adapted the code frame by adding approximately 40% lower than cal-
Retrospective audit of hospital ED and removing criteria as shown in culations based only on ATS 4 and
medical records at the St George Table 1. ATS 5 codes.
© 2019 The Authors. Emergency Medicine Australasia published by John Wiley & Sons Australia, Ltd on behalf of Australasian College
for Emergency MedicineCODE FRAME TO IDENTIFY PRIMARY CARE PATIENTS 3
TABLE 1. Criteria for defining a potential primary care presentation in the ED
Criteria Action
Low urgency and/or acuity, indicated by being classified as triage categories four or five on the Australasian Retained
Triage Scale
Did not arrive by ambulance Retained
Did not arrive by helicopter, police, community transport or internal transfer Added
Were self-referred Retained
Were not referred by aged care, community health, Department of Correctional Services, general practitioner, Added
health direct, mental health, other, other hospital, outpatient
Presenting for a new episode of care, this information code is not available and is determined by the presenting Removed
problem
Were not expected to be admitted, determined by ‘First Decision to Admit†’ code Retained
Did not have a Triage Speciality Mode of Care code‡ Added
Presenting problem§ – not any of the following: Added
• Abnormal results • Flank pain
• Assault • Intoxicated persons
• Behavioural disturbances • Mental health
• Bleeding in pregnancy • Other (as there is insufficient information to draw
• Chest pain a conclusion)
• Collapse • Overdose
• Confusion • Palpitations/abnormal heart beat
• Did not wait • Per vaginal (PV) bleed
• Depression • Self-harm
• Device care • Suicidal ideation
• Dislocation
• Fever in immunosuppressed patients
†‘First Decision to Admit’ code is a code applied as soon as the treating clinician has made a decision to admit the patient.
This usually occurs after the clinician’s clinical assessment but in some circumstances can occur earlier. This action alerts
bed management to commence the process of bed allocation. ‡Triage Speciality Mode of Care refers to the triage nurse
recognising that the patient’s presenting problem fulfils a pre-existing hospital management pathway protocol and activating
that pathway. Examples include activating a trauma call if the patient meets trauma team activation criteria, or activating a
stroke call if a patient falls within the eligibility criteria for stroke thrombolysis. §Presenting problems are pre-specified cate-
gories in the electronic medical record system that the triage nurse selects to best describe the presenting problem.
Discussion on ATS codes overestimate the solely on diagnosis are only useful
degree of presentations.9 This is for retrospective analysis. The code
Using our code frame, 29% of because the ATS is an urgency scale frame used the ‘First Decision to
patients attending the ED were and does not take into consideration Admit’ code, which is an alert acti-
deemed suitable for primary care. This the complexity of the patient’s case. vated within the electronic medical
method builds on the code frames Nagree et al.9 demonstrate this nicely record as soon as the treating clini-
developed by Bezzina et al.12 and Sim- by highlighting how an elderly cian had decided the patient needed
inski et al.11 by including the pre- patient with a fractured forearm can- to be admitted. This information is
senting problem, and expanding not be safely discharged home with- not available to the triage nurse at
arrival mode and referral source, to out allied health support, but would the time of arrival; however, it has
provide a standardised definition of a not be considered high urgency on been well documented that suitably
potential primary care presentation. the ATS. qualified and experienced triage
The code frame can be used to identify Our code frame is a robust nurses can accurately predict those
potential primary care patients in the method that can be used for triaging patients who will need admission at
ED retrospectively. potential primary care patients the time of presentation.14–17 For the
This method concurs with the because it uses presenting problem. purposes of the present study, we
findings that the calculations based Although effective, methods relying could only use data codes that were
© 2019 The Authors. Emergency Medicine Australasia published by John Wiley & Sons Australia, Ltd on behalf of Australasian College
for Emergency Medicine4 H SCHÜTZE ET AL.
routinely collected and available ret-
TABLE 2. Primary care presentations in the St George Hospital ED, rospectively from the database.
December 2016 to February 2017 Substituting the ‘First Decision to
No. Balance
Admit’ code with the triage nurses
decision to admit potentially pro-
Total presentations 19 916 vides a systematic method to identify
primary care patients prospectively.
Exclude triage categories 1–3 10 903
This may allow for future interven-
10 903 tions to redirect patients who could
safely be seen in primary care away
Triage categories 4 and 5 9013 from the ED. Redirecting non-urgent
Exclude arrival mode presentations to primary care has
State ambulance 1233 been shown to be effective in reduc-
ing non-urgent presentations in the
Community transport 4 ED and acceptable to patients.18
Helicopter 3 The code frame is highly sensitive
Wheelchair 6 in that it correctly identified a pri-
mary care appropriate presentation
Internal ambulance transfer 9
99.9% of the time. Although the
Police/correctional services 22 specificity was lower at 49%, it was
1277
deemed to be acceptable, especially if
the code frame was being used pro-
7736 spectively, for it is prudent to err on
Exclude source of referral the side of caution and see additional
primary care presentations in the
Aged care 4 ED, as opposed to redirecting a
Community health service 2 patient with an urgent or complex
Department of Community Services (DOCS) 2 condition to a primary care setting.
The conservative nature of the code
GP 401
frame extends to the fact that it takes
Health direct 2 into consideration some patient
Mental health 3 behavioural characteristics to
exclude patients from being consid-
Other 2
ered suitable for treatment in a pri-
Other hospital 6 mary care setting. For example, a
Outpatients 4 person with overt behavioural dis-
turbances or an intoxicated person
Source of referral 27
may well be clinically seen in a pri-
453 mary care setting, but patients and
primary care providers may not be
7283
comfortable with these people in
Exclude First Decision to Admit their waiting rooms and often pri-
Admit 852 mary care providers do not have the
resources to deal with disruptive
Transfer 4
patients.
856 Several factors influence a patient’s
decision to attend the ED, including
6427 their perception of primary care,
Exclude Triage Speciality Mode of Care being able to get timely
Trauma call 2 appointments,19–21 convenience of
having diagnostic facilities and spe-
2 cialists at hand,19,20 age of the
6425 patient and number of com-
orbidities.21 Consumer expectations
Exclude presenting problem have changed over time with people
Abnormal results 18 seeking flexibility around work and
Altered level of consciousness 1 family commitments, while general
practitioners are demonstrating a
Assaults 9 preference to work within normal
business hours because the financial
© 2019 The Authors. Emergency Medicine Australasia published by John Wiley & Sons Australia, Ltd on behalf of Australasian College
for Emergency MedicineCODE FRAME TO IDENTIFY PRIMARY CARE PATIENTS 5
incentives are not significant enough
TABLE 2. Continued to work in the after-hours period.22
No. Balance In addition, general practices differ
greatly in the services they can offer,
Behavioural disturbances 3 ranging from solo practitioners to
multi-practitioner health centres with
Bleed, PV 89
onsite X-ray, practice nurses and
Blanks (did not wait) 20 allied health. While EDs will always
Collapse 2 continue to see potential primary care
patients, especially where alternative
Device care 43
facilities are not available, a robust
Depressed 3 method for calculating the exact
Injury, dislocation 9 impact potential primary care patients
Intoxicated 1
have on ED performance can help
inform effective planning and policy
Mental health problem 22 decisions in the future. In areas where
Other† 197 alternate facilities do exist, the code
Overdose 3 frame offers a tool that can be used
at triage to redirect patients.
Pain, chest 40
Pain, flank 36
Strengths and limitations
Palpitations/abnormal heart beat 8
Our code frame provides a workable
Pregnancy related 104 standardised definition of a potential
Self-harm 4 primary care patient and a
Suicidal ideation 3 standardised method to calculate how
many ED attendances were consid-
615 ered safe to seen in primary care. This
Total potential primary care presentations 5810 enables more accurate data estima-
tions nationally and provides a tool
Category 4 and 5 presentations (%) 65 for comparing international trends in
both ED and primary care presenta-
Subtotal values are in italics. †Other has been classified as not being primary tions. This type of analysis requires
care appropriate because insufficient data is available to deem it a primary care consistent methods to identify pri-
presentation. mary care appropriate presentations.
Adding the Speciality Triage Mode
of Care adds an additional safety net
to capture any patients who may
have ‘slipped through the cracks’
through administrative error. For
TABLE 3. Potential primary care presentation code frame sensitivity and example, Table 1 shows two patients
specificity testing were coded as Trauma calls on the
Hospital admission
Specialty Mode of Care code. If only
the ATS codes were being used, these
code (%)
patients would have been counted as
Admitted† Departed‡ Total (%) potential primary care patients
because they were actually miscoded
Code frame result as being lower urgency (ATS 4 or
ATS 5). Although these presenta-
Admitted†
tions may well have been excluded
Within hospital admission code 99.9 51.0 68.9 by presenting problem, this criterion
Departed‡ adds an additional filter to improve
the sensitivity of the code frame.
Within hospital admission code 0.1 49.0 31.1
Another strength is that the code
Total frame uses the current presenting
Within hospital admission code 100.0 100.0 100.0 problem classifications utilised by ED
staff when triaging patients. Consider-
†Admitted = ED appropriate presentation. ‡Departed = potential primary ing the terminology that is already
care presentation. used by ED staff, the adoption of the
code frame to prospectively identify
© 2019 The Authors. Emergency Medicine Australasia published by John Wiley & Sons Australia, Ltd on behalf of Australasian College
for Emergency Medicine6 H SCHÜTZE ET AL.
and divert potential primary care all EDs was beyond the scope of the 2. Australian Bureau of Statistics.
patients in future interventions should study. 3101.0 – Australian Demographic
be acceptable to staff. Considering Statistics, Dec 2017. Canberra:
primary care appropriate presenta- Australian Bureau of Statistics,
tions effect the within-hours period as
Conclusion 2018.
much as the out-of-hours period, the Our code frame provides a workable 3. Forero R, McCarthy S, Hillman K.
code frame provides a valuable tool to standardised definition of a potential Access block and emergency depart-
do this. primary care patient and a ment overcrowding. Crit. Care
The list of presenting problems in standardised method to calculate 2011; 15: 216.
the code frame is based on the expert what proportion of ED attendances 4. Fry MM. Barriers and facilitators
opinion of the Advisory Committee could potentially have been seen in a for successful after hours care
after reviewing presenting problem primary care setting. This will enable model implementation: reducing
codes within the sample. The list is more accurate national data estima- ED utilisation. Australas. Emerg.
not an exhaustive one and other pre- tions, which are currently not avail- Nurs. J. 2009; 12: 137–44.
sentations may need to be added in able. It can be easily adapted to 5. Nagree Y, Ercleve TNO,
future. The code frame would include incorporate triage codes to use in Sprivulis PC. Afterhours general
patients requiring simple procedures international settings and provides a practice clinics are unlikely to
such as an incision and drainage as useful tool for comparing interna- reduce low acuity patient atten-
primary care appropriate; however, it tional trends in both ED and pri- dances to metropolitan Perth emer-
should be acknowledged that in some mary care presentations. gency departments. Aust. Health
practice situations primary care doc- Rev. 2004; 28: 285–91.
tors have less capacity to perform sim- 6. Durand AC, Gentile S, Devictor B
ple procedures, largely because of
Acknowledgements et al. ED patients: how non-urgent
time constraints. Our definition of pri- The authors acknowledge and thank are they? Systematic review of the
mary care appropriate as defined by Professor Andrew Bonney and Dr emergency medicine literature. Am.
our code frame may be less applicable Marybeth MacIsaac who, along with J. Emerg. Med. 2011; 29: 333–45.
in practice situations such as this. the authors, were part of the Advi- 7. Australasian College for Emergency
Our aim was to devise a code frame sory Committee to develop the Code Medicine. Policy on the Austral-
that would capture patients who were Frame. The authors also thank Cen- asian Triage Scale. Melbourne:
primary care appropriate acknowl- tral Eastern Sydney Primary Health Australasian College for Emergency
edging that there will be inherent mis- Network who funded this project. Medicine, 1993 [updated Jul 2013].
classification of a small number of 8. Australian Institute of Health and
cases that have somewhat unique Welfare. Australian Hospital Statis-
Author contributions
characteristics and low frequency that tics 2012–13: Emergency Depart-
the broad strokes of our code frame HS and KE conceived the project ment Care. Canberra: Australian
cannot capture. An example would be and obtained funding. HS coordi- Institute of Health and Welfare,
a procedure that required procedural nated the project. RR and HS col- 2013.
sedation such as a simple fracture lected and analysed the data and 9. Nagree Y, Camarda VJ,
reduction, a condition that would not drafted the manuscript. SA provided Fatovich DM et al. Quantifying the
be primary care appropriate. While critical intellectual input in the clini- proportion of general practice and
most cases would likely be excluded cal aspects of the code frame and ED low-acuity patients in the emer-
by triage category, there will still be data. KE provided critical intellectual gency department. Med. J. Aust.
some cases recorded as ATS category input into the need for the code 2013; 198: 612–5.
4 or 5 and not excluded by any other frame. All authors were involved in 10. Australian Institute of Health and
component of the code frame. the formation of the code frame. All Welfare. Australian Hospital Statis-
Regardless of whether the code authors read and approved the final tics 2013–14. Emergency Depart-
frame is used retrospectively or pro- manuscript. ment Care. Canberra: Australian
spectively, it is limited by the ED Institute of Health and Welfare,
staff’s subjective assessment of each 2014.
Competing interests
patient and their classification of the 11. Siminski PM, Bezzina AJ, Lago LP,
patient’s presenting problem and tri- None declared. Eagar K. Primary care’ presenta-
age category. In addition, individual tions at emergency departments -
patient perceptions and preferences rates and reasons by age and sex.
References
that drive their use of EDs have not Aust. Health Rev. 2008; 32: 700–9.
been taken into account and require 1. Australian Institute of Health and 12. Bezzina AJ, Smith PB,
qualitative studies. Welfare. Emergency department Cromwell D, Eagar K. Primary
The present study was limited to care 2014–15: Australian hospital care patients in the emergency
two public hospitals in Sydney. It is statistics. Canberra: Australian department: who are they? A
likely that these results are Institute of Health and Welfare, review of the definition of the ‘pri-
generalisable; however, testing across 2015. mary care patient’ in the
© 2019 The Authors. Emergency Medicine Australasia published by John Wiley & Sons Australia, Ltd on behalf of Australasian College
for Emergency MedicineCODE FRAME TO IDENTIFY PRIMARY CARE PATIENTS 7
emergency department. Emerg. disposition (EPOD) study. Aus- professionals and patients. BMC.
Med. Australas. 2005; 17: 472–9. tralas. Emerg. Nurs. J. 2014; 17: Res. Notes 2012; 5: 525.
13. Webb P, Bain C, Pirozzo S. Essen- 161–6. 20. Cheek C, Allen P, Shires L,
tial Epidemiology: An Introduction 17. Robertson-Steele IRS. Providing Parry D, Ruigrok M. Low-acuity
for Students and Health Profes- primary care in the accident and presentations to regional emergency
sionals, 9th edn. New York: Cam- emergency department: the end of departments: what is the issue?
bridge University Press, 2009. the inappropriate attender Emerg. Med. Australas. 2015; 28:
14. Holdgate A, Morris J, Fry M, (Editorial). BMJ 1998; 315: 409. 145–52.
Zecevic M. Accuracy of triage 18. Buckley DJ, Curtis PW, McGirr JG. 21. Australian Bureau of Statistics.
nurses in predicting patient disposi- The effect of a general practice 4839.0 – Patient Experiences in
tion. Emerg. Med. Australas. 2007; after-hours clinic on emergency Australia: Summary of Findings,
19: 341–5. department presentations: a regres- 2015–16. Canberra: Australian
15. Alexander D, Abbott L, Zhou Q, sion time series analysis. Med. Bureau of Statistics, 2016.
Staff I. Can triage nurses accurately J. Aust. 2010; 192: 448–51. 22. Broadway B, Kalb G, Li J, Scott A.
predict patient dispositions in the 19. Durand AC, Palazzolo S, Tanti- Do financial incentives influence
emergency department? J. Emerg. Hardouin N, Gerbeaux P, GPs’ decisions to do after-hours
Nurs. 2016; 42: 513–8. Sambuc R, Gentile S. Nonurgent work? A discrete choice labour sup-
16. Vaghasiya MR, Murphy M, patients in emergency departments: ply model. Health Econ. 2017; 26:
O’Flynn D, Shetty A. The emer- rational or irresponsible con- e52–66.
gency department prediction of sumers? Perceptions of
© 2019 The Authors. Emergency Medicine Australasia published by John Wiley & Sons Australia, Ltd on behalf of Australasian College
for Emergency MedicineYou can also read
