Rethinking Aussie hospitals
November 21, 2012
AUSTRALIAN hospital emergency
departments (EDs) need to be
redesigned and to be integrated
community care based models in
order to meet the requirements of
older patients who have a growing
need of acute care, according to a
study by the School of Public Health
and Preventive Medicine at Monash.
Presented this week at the
Emergency Medicine Conference
being held in Hobart, the study
looked at responses from 100
patients aged 70 years or older who
presented to a tertiary metro
Melbourne public hospital ED, and
was designed to determine why
older patients of lower clinical
urgency choose to attend a hospital
emergency department.
According to the breakdown 56%
of patients were female, 57% lived
alone, 73% presented during
business hours, 58% arrived by
ambulance, 80% presented for
illness, and 65% were discharged
home within 48 hours.
The results found that 56% of
patients felt “socially disconnected”,
of which 49% lived alone compared
with 65% who lived with their
spouse or other family members.
All patients attended a regular GP,
and 31% reported regular review
appointments; whilst 35% said they
waited over 2-3 days for urgent
problems, and 59% said accessing
care after hours without attending
an ED was difficult.
In addition, 23% reported that
they attended an ED 3-6 times in
the previous 12 months, with the
most popular reasons for ED visits
being a referral by a third party,
difficulty with accessibility to
primary care, patient preferences
for timely care, and fast track
access to specialist care.
“Most older patients of lower
clinical urgency presented to ED
due to perceived access block to
primary or specialist services,
alongside an expectation of more
timely and specialised care,” said
lead researcher Dr Judy Lowthian.
“This suggests we should be
considering a new design for
emergency departments to cater
for our increasingly older population.
“Expectations of care for the
elderly, by patients and their carers
are increasing, and EDs might not
be best placed to manage this.
“The solution probably lies in a
community-based system of care
currently not available,” she added.
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