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2009 CENA International Conference for Emergency Nursing

ted and 7% were discharged to residential care/hospice andthe average ED length of stay was 7 h and 47 min. The keyissues identified included: reluctance to seek emergencycare, high incidence of delayed presentation, mixed per-spectives of waiting and the factors that influence waitingtimes, importance of interpersonal relationships with EDstaff, absolute trust in skills and knowledge of ED staff, chal-lenges to effective communication and limitations to currentdischarge planning strategies. The study results highlightboth positive and negative aspects of the ED experience andwill influence reforms to improve emergency care for olderpeople.

This project was funded by the Victorian GovernmentDepartment of Human Services

Keywords: Emergency nursing; Older people; Gerontology;Patient experience

doi:10.1016/j.aenj.2009.08.073

ORAL PRESENTATIONS 5C — Health Service Delivery

Clinical risk management: ‘‘What are the sources of clin-ical risk in Emergency care?’’

Belinda Mitchell 1,∗, Julie Considine2, Mari Botti 3

1 Northern Health, 185 Cooper Street Epping, Victoria 3076,Australia2 Deakin University/Northern Health Clinical Partnership,c/-School of Nursing, Deakin University, 221 Burwood Hwy,Burwood, Victoria 3125, Australia3 Deakin University/Epworth HealthCare Clinical Partner-ship, c/-School of Nursing, Deakin University, 221 BurwoodHwy, Burwood, Victoria 3125, Australia

E-mail address: belinda.mitchell@nh.org.au (B. Mitchell).

Adverse events and clinical risk are common in healthcareand are associated with increased morbidity and mortal-ity. The Australian Quality and Safety in Healthcare studyshowed that 16.6% of patients will suffer an adverse eventduring their hospital stay: 13.7% of these patients will bepermanently disabled and 5% will die.1,2 A group at signif-icant risk of adverse events in health care are EmergencyDepartment (ED) patients. EDs have the highest incidenceof preventable and negligence-related adverse events.1,2 Itmay also be argued that EDs have specific sources of clinicalrisk, for example, high cognitive load, little or unreliableinformation, fragmented care, poor continuity of care anddiagnostic uncertainty.1—10

The sources of risk in emergency care will be examinedusing a descriptive exploratory approach. Better under-standing of the sources of clinical risk in emergency careis important as it allows for evidence-based risk reductionprograms to be implemented.

Data will be collected using (i) incident reports submittedby ED clinicians during 2008 to identify patient, human andsystem factors which are present in adverse events and (ii)structured observation in order to identify the prevalence

of medication errors, critical instability and documentationerrors at specific points in time. Preliminary data analysisindicates that there are a wide variety of adverse eventsreported by ED staff; however the most common incidentreports related to patient behaviour (67%), patient manage-

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ent (23.6%), medication (6.1%) and diagnostics (3.1%). Its anticipated that data collection will be completed in mid009. The results of data analysis will be presented in thisaper.

This study was undertaken as part of a Masters ofursing—–Deakin University and funded by a Northern Healthmall Research Grant.

eferences

1. Wilson R, Runciman W, Gibberd R, Harrison B, Newby L, Hamil-ton J. The quality in Australian Health Care study. MedicalJournal of Australia 1995;163:458—71.

2. Leape LL, Brennan T, Laird N, et al. The nature of adverseevents in hospitalized patients: results of the Harvard Medi-cal Practice Study II. The New England Journal of Medicine1991;324(6):377—84.

3. Considine J, Botti M. Who, when and where? Identification ofpatients at risk of an in-hospital adverse event: Implicationsfor nursing practice. International Journal of Nursing Practice2004; 10(1):21—31. doi:10.1111/j.1440-172X.2003.00452.x.

4. Croskerry P, Sinclair D. Emergency medicine: a practice proneto error? Journal of the Canadian Association of EmergencyPhysicians 2001;3(4):271.

5. Johnstone M-J. Patient safety ethics and human error manage-ment in ED contexts: Part I: Development of the global patientsafety movement. Australasian Emergency Nursing Journal2007;10(1):13—20.

6. Kohn L, Corrigan J, Donaldson M. To err is human: building asafer health system. Washington, DC: National Academy Press;2000.

7. Leape LL. Error in medicine. JAMA 1994;23(272):1851—7.8. Reason J. Human error. Cambridge: Cambridge University

Press; 1990.9. Reason J. Understanding adverse events: the human factor.

In: Vincent C, editor. Clinical risk management—–enhancingpatient safety. London: BMJ Publishing; 2001. p. 9—30.

10. Vincent C. Patient safety. London: Elsevier Limited; 2006.

eywords: Clinical risk; Emergency care; Emergency nurs-ng; Adverse events

oi:10.1016/j.aenj.2009.08.074

ur role as a Private Hospital Emergency Department inhe future

iona Frew ∗, Sarah Arnold

Wesley Emergency Centre, The Wesley Hospital, PO Box 499,oowong, Qld 4066, Australia

This presentation will focus on the uniqueness of theelivery of emergency care in a Private Hospital setting.his is a growth area of emergency care/medicine. Currentlyprivate emergency departments exist in the Brisbane

etropolitan area. The Wesley Emergency Centre is theusiest of these with over 24 000 presentations per year.ince opening in 1994, The Wesley Emergency Centre hasndergone a significant increase in services, and provides an

mportant service to the local community and the hospitaltself.

Despite an out of pocket cost to the patient and lim-ted rebate from Medicare, patient numbers have increasedo over 2000 per month. The range of patients present-