Reducing Avoidable Copd Emergency Room Presentations: An Integrated Cross-Health Service Utilisation Scoping Initiative In South Queensland

Reducing Avoidable Copd Emergency Room Presentations: An Integrated Cross-Health Service Utilisation Scoping Initiative In South Queensland

Introduction/Aim
Public Health Networks PHNs and The Australian Institute of Health and Welfare are calling for solutions that reduce COPD Emergency Department (ED) presentations, and decrease economic burden. The rationale for this multisite research project was to better establish the context of the situation facing EDs in South West Queensland with a focus on over-utilisation, and to provide some solutions.

Methods
1. Qualitative scoping exercise with 18 staff and 18 patients across 3 major Queensland Health (QH) sites. 2. Scoping review (International literature). 3. QH 2 year data systems summary of characteristics associated with avoidable COPD admissions. 4. Health economic analysis of actual costs for ED presentation.

Results
Thematic analysis from both staff and patient interviews reveals the following core concepts worthy of more in-depth exploration. 1. Integrated communication of patient assessment and history data. 2. A restructure of nurse led roles (Home Visits). 3. A failure to rescue. 4. Knowledge utilisation among ED clinicians. The Scoping Review confirms research should target ED avoidance and community management. Systems summary data confirm infective exacerbation, co-morbidities like Coronary heart disease, Depression, and Asthma as major contributors to presentation. Economic data reveals a total health service cost of $42, 142, 474 for ED presentations across all 3 sites. 41.1% of presentations assessed as category 3 or 4 in the EDs were transferred home on the same day. Targeting ED avoidance in this cohort reveals a cost saving of $533 per patient or $1,269,181 (as per, National Hospital Cost Data Collection estimates).

Conclusion
Innovative and targeted ED avoidance strategies are required that offer alternative COPD assessment points, ongoing support and monitoring, and earlier detection of deterioration, e.g. nurse led home visits. Clinician compliance with COPD X guidelines needs to be actively measured and reported.

Grant Support
Emergency Medicine Foundation: grant number EMSS-364R28-2017