ED to Community Program: Pre-Intervention Assessment Study in Sydney Australia

Abstract

Background: The increase in individuals frequently attending the hospital emergency department (ED) can lead to decreased efficiency, poor patient outcomes and reduced worker satisfaction. Aims/Objectives: The ED to Community program aims to develop a community-based program for persistent ED attenders. A pre-intervention assessment sought staff experiences to inform program implementation. Method(s): The study design was qualitative at two hospitals. Normalisation Process Theory (NPT) assessed the necessary interventions: coherence, cognitive participation, collective action and reflexive monitoring. Finding(s): 60 staff were surveyed, and 23 staff were interviewed. Issues included managing patient expectations; staff frustration; and ED being incompatible with patients' complex needs. Barriers included easily accessible emergency care and fear of patient risk facilitating reappearance; variation in staff skills; and patient stigma and departmental silos not conducive to comprehensive care. Enablers were ED acceptance; increased workforce capacity; care coordination and care planning; and active engagement with GPs and community health. Applying NPT, there was coherence with all staff recognising the necessity of the program. However, Departmental goals differed from wanting reduced admissions to accepting frequent attenders will continue to come. Collective action included being able to harmonise different care plans, sharing data between hospitals, and increasing junior staff capacity. Reflective monitoring demonstrated frontline staff lacked program awareness. Implications: While all staff recognised the need for solutions to ED frequent attenders, multi-disciplinary differences need to be addressed as well as adequate work processes of data sharing, harmonising care plans with clinicians, referrals and assertive community follow up.