Consensus between healthcare professionals on the "appropriateness" of attendances in an Irish emergency department.

BACKGROUND

Non-urgent care attendances to the emergency department (ED) increase the strain on this sector. Identification of patients who may benefit from appropriate alternative care pathways may serve to lessen ED crowding. However, healthcare professionals from different specialties may differ in their opinion of what is an appropriate use of ED services.

AIM

The study aims to establish the consensus between healthcare professionals, from different specialties, on the appropriateness of attendances to an Irish ED.

METHODS

This was a single centre, cross-sectional study. Data were compiled in anonymised patient summary files (n = 77) from adults attending the ED over 24 h period. These summary files were reviewed by five different healthcare professionals; an emergency medicine consultant (EMC), an emergency medicine specialist registrar (EM SpR), an ED clinical nurse manager (CMN), an advanced paramedic (AP) and a general practitioner (GP). The clinicians were asked if the patient could have been managed by GP the same day or next day, if the patient's ED visit was an inappropriate use of ED resources and to rank on a scale of 0-10 how appropriate the ED visit was.

RESULTS

Inter-rater agreement on management by GP in 24-48 h was 56% and ranged from 30% (CMN) to 40% (EMC). For inappropriate use of ED resources, consensus was 58% and ranged from 12% (GP) to 35% (EMC). Median "appropriateness" rating ranged from 6 (EM SpR) to 8 (AP and CMN). When the "appropriateness" scale was trichotomized, the "inappropriate" attendances ranged from 1% (CMN) to 21% (EM SpR), whilst "appropriate" attendances ranged from 47% (EM SpR) to CMN (78%).

CONCLUSION

Despite agreement that there was "inappropriate" use of ED services, healthcare professionals from different backgrounds did not reach a general consensus on which attendances were inappropriate. Therefore, expectations regarding patients' ability to self-assess illness or injury severity related to ED attendances may not be reasonable.