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Conference Abstracts

Clinical 2D

ED overcrowding and the ‘inappropriate patient’ — Whosedefinition?

Sandra Richardsona,b

a Centre for PostGraduate Nursing Studies, University ofOtago, 72 Oxford Tce, Christchurch, New Zealandb Emergency Department, Christchurch Hospital, CDHB,New Zealand

E-mail addresses: sandra.richardson@otago.ac.nz,sandra.richardson@cdhb.govt.nz.

Aim: Emergency Department overcrowding is a seriousproblem internationally. One response to this has been afocus on the non-urgent patient population who are thoughtto utilise ED services, with the intent of reducing this per-ceived burden. This assumes that there is a clear definitionand means of determining what constitutes an ‘appropriate’reason for seeking ED care, with the further assumption thatthis can then be used to inform prospective identification ofpatients who form this population. There is limited evidencethat such a consensus does (or could potentially) exist. Theaim of this study is to determine whether there is a con-sensus definition of the ‘inappropriate’ ED patient withinthe NZ Emergency Medicine field, and if not whether such aconsensus could be developed.

Methods: A systematic review of the literature wasundertaken followed by a 3 round national Delphi consen-sus survey of Emergency Department experts (medical andnursing). Data from this was subjected to simple statisticalanalysis and free text responses coded for thematic analysis.

Results: 65 senior medical and nursing professionals frommajor New Zealand EDs took part in a Delphi survey in 2009.While a degree of consensus was reached, this was limitedin terms of developing a criterion set that could be used tomeasure the extent of the problem.

Conclusion: There is little evidence of a robust consen-sus around ED patient appropriateness. This has significantimplications for policy development in regards to processessuch as referral away that are predicated on such an under-standing.

Keywords: ED overcrowding; Consensus; Inappropriateattenders

doi:10.1016/j.aenj.2010.08.278

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143

he efficiacy and safety of a chest pain protocol for shorttay unit patients — A 1-year follow-up

eraldine Lee, Sam Dixa, Dev Mitrab, John Coleridgeb,eter Cameronc

La Trobe University/Alfred Clinical School of Nursing, 99ommercial Road, Prahran, Victoria 3181, AustraliaEmergency & trauma centre, Alfred Hospital, Commerciaload, Prahran, Victoria 3181, AustraliaDepartment of Epidemiology & Preventive Medicine,onash University, 99 Commercial Road, Prahran, Victoria181, Australia

-mail addresses: g.lee@latrobe.edu.au (G. Lee),.dix@latrobe.edu.au (S. Dix), d.mitra@alfred.org.auD. Mitra), j.coleridge@alfred.org.au (J. Coleridge),.cameron@med.monash.edu.au (P. Cameron).

Background: The Alfred Emergency Short Stay UnitESSU) initiated a chest pain protocol for patients with acutehest pain who were low-to-intermediate risk for Acuteoronary Syndrome (ACS) and short-term adverse cardiacutcomes. Via a phone interview, a 30-day follow-up analysisemonstrated no deaths, myocardial infarctions, coronarynterventions or returns to ED for chest pain in 300 patients.he protocol appeared to be efficacious and safe in the shorterm (i.e. 1 month follow-up).

Aim of the study: A 1-year follow-up was undertakeno evaluate the long-term outcomes to audit the adverseardiac and non-cardiac events using a telephone question-aire.

Results: A total of 300 patients were consented andompleted the 30-day follow-up and three quarters wereontacted 12 month post discharge (n = 224) with follow-p phone calls. Forty-five percent (n = 101) had returned toD for various conditions and of these, 42 patients experi-nced further chest pain and returned to ED for treatment.hree patients had an acute myocardial infarction (1.3%)nd four more were diagnosed with angina (1.8%). Thereas one death from a stroke (0.4%) and another from annknown cause and five patients were diagnosed with atrialbrillation (2.2%). A total of 96 had specialist referrals — 34ad cardiology referrals and 25 patients had gastroenterol-gy referrals. Cardiac investigations undertaken includedngiograms (n = 10), 24-h tapes (n = 17), 24-h blood pressureonitoring (n = 4) and thallium scans (n = 5).Conclusion: The study demonstrated that the risk strat-

fication of patients deemed at low-to-intermediate risk ofCS had a low risk of adverse events 12 months after dis-harge.

eywords: Chest pain protocol; Short stay unit; 1-yearollow-up

oi:10.1016/j.aenj.2010.08.279