The causes of ED crowding are multifactorial and relate to input, throughout and output factors. Therefore, ED crowding is a significant patient safety issue associated with increased morbidity and mortality. The ED provides “rapid, high quality, continuously accessible, unscheduled care” for a wide range of acute illnesses and injuries and illnesses but the primary purpose of the ED is to treat patients with potentially life-threatening illnesses and injuries. Crowding occurs when the demand for ED services exceeds the resources available to provide urgent care to patients within an appropriate time frame. This research again demonstrates the complexity of ED crowding, the introduction of evidence-based care pathways targeting avoidable presentations may serve to alleviate the problem in our EDs.Įmergency Department (ED) crowding is a global public health crisis which has been compounded by the COVID-19 pandemic. ![]() However, obtaining consensus on appropriateness of attendance is challenging and there was a significant cohort of complex heterogenous presentations where agreement could not be reached by clinicians in this study. Multidisciplinary clinicians agree that “inappropriate” use of the ED in Ireland is an issue. For the Local Panel review (n = 306) consensus on appropriateness ranged from 40 to 76% across ED sites. Subset analysis by the IRP determined that consensus for appropriate attendances ranged from 0 to 59% and for inappropriate attendances ranged from 0 to 29%. There was no consensus on 45% of charts (n = 136). For attendances deemed “appropriate” the admission rate was 47% compared to 0% for “inappropriate” attendees. The National Panel determined that 11% (GP) to 38% (EMC) of n = 306 lower acuity presentations could be treated by a GP within 24-48 h (k = 0.259 p < 0.001) and that 18% (GP) to 35% (EMC) of attendances could be considered “inappropriate” (k = 0.341 p < 0.001). At each site all files were autonomously assessed by local GP-EMC panels. ![]() In cases where consensus was not reached charts were assessed by an Independent Review Panel (IRP). Data was compiled in patient summary files which were assessed for measures of appropriateness by an academic General Practitioner (GP) and academic Emergency Medicine Consultant (EMC) National Panel. The Better Data, Better Planning study was a multi-centre, cross-sectional study investigating factors influencing ED utilisation in Ireland. This study aims to develop a consensus between clinicians across care settings about the “appropriateness” of attendances to the ED in Ireland. Utilisation of the Emergency Department (ED) for non-urgent care increases demand for services, therefore reducing inappropriate or avoidable attendances is an important area for intervention in prevention of ED crowding.
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