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The effectiveness of primary care streaming in emergency departments on decision-making and patient flow and safety – A realist evaluation

Michelle Edwards, Alison Cooper, Thomas Hughes, Freya Davies, Delyth Price, Pippa Anderson, Bridie Evans Orcid Logo, Andrew Carson-Stevens, Jeremy Dale, Peter Hibbert, Barbara Harrington, Julie Hepburn, Aloysius Niroshan Siriwardena, Helen Snooks Orcid Logo, Adrian Edwards

International Emergency Nursing, Volume: 62, Start page: 101155

Swansea University Authors: Bridie Evans Orcid Logo, Helen Snooks Orcid Logo

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DOI (Published version): 10.1016/j.ienj.2022.101155

Abstract

Primary care streaming was implemented in UK Emergency Departments (EDs) to manage an increasing demand for urgent care. We aimed to explore its effectiveness in EDs with different primary care models and identify contexts and mechanisms that influenced outcomes: streaming patients to the most appro...

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Published in: International Emergency Nursing
ISSN: 1755-599X
Published: Elsevier BV 2022
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URI: https://cronfa.swan.ac.uk/Record/cronfa60480
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We aimed to explore its effectiveness in EDs with different primary care models and identify contexts and mechanisms that influenced outcomes: streaming patients to the most appropriate clinician or service, ED flow and patient safety.MethodWe observed streaming and interviewed ED and primary care staff during case study visits to 10 EDs in England. We used realist methodology, synthesising a middle-range theory with our qualitative data to refine and create a set of theories that explain relationships between contexts, mechanisms and outcomes.ResultsMechanisms contributing to the effectiveness of primary care streaming were: quality of decision-making, patient flow, redeploying staff, managing patients across streams, the implementation of governance protocols, guidance, training, service evaluation and quality improvement efforts. Experienced nurses and good teamworking and strategic and operational management were key contextual factors.ConclusionWe recommend service improvement strategies, operational management, monitoring, evaluation and training to ensure that ED nurses stream patients presenting at an ED seeking urgent care to the most appropriate clinicians for their needs in a safe and efficient manner.</abstract><type>Journal Article</type><journal>International Emergency Nursing</journal><volume>62</volume><journalNumber/><paginationStart>101155</paginationStart><paginationEnd/><publisher>Elsevier BV</publisher><placeOfPublication/><isbnPrint/><isbnElectronic/><issnPrint>1755-599X</issnPrint><issnElectronic/><keywords/><publishedDay>1</publishedDay><publishedMonth>5</publishedMonth><publishedYear>2022</publishedYear><publishedDate>2022-05-01</publishedDate><doi>10.1016/j.ienj.2022.101155</doi><url/><notes/><college>COLLEGE NANME</college><department>Health Data Science</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>HDAT</DepartmentCode><institution>Swansea University</institution><apcterm/><funders>Funded by The National Insititute of Health Research, Health Services and Delivery Research Programme ref 15/145/04.</funders><projectreference/><lastEdited>2022-08-02T14:55:13.9765298</lastEdited><Created>2022-07-13T12:12:53.7505998</Created><path><level id="1">Faculty of Medicine, Health and Life Sciences</level><level id="2">Swansea University Medical School - Medicine</level></path><authors><author><firstname>Michelle</firstname><surname>Edwards</surname><order>1</order></author><author><firstname>Alison</firstname><surname>Cooper</surname><order>2</order></author><author><firstname>Thomas</firstname><surname>Hughes</surname><order>3</order></author><author><firstname>Freya</firstname><surname>Davies</surname><order>4</order></author><author><firstname>Delyth</firstname><surname>Price</surname><order>5</order></author><author><firstname>Pippa</firstname><surname>Anderson</surname><order>6</order></author><author><firstname>Bridie</firstname><surname>Evans</surname><orcid>0000-0003-0293-0888</orcid><order>7</order></author><author><firstname>Andrew</firstname><surname>Carson-Stevens</surname><order>8</order></author><author><firstname>Jeremy</firstname><surname>Dale</surname><order>9</order></author><author><firstname>Peter</firstname><surname>Hibbert</surname><order>10</order></author><author><firstname>Barbara</firstname><surname>Harrington</surname><order>11</order></author><author><firstname>Julie</firstname><surname>Hepburn</surname><order>12</order></author><author><firstname>Aloysius Niroshan</firstname><surname>Siriwardena</surname><order>13</order></author><author><firstname>Helen</firstname><surname>Snooks</surname><orcid>0000-0003-0173-8843</orcid><order>14</order></author><author><firstname>Adrian</firstname><surname>Edwards</surname><order>15</order></author></authors><documents><document><filename>60480__24810__2d4fd38fb70e4ebf8ccf9d0113da8904.pdf</filename><originalFilename>60480.pdf</originalFilename><uploaded>2022-08-02T14:52:56.5171069</uploaded><type>Output</type><contentLength>615061</contentLength><contentType>application/pdf</contentType><version>Version of Record</version><cronfaStatus>true</cronfaStatus><documentNotes>&#xA9; 2022 The Authors. 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spelling 2022-08-02T14:55:13.9765298 v2 60480 2022-07-13 The effectiveness of primary care streaming in emergency departments on decision-making and patient flow and safety – A realist evaluation 6098eddc58e31ac2f3e070cb839faa6a 0000-0003-0293-0888 Bridie Evans Bridie Evans true false ab23c5e0111b88427a155a1f495861d9 0000-0003-0173-8843 Helen Snooks Helen Snooks true false 2022-07-13 HDAT Primary care streaming was implemented in UK Emergency Departments (EDs) to manage an increasing demand for urgent care. We aimed to explore its effectiveness in EDs with different primary care models and identify contexts and mechanisms that influenced outcomes: streaming patients to the most appropriate clinician or service, ED flow and patient safety.MethodWe observed streaming and interviewed ED and primary care staff during case study visits to 10 EDs in England. We used realist methodology, synthesising a middle-range theory with our qualitative data to refine and create a set of theories that explain relationships between contexts, mechanisms and outcomes.ResultsMechanisms contributing to the effectiveness of primary care streaming were: quality of decision-making, patient flow, redeploying staff, managing patients across streams, the implementation of governance protocols, guidance, training, service evaluation and quality improvement efforts. Experienced nurses and good teamworking and strategic and operational management were key contextual factors.ConclusionWe recommend service improvement strategies, operational management, monitoring, evaluation and training to ensure that ED nurses stream patients presenting at an ED seeking urgent care to the most appropriate clinicians for their needs in a safe and efficient manner. Journal Article International Emergency Nursing 62 101155 Elsevier BV 1755-599X 1 5 2022 2022-05-01 10.1016/j.ienj.2022.101155 COLLEGE NANME Health Data Science COLLEGE CODE HDAT Swansea University Funded by The National Insititute of Health Research, Health Services and Delivery Research Programme ref 15/145/04. 2022-08-02T14:55:13.9765298 2022-07-13T12:12:53.7505998 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Medicine Michelle Edwards 1 Alison Cooper 2 Thomas Hughes 3 Freya Davies 4 Delyth Price 5 Pippa Anderson 6 Bridie Evans 0000-0003-0293-0888 7 Andrew Carson-Stevens 8 Jeremy Dale 9 Peter Hibbert 10 Barbara Harrington 11 Julie Hepburn 12 Aloysius Niroshan Siriwardena 13 Helen Snooks 0000-0003-0173-8843 14 Adrian Edwards 15 60480__24810__2d4fd38fb70e4ebf8ccf9d0113da8904.pdf 60480.pdf 2022-08-02T14:52:56.5171069 Output 615061 application/pdf Version of Record true © 2022 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license true eng http://creativecommons.org/licenses/by/4.0/
title The effectiveness of primary care streaming in emergency departments on decision-making and patient flow and safety – A realist evaluation
spellingShingle The effectiveness of primary care streaming in emergency departments on decision-making and patient flow and safety – A realist evaluation
Bridie Evans
Helen Snooks
title_short The effectiveness of primary care streaming in emergency departments on decision-making and patient flow and safety – A realist evaluation
title_full The effectiveness of primary care streaming in emergency departments on decision-making and patient flow and safety – A realist evaluation
title_fullStr The effectiveness of primary care streaming in emergency departments on decision-making and patient flow and safety – A realist evaluation
title_full_unstemmed The effectiveness of primary care streaming in emergency departments on decision-making and patient flow and safety – A realist evaluation
title_sort The effectiveness of primary care streaming in emergency departments on decision-making and patient flow and safety – A realist evaluation
author_id_str_mv 6098eddc58e31ac2f3e070cb839faa6a
ab23c5e0111b88427a155a1f495861d9
author_id_fullname_str_mv 6098eddc58e31ac2f3e070cb839faa6a_***_Bridie Evans
ab23c5e0111b88427a155a1f495861d9_***_Helen Snooks
author Bridie Evans
Helen Snooks
author2 Michelle Edwards
Alison Cooper
Thomas Hughes
Freya Davies
Delyth Price
Pippa Anderson
Bridie Evans
Andrew Carson-Stevens
Jeremy Dale
Peter Hibbert
Barbara Harrington
Julie Hepburn
Aloysius Niroshan Siriwardena
Helen Snooks
Adrian Edwards
format Journal article
container_title International Emergency Nursing
container_volume 62
container_start_page 101155
publishDate 2022
institution Swansea University
issn 1755-599X
doi_str_mv 10.1016/j.ienj.2022.101155
publisher Elsevier BV
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Medicine{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Medicine
document_store_str 1
active_str 0
description Primary care streaming was implemented in UK Emergency Departments (EDs) to manage an increasing demand for urgent care. We aimed to explore its effectiveness in EDs with different primary care models and identify contexts and mechanisms that influenced outcomes: streaming patients to the most appropriate clinician or service, ED flow and patient safety.MethodWe observed streaming and interviewed ED and primary care staff during case study visits to 10 EDs in England. We used realist methodology, synthesising a middle-range theory with our qualitative data to refine and create a set of theories that explain relationships between contexts, mechanisms and outcomes.ResultsMechanisms contributing to the effectiveness of primary care streaming were: quality of decision-making, patient flow, redeploying staff, managing patients across streams, the implementation of governance protocols, guidance, training, service evaluation and quality improvement efforts. Experienced nurses and good teamworking and strategic and operational management were key contextual factors.ConclusionWe recommend service improvement strategies, operational management, monitoring, evaluation and training to ensure that ED nurses stream patients presenting at an ED seeking urgent care to the most appropriate clinicians for their needs in a safe and efficient manner.
published_date 2022-05-01T04:18:37Z
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