Unscheduled care services ‘unsustainable’, says review

Abstract Background: In France, the number of admissions to emergency departments doubled between 1996 and 2016, leading to overcrowding. To cope with the resultant overcrowding, redirecting patients to new healthcare services is a viable solution, to spread demand more evenly across available healthcare delivery points, and render care more efficient. The goal of this study was to analyse the impact of opening new unscheduled care services on variations in patient attendance at a large emergency department. Methods: We performed a before-and-after study investigating the use of unscheduled care services in the Aube Department (Eastern France), focusing on emergency department attendance of Troyes Hospital. We applied a hierarchical clustering based on co-occurrence of diagnoses, to divide the population into different multimorbidity profiles and study their temporal trends. A multivariate logistic regression model was constructed to adjust the period effect for appropriate confounders. Results: In total, 120,718 visits to the emergency department were recorded over a 24-month period (2018-2019), and 14 clusters were identified accounting for 94.76% of all visits. The before-and-after analysis showed a decrease of 57.95 visits per week in 7 specific clusters, while the consumption of unscheduled health care services increased by 328.12 visits per week.Conclusions: Using an innovative and reliable methodology to evaluate changes in patient flow through the emergency department, our results could help to inform public health policy regarding the implementation of unscheduled care services, to ease pressure on emergency departments.

Download Full-text

The management of children in unscheduled care services by emergency care practitioners

Emergency Medicine Journal ◽

10.1136/emj.2010.103150.22 ◽

2010 ◽

Vol 27 (Suppl 1) ◽

pp. A8.2-A8

Author(s):

Colin O'Keefe

Keyword(s):

Emergency Care ◽

Urgent Care ◽

Health Providers ◽

Out Of Hours ◽

Randomised Study ◽

Care Services ◽

Unscheduled Care ◽

Discharge Rates ◽

The Difference ◽

A Minor

Background/objectivesEmergency Care Practitioners (ECPs) are an example of a new role in healthcare. ECPs are substituting for standard providers such as doctors in various unscheduled care services. In these services ECPs are managing paediatric cases, although there is no evidence for their effective management of this patient group. As part of a multi-centre trial we evaluated ECP effectiveness in the discharge of children following a minor illness or injury care episode.MethodsThree pairs of unscheduled services (urgent care, minor injury unit and out of hours) were included in the trial. Each pair comprised an intervention ECP service and a matched control service employing standard non-ECP providers. All care episodes of patients under the age of 16 were identified from the three pairs of services. The primary outcome was percentage of patients discharged after consultation.ResultsAcross all services the percentage of patients discharged by ECPs was significantly less than the percentage discharged by standard non-ECP providers (59% vs 66%; X2 = 10.1; df=1; p<0.05). ECPs discharged fewer patients in all three pairs of services and in the Out of Hours (X2=4.1; df=1; p< 0.05) and the Urgent Care Centre (X2=4.7; df=1; p<0.05) pairs the difference in discharge rates was statistically significant.ImplicationsECPs do not appear to be as effective as standard health providers in discharging children after care. ECPs may be better targeted at patients groups in which there is better evidence of their effectiveness.LimitationsFindings for these services individually may not be generalisable to other similar service settings. However, nationally, the participating services were not considered atypical in how ECP services had developed. It was not possible to design a randomised study in the context of ECP working because the services were already operational.

Download Full-text

Telecare, telehealth and assistive technologies: do we know what we're talking about?

Housing Care and Support ◽

10.1108/14608790200800023 ◽

2008 ◽

Vol 11 (3) ◽

pp. 36-41 ◽

Cited By ~ 2

Author(s):

Kevin Doughty ◽

Andrew Monk ◽

Carole Bayliss ◽

Sian Brown ◽

Lena Dewsbury ◽

...

Keyword(s):

Assistive Technologies ◽

Intermediate Care ◽

Service Users ◽

Care Services ◽

Department Of Health ◽

Unscheduled Care ◽

Service Models ◽

Technology Services ◽

Direct Payments ◽

The Uk

The development of telecare services in the UK has been supported by grants from the respective governments of Scotland and Wales, and by the Department of Health in England. New services are being established, sometimes to operate alongside existing community equipment services and community alarm services. Elsewhere they are embracing a wider range of services including rehabilitation, intermediate care and health services designed to reduce use of unscheduled care services. This paper discusses the difficulties in understanding the scope of telecare services, and the definitions of services that will need to be confirmed if service users are to be able to choose appropriately if offered direct payments. Two service models are offered, one of which uses telehealth as an umbrella term to cover all telecare, e‐care and m‐care, and telemedicine, where the former includes all such services offered in the service user's home, including those of a medical nature. The second model views telecare alongside assistive technologies and telemedicine as one of three technology groups designed to make people more independent, or to bring care closer to home. There is significant overlap between the three groups, which justifies the introduction of a new term ‐ ARTS (assistive and remote technology services) ‐ to describe this area of support.

Download Full-text

Improving breast care services in inner-Eastern Melbourne a collaborative approach

European Journal of Cancer ◽

10.1016/s0959-8049(02)80255-6 ◽

2002 ◽

Vol 38 (11) ◽

pp. S82-S83

Author(s):

C Scott

Keyword(s):

Collaborative Approach ◽

Care Services ◽

Breast Care

Download Full-text

Ethnic Differences in Self-Poisoning Across South London

Crisis ◽

10.1027/0227-5910/a000258 ◽

2014 ◽

Vol 35 (4) ◽

pp. 268-272

Author(s):

Sean Cross ◽

Dinesh Bhugra ◽

Paul I. Dargan ◽

David M. Wood ◽

Shaun L. Greene ◽

...

Keyword(s):

Black Women ◽

Data Collection ◽

White Women ◽

Population Based ◽

Care Services ◽

Self Harm ◽

Managing Risk ◽

The Uk ◽

Incident Cases ◽

Minority Ethnic

Background: Self-poisoning (overdose) is the commonest form of self-harm cases presenting to acute secondary care services in the UK, where there has been limited investigation of self-harm in black and minority ethnic communities. London has the UK’s most ethnically diverse areas but presents challenges in resident-based data collection due to the large number of hospitals. Aims: To investigate the rates and characteristics of self-poisoning presentations in two central London boroughs. Method: All incident cases of self-poisoning presentations of residents of Lambeth and Southwark were identified over a 12-month period through comprehensive acute and mental health trust data collection systems at multiple hospitals. Analysis was done using STATA 12.1. Results: A rate of 121.4/100,000 was recorded across a population of more than half a million residents. Women exceeded men in all measured ethnic groups. Black women presented 1.5 times more than white women. Gender ratios within ethnicities were marked. Among those aged younger than 24 years, black women were almost 7 times more likely to present than black men were. Conclusion: Self-poisoning is the commonest form of self-harm presentation to UK hospitals but population-based rates are rare. These results have implications for formulating and managing risk in clinical services for both minority ethnic women and men.

Download Full-text