Interventions to Reduce Emergency Department Visits and Improve Medical Care

Abstract

Introduction: Hospital nursing staff are often overstretched, particularly in the emergency department, with too many tasks and too little time. This results in an unsatisfactory work environment and, as a consequence, compromises patient care and outcomes. Interventions to reduce unnecessary visits and optimize nursing care are needed to make the healthcare system more sustainable and improve the quality of patient care. Used in the right way, with the right patients and the right infrastructure, mobile applications and sensors might represent such an intervention. The primary aim of the project is to evaluate the effects of a novel mobile intervention designed to reduce the number of patients who visit the emergency department unnecessarily and to provide nurses with situational awareness and decision support using simple visual cues. In this paper, we describe the design of a quasi-experimental study where we have used methods from intervention mapping for the development of the mobile intervention. The evaluation considers the multifaceted nature of the process related to implementation and mechanisms of impact. The study protocol is designed in line with guidance for the development and evaluation of complex interventions.
Methods: Building on previous work, we conducted interviews with physicians, oncologists, and caregivers of advanced cancer patients visiting the emergency department. Using content analysis, we developed an intervention based on our previous study, aligned with calls to action in community oncology. Our study explores interventions to reduce ED visits and improve nursing care for advanced cancer patients. The feasibility and potential for our interventions pave the way for large-scale implementation trials. Our research aims to enhance nursing care for better interactions and optimize advanced cancer nursing.
Conclusion: Interpretation of each research finding is limited because only one study investigated each comparison. The evidence suggested that examples of interventions that might reduce ED visits and optimize nursing care included minor injury units, particularly for improving waiting times for people with acute conditions of the ear, nose, or throat, and for patients with injuries. These findings are based on evidence of moderate quality. Moderate-quality evidence also suggested that treatments given by pharmacists for people with self-limiting conditions might help to significantly reduce the length of stay among people who are waiting for admission to hospital compared with ED medical staff. There is limited evidence for the effect of these minor injury unit interventions on patient safety, cost and other outcomes. High-quality studies are needed to directly compare these different types of services with the use of existing data or to examine patients' views about introducing or extending the range of services available at these units. It is also important to explicitly examine the themes that are underpinning the different interventions and services. High-quality studies may involve using qualitative and quantitative research that takes a mixed-methods approach, and highly transferable economic evaluations. With either approach, this would require a linked team drawn from the disciplines of strategy, management, nursing and clinical care. These findings are based on data of moderate to low quality. Future investigations should consider differences in the way resources are used and whether one strategy is more resourced than another but also more beneficial in terms of patient care, financial cost savings and the positive aspects experienced by those who contribute clinically.