Impact of opening a new emergency department on healthcare service and patient outcomes: analyses based on linking ambulance, emergency and hospital databases

BACKGROUND

Emergency department (ED) crowding caused by access block is an increasing public health issue and has been associated with impaired healthcare delivery, negative patient outcomes and increased staff workload.

AIM

To investigate the impact of opening a new ED on patient and healthcare service outcomes.

METHODS

A 24-month time series analysis was employed using deterministically linked data from the ambulance service and three ED and hospital admission databases in Queensland, Australia.

RESULTS

Total volume of ED presentations increased 18%, while local population growth increased by 3%. Healthcare service and patient outcomes at the two pre-existing hospitals did not improve. These outcomes included ambulance offload time: (Hospital A PRE: 10 min, POST: 10 min, P < 0.001; Hospital B PRE: 10 min, POST: 15 min, P < 0.001); ED length of stay: (Hospital A PRE: 242 min, POST: 246 min, P < 0.001; Hospital B PRE: 182 min, POST: 210 min, P < 0.001); and access block: (Hospital A PRE: 41%, POST: 46%, P < 0.001; Hospital B PRE: 23%, POST: 40%, P < 0.001). Time series modelling indicated that the effect was worst at the hospital furthest away from the new ED.

CONCLUSIONS

An additional ED within the region saw an increase in the total volume of presentations at a rate far greater than local population growth, suggesting it either provided an unmet need or a shifting of activity from one sector to another. Future studies should examine patient decision making regarding reasons for presenting to a new or pre-existing ED. There is an inherent need to take a 'whole of health service area' approach to solve crowding issues.

Critical care nursing organizations and activities--a second worldwide review

BACKGROUND

This study is the second world survey of critical care nursing organizations (CCNOs). The first survey was undertaken 6 years ago and data were collected from 23 countries over a 2-year period. The aim of the second survey was to profile the issues and activities of critical care nurses and their professional organizations, expanding on the previous survey to obtain both an update of the issues and a wider global perspective.

METHODS

A descriptive survey was emailed to 80 potential responding countries with recognized CCNOs or nursing leaders. Responses were analysed descriptively by geographical region.

RESULTS

A total of 51 respondents completed the questionnaire over a 6-month period, achieving a return rate of 64%. The most common issues identified by critical care nurses were staffing levels and teamwork. Other important issues included wages, working conditions and access to quality educational programmes. The respondents perceived national conferences, professional representation, standards for educational courses, provision of a website, and educational workshops and forums as the five most important activities that should be provided for critical care nurses by national CCNOs.

CONCLUSIONS

Workforce and education issues remain dominant themes among critical care nurses of the world. These issues have changed very little in the last 6 years. Using the World Federation of Critical Care Nurses network of regional CCNOs and critical care nursing leaders has proven to be a successful strategy for the collection of data on world issues and for international communication and support.