The impact of a new emergency department on patient presentations and ambulance service delivery

What is the impact on the existing health service when a new ED opens?

Grant ID: PROJ-2008-001-LIND-REDI

Project Summary

This research aimed to investigate the impact of opening a new ED within a health service district. The study involved linking ambulance, emergency department (ED) and hospital data from three EDs to better understand the patient journey and patient and health service outcomes when a new ED opens within the health service. The project aims were to:
1. Describe and compare patient and health service outcomes at three EDs before and 12 months after Robina ED opening;
2. Describe and compare outcomes for patients arriving to ED by ambulance based on whether off stretcher time is/is not delayed by >30 mins.

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Outcomes

From this body of research, the team concluded that the whole patient journey needs to be included in future planning and in the design of health services. Strategic innovation needs careful analysis to ensure that the intervention does not shift the problem onto another part of the system. That is, to improve all service outcomes, when altering (increasing or decreasing) emergency department bed numbers, the whole healthcare system needs to be considered.

Specifically, the team found that by adding an additional emergency department within a health service area and increasing emergency department capacity from 81 to 122 beds:
1) Led to an increase (18%) in the total volume of emergency department presentations at a rate far greater than local population growth (3.1%): suggesting it either tapped into a previously unmet need within the local community or resulted in a shifting of activity from one sector to another;
2) Decreased the rate of deaths in emergency; but
3) Did not improve time-related service outcomes, such as ambulance offload time, time to see doctor and emergency department length of stay.

In further analysis, the team demonstrated that patient transport by ambulance to hospital did not guarantee timely access to medical care when there is a delay in ambulance offload time and blocked access to hospital inpatient beds. They concluded that along with older age, triage category (ATS 2, 3, 4) and offload times exceeding 30 min are easily identifiable predictors of an emergency department length of stay greater than four hours.

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Dissemination

Crilly J, Keijzers G, Tippett V, O’Dwyer J, Lind J, Bost N, O’Dwyer M, Shiels S, Wallis M. Improved outcomes for Emergency Department patients whose Ambulance off-stretcher time is not delayed. Emergency Medicine Australia. 2015: 27 (3):216-224.

Crilly, J.L., Keijzers, G.B., Tippett, V.C., O'Dwyer, J.A., Wallis, M.C., Lind, J.F., Bost, N.F., O'Dwyer, M.A. and Shiels, S., 2014. Expanding emergency department capacity: a multisite study. Australian Health Review, 38(3), pp.278-287.

Crilly, J., O'Dwyer, J., Lind, J., Tippett, V., Thalib, L., O'Dwyer, M., Keijzers, G., Wallis, M., Bost, N. and Shiels, S., 2013. The impact of opening a new emergency department on healthcare service and patient outcomes: analyses based on linking ambulance, emergency and hospital databases. Internal medicine journal, 43(12), pp.1293-1303.

Conference Proceedings/Abstracts
- Crilly J, Keijzers G, Tippett V, O’Dwyer J, Lind J, Bost N, O’Dwyer M, Shiels S, Wallis M. A multisite analysis of patients arriving to the emergency department via ambulance: do delays impact on outcomes? Sigma Theta Tau International Honor Society 2nd European Regional Conference. June 2014, Gothenberg, Sweden.
- Crilly J, Lind J, O’Dwyer J, O’Dwyer M, Tippett V, Bost N, Wallis M, Keijzers G, Shiels S. Patient flow: Linking data to follow the patient’s journey through the acute health care system and predict outcomes. 13th International Conference on Emergency Medicine, June 2010, Singapore.
- Crilly J, Lind J, O’Dwyer J, O’Dwyer M, Tippett V, Wallis M, Bost N, Keijzers G, Shiels S. Planning for the future? Look to the past. What happened when a new ED (Robina) opened in 2007? 2010 Gold Coast Health Symposium: Innovation and partnership, May 2010, Gold Coast.
- Crilly J, O’Dwyer J, O’Dwyer M, Lind J, Wallis M, Tippett V, Keijzers G, Bost N, Shiels S. Linking ambulance, emergency department and hospital admission records to examine patient and health service delivery outcomes when opening an additional emergency department: a before and after study. 7th International Conference for Emergency Nursing, October 2009, Gold Coast.

In 2014, Crilly was invited by the Manager of Deeble Institute for Health Policy Research, Australian Healthcare & Hospitals Association to participate as a speaker regarding research published in the Australian Health Review (Crilly et al AHR 2014) at the first AHR Live moderated discussion held at the PA Hospital, Brisbane.

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