ArticleIrish journal of medical science2025
Consensus between healthcare professionals on the "appropriateness" of attendances in an Irish emergency department.
Article in Irish journal of medical science, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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Who cites it
1 citing paper in PubMed.
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Authors and funding
5 authors.
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No grant is acknowledged in the PubMed record.
Abstract
backgroundNon-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.
aimThe study aims to establish the consensus between healthcare professionals, from different specialties, on the appropriateness of attendances to an Irish ED.
methodsThis 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.
resultsInter-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%).
conclusionDespite 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.
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