Effectiveness of clinical criteria in directing patient flow from the emergency department to a medical assessment unit in Queensland, Australia: a retrospective chart review of hospital administrative data

Article


Osborne, Sonya, Cleak, Helen, White, Nicole, Lee, Xing, Deacon, Anthony and de Looze, Julian W. M.. 2021. "Effectiveness of clinical criteria in directing patient flow from the emergency department to a medical assessment unit in Queensland, Australia: a retrospective chart review of hospital administrative data." BMC Health Services Research. 21 (1). https://doi.org/10.1186/s12913-021-06537-7
Article Title

Effectiveness of clinical criteria in directing patient flow from the emergency department to a medical assessment unit in Queensland, Australia: a retrospective chart review of hospital administrative data

ERA Journal ID13444
Article CategoryArticle
AuthorsOsborne, Sonya (Author), Cleak, Helen (Author), White, Nicole (Author), Lee, Xing (Author), Deacon, Anthony (Author) and de Looze, Julian W. M. (Author)
Journal TitleBMC Health Services Research
Journal Citation21 (1)
Article Number527
Number of Pages12
Year2021
PublisherBioMed Central Ltd.
Place of PublicationUnited Kingdom
ISSN1472-6963
Digital Object Identifier (DOI)https://doi.org/10.1186/s12913-021-06537-7
Abstract

Background
Medical Assessment Units (MAUs) have become a popular model of acute medical care to improve patient flow through timely clinical assessment and patient management. The purpose of this study was to determine the effectiveness of a consensus-derived set of clinical criteria for patient streaming from the Emergency Department (ED) to a 15-bed MAU within the highly capacity-constrained environment of a large quaternary hospital in Queensland, Australia.

Methods
Clinically coded data routinely submitted for inter-hospital benchmarking purposes was used to identify the cohort of medical admission patients presenting to the ED in February 2016 (summer) and June 2016 (winter). A retrospective review of patient medical records for this cohort was then conducted to extract MAU admission data, de-identified patient demographic data, and clinical criteria. The primary outcome was the proportion of admissions that adhered to the MAU admission criteria.

Results
Of the total of 540 included patients, 386 (71 %) patients were deemed to meet the MAU eligibility admission criteria. Among patients with MAU indications, 66 % were correctly transferred (95 % CI: 61 to 71) to the MAU; this estimated sensitivity was statistically significant when compared with random allocation (p-value < 0.001). Transfer outcomes for patients with contraindications were subject to higher uncertainty, with a high proportion of these patients incorrectly transferred to the MAU (73 % transferred; 95 % CI: 50 to 89 %; p-value = 0.052).

Conclusions
Based on clinical criteria, approximately two-thirds of patients were appropriately transferred to the MAU; however, a larger proportion of patients were inappropriately transferred to the MAU. While clinical criteria and judgement are generally established as the process in making decisions to transfer patients to a limited-capacity MAU, our findings suggest that other contextual factors such as bed availability, time of day, and staffing mix, including discipline profile of decision-making staff during ordinary hours and after hours, may influence decisions in directing patient flow. Further research is needed to better understand the interplay of other determinants of clinician decision making behaviour to inform strategies for improving more efficient use of MAUs, and the impact this has on clinical outcomes, length of stay, and patient flow measures in MAUs.

Keywordsmedical assessment unit, MAU, emergency room, patient flow, retrospective medical record review, chart audit
ANZSRC Field of Research 2020420399. Health services and systems not elsewhere classified
Byline AffiliationsSchool of Nursing and Midwifery
La Trobe University
Queensland University of Technology
Department of Health, Queensland
University of Queensland
Institution of OriginUniversity of Southern Queensland
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A theoretical framework to support research of health service innovation
Fox, Amanda, Gardner, Glenn and Osborne, Sonya. 2015. "A theoretical framework to support research of health service innovation." Australian Health Review. 39 (1), pp. 70-75. https://doi.org/10.1071/AH14031
Incidence and predictors of lower limb split-skin graft failure and primary closure dehiscence in day-case surgical patients
Stankiewicz, Monica, Coyer, Fiona, Webster, Joan and Osborne, Sonya. 2015. "Incidence and predictors of lower limb split-skin graft failure and primary closure dehiscence in day-case surgical patients." Dermatologic Surgery. 41 (7), pp. 775-783. https://doi.org/10.1097/DSS.0000000000000391
The skin safety model: reconceptualizing skin vulnerability in older patients
Campbell, Jill L, Coyer, Fiona M. and Osborne, Sonya R.. 2016. "The skin safety model: reconceptualizing skin vulnerability in older patients." Journal of Nursing Scholarship. 48 (1), pp. 14-22. https://doi.org/10.1111/jnu.12176
Skin preparation of the patient – more than skin deep
Levada, Lilliana and Osborne, Sonya. 2017. "Skin preparation of the patient – more than skin deep." Journal of Perioperative Nursing. 30 (2), pp. 57-59.
Making evidence-based perioperative practices stick: an introduction to an implementation science approach
Osborne, Sonya. 2017. "Making evidence-based perioperative practices stick: an introduction to an implementation science approach." Journal of Perioperative Nursing. 30 (4), pp. 53-55.
New ACORN guideline: perioperative nursing management of posthumous organ procurement
Gore, Amanda and Osborne, Sonya. 2017. "New ACORN guideline: perioperative nursing management of posthumous organ procurement." Journal of Perioperative Nursing. 30 (1 - Autumn), pp. 56-59.
Nursing physical assessment for patient safety in general wards: reaching consensus on core skills
Douglas, Clint, Booker, Catriona, Fox, Robyn, Windsor, Carol, Osborne, Sonya and Gardner, Glenn. 2016. "Nursing physical assessment for patient safety in general wards: reaching consensus on core skills." Journal of Clinical Nursing. 25 (13-14), pp. 1890-1900. https://doi.org/10.1111/jocn.13201
Intrathecal morphine–related perioperative hypothermia in women undergoing cesarean delivery: a retrospective case-control study
Munday, Judy, Osborne, Sonya and Yates, Patsy. 2018. "Intrathecal morphine–related perioperative hypothermia in women undergoing cesarean delivery: a retrospective case-control study." Journal of PeriAnesthesia Nursing. 33 (1), pp. 3-12. https://doi.org/10.1016/j.jopan.2016.04.142
Preoperative warming versus no preoperative warming for maintenance of normothermia in women receiving intrathecal morphine for cesarean delivery: a single-blinded, randomized controlled trial
Munday, Judy, Osborne, Sonya, Yates, Patsy, Jones, Lee and Gosden, Edward. 2018. "Preoperative warming versus no preoperative warming for maintenance of normothermia in women receiving intrathecal morphine for cesarean delivery: a single-blinded, randomized controlled trial." Anesthesia and Analgesia. 126 (1), pp. 183-189. https://doi.org/10.1213/ANE.0000000000002026
Nursing service innovation: a case study examining emergency nurse practitioner service sustainability
Fox, Amanda, Gardner, Glenn and Osborne, Sonya. 2018. "Nursing service innovation: a case study examining emergency nurse practitioner service sustainability." Journal of Advanced Nursing. 74 (2), pp. 454-464. https://doi.org/10.1111/jan.13454
Cohort study of a specialist social worker intervention on hospital use for patients at risk of long stay
Osborne, Sonya, Harrison, Gai, O'Malia, Angela, Barnett, Adrian Gerard, Carter, Hannah E. and Graves, Nicholas. 2018. "Cohort study of a specialist social worker intervention on hospital use for patients at risk of long stay." BMJ Open. 8 (12), pp. 1-6. https://doi.org/10.1136/bmjopen-2018-023127
Interaction Of myxomatosis and Rabbit Haemorrhagic Disease in wild rabbit
Fulford, G. R., Lee, X. J., Berman, D. and Hamilton, G.. 2011. "Interaction Of myxomatosis and Rabbit Haemorrhagic Disease in wild rabbit." 19th International Congress on Modelling and Simulation (MODSIM2011). Perth, Australia 12 - 16 Dec 2011 New Zealand.
Does preoperative oral carbohydrate reduce hospital stay? A randomized trial
Webster, Joan, Osborne, Sonya Ranee, Gill, Richard, Chow, Carina Faran Kalan, Wallin, Siobhan, Jones, Lee and Tang, Annie. 2014. "Does preoperative oral carbohydrate reduce hospital stay? A randomized trial." AORN Journal. 99 (2), pp. 233-242. https://doi.org/10.1016/j.aorn.2013.12.003
Quantitative data collection and study validity
Osborne, Sonya and Schneider, Zevia. 2013. "Quantitative data collection and study validity." Schneider, Zevia, Whitehead, Dean, LoBiondo-Wood, Geri and Haber, Judith (ed.) Nursing and midwifery research: methods and appraisal for evidence-based practice. Australia. Elsevier - Mosby. pp. 200-217
Infection control
Osborne, Sonya. 2013. "Infection control." Crisp, Jackie, Potter, Patricia Ann, Taylor, Catherine, Rebeiro, Geraldine and Douglas, Clint (ed.) Potter and Perry's fundamentals of nursing. Chatswood, NSW, Australia. Elsevier - Mosby. pp. 703-752
The ACORN standards - our aide-memoire to professional practice
Osborne, Sonya. 2013. "The ACORN standards - our aide-memoire to professional practice." ACORN: the journal of perioperative nursing in Australia. 26 (4), pp. 14-15.
Clinically-indicated replacement versus routine replacement of peripheral venous catheters [Review]
Webster, Joan, Osborne, Sonya, Rickard, Clare M. and New, Karen. 2013. "Clinically-indicated replacement versus routine replacement of peripheral venous catheters [Review]." Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.CD007798.pub3
Nursing management: intraoperative care
Shoup, Anita, Reilly, Maureen, Kless, Jack and Osborne, Sonya. 2012. "Nursing management: intraoperative care." Brown, Diane and Edwards, Helen (ed.) Lewis's medical surgical nursing: assessment and management of clinical problems. Australia. Elsevier. pp. 402-420
Exploring the culture of non-reporting in the perioperative environment
Marshall, J. and Osborne, Sonya. 2007. "Exploring the culture of non-reporting in the perioperative environment." ACORN: the journal of perioperative nursing in Australia. 20 (2), pp. 10-21.
Imperatives and strategies for developing an evidence-based practice in perioperative nursing
Osborne, Sonya and Gardner, Glenn. 2004. "Imperatives and strategies for developing an evidence-based practice in perioperative nursing." ACORN: the journal of perioperative nursing in Australia. 17 (1), pp. 18-24.
Occupational exposures: balancing the costs of prevention vs treatment in operating theatres, with particular focus on double gloving practices
Osborne, Sonya. 2001. "Occupational exposures: balancing the costs of prevention vs treatment in operating theatres, with particular focus on double gloving practices." ACORN: the journal of perioperative nursing in Australia. 14 (2), pp. 16-21.
Care and preventative maintenance of surgical instrumentation: the scrub nurse's responsibility
Osborne, Sonya R.. 1999. "Care and preventative maintenance of surgical instrumentation: the scrub nurse's responsibility." ACORN: the journal of perioperative nursing in Australia. 12 (4), pp. 10-13.
Latex allergy: a perioperative environmental hazard
Osborne, Sonya R.. 1998. "Latex allergy: a perioperative environmental hazard." ACORN: the journal of perioperative nursing in Australia. 11 (4), pp. 26-28.