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Jon Nicholl - One of the best experts on this subject based on the ideXlab platform.
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Effect of a national Urgent Care telephone triage service on population perceptions of Urgent Care provision: Controlled before and after study
BMJ Open, 2016Co-Authors: Emma Knowles, A. O'cathain, J Turner, Jon NichollAbstract:OBJECTIVE To measure the effect of an Urgent Care telephone service NHS 111 on population perceptions of Urgent Care. DESIGN Controlled before and after population survey, using quota sampling to identify 2000 respondents reflective of the age/sex profile of the general population. SETTING England. 4 areas where NHS 111 was introduced, and 3 control areas where NHS 111 had yet to be introduced. PARTICIPANTS 28 071 members of the general population, including 2237 recent users of Urgent Care. INTERVENTION NHS 111 offers advice to members of the general population seeking Urgent Care, recommending the best service to use or self-management. Policymakers introduced NHS 111 to improve access to Urgent Care. OUTCOMES MEASURES The primary outcome was change in satisfaction with recent Urgent Care use 9 months after the launch of NHS 111. Secondary outcomes were change in satisfaction with Urgent Care generally and with the national health service. RESULTS The overall response rate was 28% (28 071/100 408). 8% (2237/28 071) had used Urgent Care in the previous 3 months. Of the 652 recent users of Urgent Care in the NHS 111 intervention areas, 9% (60/652) reported calling NHS 111 in the 'after' period. There was no evidence that the introduction of NHS 111 was associated with a changed perception of recent Urgent Care. For example, the percentage rating their experience as excellent remained at 43% (OR 0.97, 95% CI 0.69 to 1.37). Similarly, there was no change in population perceptions of Urgent Care generally (1.06, 95% CI 0.95 to 1.17) or the NHS (0.94, 95% CI 0.85 to 1.05) following the introduction of NHS 111. CONCLUSIONS A new telephone triage service did not improve perceptions of Urgent Care or the health service. This could be explained by the small amount of NHS 111 activity in a large emergency and Urgent Care system.
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a system wide approach to explaining variation in potentially avoidable emergency admissions national ecological study
BMJ Quality & Safety, 2014Co-Authors: Alicia Ocathain, Emma Knowles, Janette Turner, Ravi Maheswaran, Tim Pearson, Enid Hirst, Steve Goodacre, Jon NichollAbstract:Background Some emergency admissions can be avoided if acute exacerbations of health problems are managed by the range of health services providing emergency and Urgent Care. Aim To identify system-wide factors explaining variation in age sex adjusted admission rates for conditions rich in avoidable admissions. Design National ecological study. Setting 152 emergency and Urgent Care systems in England. Methods Hospital Episode Statistics data on emergency admissions were used to calculate an age sex adjusted admission rate for conditions rich in avoidable admissions for each emergency and Urgent Care system in England for 2008–2011. Results There were 3 273 395 relevant admissions in 2008–2011, accounting for 22% of all emergency admissions. The mean age sex adjusted admission rate was 2258 per year per 100 000 population, with a 3.4-fold variation between systems (1268 and 4359). Factors beyond the control of health services explained the majority of variation: unemployment rates explained 72%, with urban/rural status explaining further variation (R2=75%). Factors related to emergency departments, hospitals, emergency ambulance services and general practice explained further variation (R2=85%): the attendance rate at emergency departments, percentage of emergency department attendances converted to admissions, percentage of emergency admissions staying less than a day, percentage of emergency ambulance calls not transported to hospital and perceived access to general practice within 48 h. Conclusions Interventions to reduce avoidable admissions should be targeted at deprived communities. Better use of emergency departments, ambulance services and primary Care could further reduce avoidable emergency admissions.
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Impact of the Urgent Care telephone service NHS 111 pilot sites: A controlled before and after study
BMJ Open, 2013Co-Authors: Janette Turner, Emma Knowles, Alicia Ocathain, Jon NichollAbstract:OBJECTIVES To measure the impact of the Urgent Care telephone service NHS 111 on the emergency and Urgent Care system. DESIGN Controlled before and after study using routine data. SETTING Four pilot sites and three control sites covering a total population of 3.6 million in England, UK. PARTICIPANTS AND DATA Routine data on 36 months of use of emergency ambulance service calls and incidents, emergency department attendances, Urgent Care contacts (general practice (GP) out of hours, walk in and Urgent Care centres) and calls to the telephone triage service NHS direct. INTERVENTION NHS 111, a new 24 h 7 day a week telephone service for non-emergency health problems, operated by trained non-clinical call handlers with clinical support from nurse advisors, using NHS Pathways software to triage calls to different services and home Care. MAIN OUTCOMES Changes in use of emergency and Urgent Care services. RESULTS NHS 111 triaged 277 163 calls in the first year of operation for a population of 1.8 million. There was no change overall in emergency ambulance calls, emergency department attendances or Urgent Care use. There was a 19.3% reduction in calls to NHS Direct (95% CI -24.6% to -14.0%) and a 2.9% increase in emergency ambulance incidents (95% CI 1.0% to 4.8%). There was an increase in activity overall in the emergency and Urgent Care system in each site ranging 4.7-12%/month and this remained when assuming that NHS 111 will eventually take all NHS Direct and GP out of hours calls. CONCLUSIONS In its first year of operation in four pilot sites NHS 111 did not deliver the expected system benefits of reducing calls to the 999 ambulance service or shifting patients to Urgent rather than emergency Care. There is potential that this type of service increases overall demand for Urgent Care.
Ateev Mehrotra - One of the best experts on this subject based on the ideXlab platform.
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antibiotic prescribing during pediatric direct to consumer telemedicine visits
Pediatrics, 2019Co-Authors: Ateev Mehrotra, Sabrina J Poon, Courtney A Gidengil, Lori UscherpinesAbstract:BACKGROUND AND OBJECTIVES: Use of commercial direct-to-consumer (DTC) telemedicine outside of the pediatric medical home is increasing among children, and acute respiratory infections (ARIs) are the most commonly diagnosed condition at DTC telemedicine visits. Our objective was to compare the quality of antibiotic prescribing for ARIs among children across 3 settings: DTC telemedicine, Urgent Care, and the primary Care provider (PCP) office. METHODS: In a retrospective cohort study using 2015–2016 claims data from a large national commercial health plan, we identified ARI visits by children (0–17 years old), excluding visits with comorbidities that could affect antibiotic decisions. Visits were matched on age, sex, chronic medical complexity, state, rurality, health plan type, and ARI diagnosis category. Within the matched sample, we compared the percentage of ARI visits with any antibiotic prescribing and the percentage of ARI visits with guideline-concordant antibiotic management. RESULTS: There were 4604 DTC telemedicine, 38 408 Urgent Care, and 485 201 PCP visits for ARIs in the matched sample. Antibiotic prescribing was higher for DTC telemedicine visits than for other settings (52% of DTC telemedicine visits versus 42% Urgent Care and 31% PCP visits; P CONCLUSIONS: At DTC telemedicine visits, children with ARIs were more likely to receive antibiotics and less likely to receive guideline-concordant antibiotic management compared to children at PCP visits and Urgent Care visits.
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the impact of conversion from an Urgent Care center to a freestanding emergency department on patient population conditions managed and reimbursement
Journal of Emergency Medicine, 2019Co-Authors: Sabrina J Poon, Ateev Mehrotra, Leanne Metcalfe, Olesya Baker, Jeremiah D SchuurAbstract:Abstract Background Freestanding emergency departments (FSEDs), EDs not attached to acute Care hospitals, are expanding. One key question is whether FSEDs are more similar to higher-cost hospital-based EDs or to lower-cost Urgent Care centers (UCCs). Objective Our aim was to determine whether there was a change in patient population, conditions managed, and reimbursement among three facilities that converted from a UCC to an FSED. Methods Using insurance claims from Blue Cross Blue Shield of Texas, we compared outcomes of interest for three facilities that converted from a UCC to an FSED for 1 year before and after conversion. Results There was no significant change in age, sex, and comorbidities among patients treated after conversion. Conditions were similar after conversion, though there was a small increase in visits for potentially more severe conditions. For example, the most common diagnoses before and after conversion were upper respiratory infections (42.8% of UCC visits, 26.0% of FSED visits), while chest pain increased from rank 30 to 10 (0.5% of UCC visits, 2.3% of FSED visits). Yearly number of visits decreased after conversion, while median reimbursement per visit increased (facility A: $148 to $2,153; facility B: $137 to $1,466; and facility C: $131 to $1,925) and total revenue increased (facility A: $1,389,590 to $1,486,203; facility B: $896,591 to $4,294,636; and facility C: $637,585 to $8,429,828). Conclusions After three UCCs converted to FSEDs, patient volume decreased and reimbursement per visit increased, despite no change in patient characteristics and little change in conditions managed. These case studies suggest that some FSEDs are similar to UCCs in patient mix and conditions treated.
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Many emergency department visits could be managed at Urgent Care centers and retail clinics
Health Affairs, 2010Co-Authors: Robin M. Weinick, Rachel M. Burns, Ateev MehrotraAbstract:Americans seek a large amount of nonemergency Care in emergency departments, where they often encounter long waits to be seen. Urgent Care centers and retail clinics have emerged as alternatives to the emergency department for nonemergency Care. We estimate that 13.7–27.1 percent of all emergency department visits could take place at one of these alternative sites, with a potential cost savings of approximately $4.4 billion annually. The primary conditions that could be treated at these sites include minor acute illnesses, strains, and fractures. There is some evidence that patients can safely direct themselves to these alternative sites. However, more research is needed to ensure that Care of equivalent quality is provided at Urgent Care centers and retail clinics compared to emergency departments.
Emma Knowles - One of the best experts on this subject based on the ideXlab platform.
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Effect of a national Urgent Care telephone triage service on population perceptions of Urgent Care provision: Controlled before and after study
BMJ Open, 2016Co-Authors: Emma Knowles, A. O'cathain, J Turner, Jon NichollAbstract:OBJECTIVE To measure the effect of an Urgent Care telephone service NHS 111 on population perceptions of Urgent Care. DESIGN Controlled before and after population survey, using quota sampling to identify 2000 respondents reflective of the age/sex profile of the general population. SETTING England. 4 areas where NHS 111 was introduced, and 3 control areas where NHS 111 had yet to be introduced. PARTICIPANTS 28 071 members of the general population, including 2237 recent users of Urgent Care. INTERVENTION NHS 111 offers advice to members of the general population seeking Urgent Care, recommending the best service to use or self-management. Policymakers introduced NHS 111 to improve access to Urgent Care. OUTCOMES MEASURES The primary outcome was change in satisfaction with recent Urgent Care use 9 months after the launch of NHS 111. Secondary outcomes were change in satisfaction with Urgent Care generally and with the national health service. RESULTS The overall response rate was 28% (28 071/100 408). 8% (2237/28 071) had used Urgent Care in the previous 3 months. Of the 652 recent users of Urgent Care in the NHS 111 intervention areas, 9% (60/652) reported calling NHS 111 in the 'after' period. There was no evidence that the introduction of NHS 111 was associated with a changed perception of recent Urgent Care. For example, the percentage rating their experience as excellent remained at 43% (OR 0.97, 95% CI 0.69 to 1.37). Similarly, there was no change in population perceptions of Urgent Care generally (1.06, 95% CI 0.95 to 1.17) or the NHS (0.94, 95% CI 0.85 to 1.05) following the introduction of NHS 111. CONCLUSIONS A new telephone triage service did not improve perceptions of Urgent Care or the health service. This could be explained by the small amount of NHS 111 activity in a large emergency and Urgent Care system.
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a system wide approach to explaining variation in potentially avoidable emergency admissions national ecological study
BMJ Quality & Safety, 2014Co-Authors: Alicia Ocathain, Emma Knowles, Janette Turner, Ravi Maheswaran, Tim Pearson, Enid Hirst, Steve Goodacre, Jon NichollAbstract:Background Some emergency admissions can be avoided if acute exacerbations of health problems are managed by the range of health services providing emergency and Urgent Care. Aim To identify system-wide factors explaining variation in age sex adjusted admission rates for conditions rich in avoidable admissions. Design National ecological study. Setting 152 emergency and Urgent Care systems in England. Methods Hospital Episode Statistics data on emergency admissions were used to calculate an age sex adjusted admission rate for conditions rich in avoidable admissions for each emergency and Urgent Care system in England for 2008–2011. Results There were 3 273 395 relevant admissions in 2008–2011, accounting for 22% of all emergency admissions. The mean age sex adjusted admission rate was 2258 per year per 100 000 population, with a 3.4-fold variation between systems (1268 and 4359). Factors beyond the control of health services explained the majority of variation: unemployment rates explained 72%, with urban/rural status explaining further variation (R2=75%). Factors related to emergency departments, hospitals, emergency ambulance services and general practice explained further variation (R2=85%): the attendance rate at emergency departments, percentage of emergency department attendances converted to admissions, percentage of emergency admissions staying less than a day, percentage of emergency ambulance calls not transported to hospital and perceived access to general practice within 48 h. Conclusions Interventions to reduce avoidable admissions should be targeted at deprived communities. Better use of emergency departments, ambulance services and primary Care could further reduce avoidable emergency admissions.
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Impact of the Urgent Care telephone service NHS 111 pilot sites: A controlled before and after study
BMJ Open, 2013Co-Authors: Janette Turner, Emma Knowles, Alicia Ocathain, Jon NichollAbstract:OBJECTIVES To measure the impact of the Urgent Care telephone service NHS 111 on the emergency and Urgent Care system. DESIGN Controlled before and after study using routine data. SETTING Four pilot sites and three control sites covering a total population of 3.6 million in England, UK. PARTICIPANTS AND DATA Routine data on 36 months of use of emergency ambulance service calls and incidents, emergency department attendances, Urgent Care contacts (general practice (GP) out of hours, walk in and Urgent Care centres) and calls to the telephone triage service NHS direct. INTERVENTION NHS 111, a new 24 h 7 day a week telephone service for non-emergency health problems, operated by trained non-clinical call handlers with clinical support from nurse advisors, using NHS Pathways software to triage calls to different services and home Care. MAIN OUTCOMES Changes in use of emergency and Urgent Care services. RESULTS NHS 111 triaged 277 163 calls in the first year of operation for a population of 1.8 million. There was no change overall in emergency ambulance calls, emergency department attendances or Urgent Care use. There was a 19.3% reduction in calls to NHS Direct (95% CI -24.6% to -14.0%) and a 2.9% increase in emergency ambulance incidents (95% CI 1.0% to 4.8%). There was an increase in activity overall in the emergency and Urgent Care system in each site ranging 4.7-12%/month and this remained when assuming that NHS 111 will eventually take all NHS Direct and GP out of hours calls. CONCLUSIONS In its first year of operation in four pilot sites NHS 111 did not deliver the expected system benefits of reducing calls to the 999 ambulance service or shifting patients to Urgent rather than emergency Care. There is potential that this type of service increases overall demand for Urgent Care.
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a pragmatic quasi experimental multi site community intervention trial evaluating the impact of emergency Care practitioners in different uk health settings on patient pathways neecap trial
Emergency Medicine Journal, 2012Co-Authors: Suzanne Mason, Emma Knowles, C Okeeffe, Mike Bradburn, Michael J Campbell, Patricia Coleman, Chris Stride, Rachel Ohara, Jo Rick, Malcolm PattersonAbstract:Background Emergency Care Practitioners (ECPs) are operational in the UK in a variety of emergency and Urgent Care settings. However, there is little evidence of the effectiveness of ECPs within these different settings. The aim of this study was to evaluate the impact of ECPs on patient pathways and Care in different emergency Care settings. Methods A pragmatic quasi-experimental multi-site community intervention trial comprising five matched pairs of intervention (ECP) and control services (usual Care providers): ambulance, Care home, minor injury unit, Urgent Care centre and GP out-of-hours. The main outcome being assessed was patient disposal pathway following the Care episode. Results 5525 patient episodes (n=2363 intervention and n=3162 control) were included in the study. A significantly greater percentage of patients were discharged by ECPs working in mobile settings such as the ambulance service (percentage diff. 36.7%, 95% CI 30.8% to 42.7%) and Care home service (36.8%, 26.7% to 46.8%). In static services such as out-of-hours (−17.9%, −30.8% to −42.7%) and Urgent Care centres (−11.5%, −18.0% to −5.1%), a significantly greater percentage of patients were discharged by usual Care providers. Conclusions ECPs have a differential impact compared with usual Care providers dependent on the operational service settings. Maximal impact occurs when they operate in mobile settings when Care is taken to the patient. In these settings ECPs have a broader range of skills than the usual Care providers (eg, paramedic), and are targeted to specific clinical groups who can benefit from alternative pathways of Care (such as older people who have fallen). Trial Registration No ISRCTN22085282 (Controlled trials.com).
Susan Halford - One of the best experts on this subject based on the ideXlab platform.
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has the nhs 111 Urgent Care telephone service been a success case study and secondary data analysis in england
BMJ Open, 2017Co-Authors: Catherine Pope, Joanne Turnbull, Jeremy Jones, Jane Prichard, Alison Rowsell, Susan HalfordAbstract:Objectives To explore the success of the introduction of the National Health Service (NHS) 111 Urgent Care service and describe service activity in the period 2014–2016. Design Comparative mixed method case study of five NHS 111 service providers and analysis of national level routine data on activity and service use. Settings and data Our primary research involved five NHS 111 sites in England. We conducted 356 hours of non-participant observation in NHS 111 call centres and the Urgent Care centres and, linked to these observations, held 6 focus group interviews with 47 call advisors, clinical and managerial staff. This primary research is augmented by a secondary analysis of routine data about the 44 NHS 111 sites in England contained in the NHS 111 Minimum Data Set made available by NHS England. Results Opinions vary depending on the criteria used to judge the success of NHS 111. The service has been rolled out across 44 sites. The 111 phone number is operational and the service has replaced its predecessor NHS Direct. This new service has led to changes in who does the work of managing Urgent Care demand, achieving significant labour substitution. Judged against internal performance criteria, the service appears not to meet some targets such as call answering times, but it has seen a steady increase in use over time. Patients appear largely satisfied with NHS 111, but the view from some stakeholders is more mixed. The impact of NHS 111 on other health services is difficult to assess and cost-effectiveness has not been established. Conclusion The new Urgent Care service NHS 111 has been brought into use but its success against some key criteria has not been comprehensively proven.
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Using computer decision support systems in NHS emergency and Urgent Care: ethnographic study using normalisation process theory
BMC Health Services Research, 2013Co-Authors: Catherine Pope, Joanne Turnbull, Jane Prichard, Susan Halford, Melania Calestani, Carl MayAbstract:Background Information and communication technologies (ICTs) are often proposed as ‘technological fixes’ for problems facing healthCare. They promise to deliver services more quickly and cheaply. Yet research on the implementation of ICTs reveals a litany of delays, compromises and failures. Case studies have established that these technologies are difficult to embed in everyday healthCare. Methods We undertook an ethnographic comparative analysis of a single computer decision support system in three different settings to understand the implementation and everyday use of this technology which is designed to deal with calls to emergency and Urgent Care services. We examined the deployment of this technology in an established 999 ambulance call-handling service, a new single point of access for Urgent Care and an established general practice out-of-hours service. We used Normalization Process Theory as a framework to enable systematic cross-case analysis. Results Our data comprise nearly 500 hours of observation, interviews with 64 call-handlers, and stakeholders and documents about the technology and settings. The technology has been implemented and is used distinctively in each setting reflecting important differences between work and contexts. Using Normalisation Process Theory we show how the work ( collective action ) of implementing the system and maintaining its routine use was enabled by a range of actors who established coherence for the technology, secured buy-in ( cognitive participation ) and engaged in on-going appraisal and adjustment ( reflexive monitoring ). Conclusions Huge effort was expended and continues to be required to implement and keep this technology in use. This innovation must be understood both as a computer technology and as a set of practices related to that technology, kept in place by a network of actors in particular contexts. While technologies can be ‘made to work’ in different settings, successful implementation has been achieved, and will only be maintained, through the efforts of those involved in the specific settings and if the wider context continues to support the coherence, cognitive participation, and reflective monitoring processes that surround this collective action. Implementation is more than simply putting technologies in place – it requires new resources and considerable effort, perhaps on an on-going basis.
Janette Turner - One of the best experts on this subject based on the ideXlab platform.
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Digital and online symptom checkers and assessment services for Urgent Care to inform a new digital platform: a systematic review
Health Services and Delivery Research, 2019Co-Authors: Duncan Chambers, Maxine Johnson, Louise Preston, Susan Baxter, Andrew Booth, Anna Cantrell, Janette TurnerAbstract:Background Digital and online symptom checkers and assessment services are used by patients seeking guidance about health problems. NHS England is planning to introduce a digital platform (NHS111 Online) to operate alongside the NHS111 Urgent-Care telephone service. This review focuses on digital and online symptom checkers for Urgent health problems. Objectives This systematic review was commissioned to provide NHS England with an independent review of previous research in this area to inform strategic decision-making and service design. Data sources Focused searches of seven bibliographic databases were performed and supplemented by phrase searching for names of symptom checker systems and citation searches of key included studies. The bibliographic databases searched were MEDLINE, EMBASE, The Cochrane Library, CINAHL (Cumulative Index to Nursing and Allied Health Literature), HMIC (Health Management Information Consortium), Web of Science and the Association of Computing Machinery (ACM) Digital Library, from inception up to April 2018. Review methods Brief inclusion criteria were (1) population – general population seeking information online or digitally to address an Urgent health problem; (2) intervention – any online or digital service designed to assess symptoms, provide health advice and direct patients to appropriate services; and (3) comparator – telephone or face-to-face assessment, comparative performance in tests or simulations (studies with no comparator were included if they reported relevant outcomes). Outcomes of interest included safety, clinical effectiveness, costs or cost-effectiveness, diagnostic and triage accuracy, use of and contacts with health services, compliance with advice received, patient/Carer satisfaction, and equity and inclusion. Inclusion was not restricted by study design. Screening studies for inclusion, data extraction and quality assessment were carried out by one reviewer with a sample checked for accuracy and consistency. Final decisions on study inclusion were taken by consensus of the review team. A narrative synthesis of the included studies was performed and structured around the predefined research questions and key outcomes. The overall strength of evidence for each outcome was classified as ‘stronger’, ‘weaker’, ‘conflicting’ or ‘insufficient’, based on study numbers and design. Results In total, 29 publications describing 27 studies were included. Studies were diverse in their design and methodology. The overall strength of the evidence was weak because it was largely based on observational studies and with a substantial component of non-peer-reviewed grey literature. There was little evidence to suggest that symptom checkers are unsafe, but studies evaluating their safety were generally short term and small scale. Diagnostic accuracy was highly variable between different systems but was generally low. Algorithm-based triage tended to be more risk averse than that of health professionals. Inconsistent evidence was found on effects on service use. There was very limited evidence on patients’ reactions to online triage advice. The studies showed that younger and more highly educated people are more likely to use these services. Study participants generally expressed high levels of satisfaction with digital and online triage services, albeit in uncontrolled studies. Limitations Findings from symptom checker systems for specific conditions may not be applicable to more general systems and vice versa. Studies of symptom checkers as part of electronic consultation systems in general practice were also included, which is a slightly different setting from a general ‘digital 111’ service. Most studies were screened by one reviewer. Conclusions Major uncertainties surround the probable impact of digital 111 services on most outcomes. It will be important to monitor and evaluate the services using all available data sources and by commissioning high-quality research. Future work Priorities for research include comparisons of different systems, rigorous economic evaluations and investigations of patient pathways. Study registration The study is registered as PROSPERO CRD42018093564.
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why do people choose emergency and Urgent Care services a rapid review utilizing a systematic literature search and narrative synthesis
Academic Emergency Medicine, 2017Co-Authors: Joanne Coster, Janette Turner, Daniel Bradbury, Anna CantrellAbstract:Objectives Rising demand for emergency and Urgent Care services is well documented, as are the consequences, for example, emergency department (ED) crowding, increased costs, pressure on services, and waiting times. Multiple factors have been suggested to explain why demand is increasing, including an aging population, rising number of people with multiple chronic conditions, and behavioral changes relating to how people choose to access health services. The aim of this systematic mapping review was to bring together published research from Urgent and emergency Care settings to identify drivers that underpin patient decisions to access Urgent and emergency Care. Methods Systematic searches were conducted across Medline (via Ovid SP), EMBASE (via Ovid), The Cochrane Library (via Wiley Online Library), Web of Science (via the Web of Knowledge), and the Cumulative Index to Nursing and Allied Health Literature (CINAHL; via EBSCOhost). Peer-reviewed studies written in English that reported reasons for accessing or choosing emergency or Urgent Care services and were published between 1995 and 2016 were included. Data were extracted and reasons for choosing emergency and Urgent Care were identified and mapped. Thematic analysis was used to identify themes and findings were reported qualitatively using framework-based narrative synthesis. Results Thirty-eight studies were identified that met the inclusion criteria. Most studies were set in the United Kingdom (39.4%) or the United States (34.2%) and reported results relating to ED (68.4%). Thirty-nine percent of studies utilized qualitative or mixed research designs. Our thematic analysis identified six broad themes that summarized reasons why patients chose to access ED or Urgent Care. These were access to and confidence in primary Care; perceived urgency, anxiety, and the value of reassurance from emergency-based services; views of family, friends, or healthCare professionals; convenience (location, not having to make appointment, and opening hours); individual patient factors (e.g., cost); and perceived need for emergency medical services or hospital Care, treatment, or investigations. Conclusions We identified six distinct reasons explaining why patients choose to access emergency and Urgent Care services: limited access to or confidence in primary Care; patient perceived urgency; convenience; views of family, friends, or other health professionals; and a belief that their condition required the resources and facilities offered by a particular healthCare provider. There is a need to examine demand from a whole system perspective to gain better understanding of demand for different parts of the emergency and Urgent Care system and the characteristics of patients within each sector.
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a system wide approach to explaining variation in potentially avoidable emergency admissions national ecological study
BMJ Quality & Safety, 2014Co-Authors: Alicia Ocathain, Emma Knowles, Janette Turner, Ravi Maheswaran, Tim Pearson, Enid Hirst, Steve Goodacre, Jon NichollAbstract:Background Some emergency admissions can be avoided if acute exacerbations of health problems are managed by the range of health services providing emergency and Urgent Care. Aim To identify system-wide factors explaining variation in age sex adjusted admission rates for conditions rich in avoidable admissions. Design National ecological study. Setting 152 emergency and Urgent Care systems in England. Methods Hospital Episode Statistics data on emergency admissions were used to calculate an age sex adjusted admission rate for conditions rich in avoidable admissions for each emergency and Urgent Care system in England for 2008–2011. Results There were 3 273 395 relevant admissions in 2008–2011, accounting for 22% of all emergency admissions. The mean age sex adjusted admission rate was 2258 per year per 100 000 population, with a 3.4-fold variation between systems (1268 and 4359). Factors beyond the control of health services explained the majority of variation: unemployment rates explained 72%, with urban/rural status explaining further variation (R2=75%). Factors related to emergency departments, hospitals, emergency ambulance services and general practice explained further variation (R2=85%): the attendance rate at emergency departments, percentage of emergency department attendances converted to admissions, percentage of emergency admissions staying less than a day, percentage of emergency ambulance calls not transported to hospital and perceived access to general practice within 48 h. Conclusions Interventions to reduce avoidable admissions should be targeted at deprived communities. Better use of emergency departments, ambulance services and primary Care could further reduce avoidable emergency admissions.
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Impact of the Urgent Care telephone service NHS 111 pilot sites: A controlled before and after study
BMJ Open, 2013Co-Authors: Janette Turner, Emma Knowles, Alicia Ocathain, Jon NichollAbstract:OBJECTIVES To measure the impact of the Urgent Care telephone service NHS 111 on the emergency and Urgent Care system. DESIGN Controlled before and after study using routine data. SETTING Four pilot sites and three control sites covering a total population of 3.6 million in England, UK. PARTICIPANTS AND DATA Routine data on 36 months of use of emergency ambulance service calls and incidents, emergency department attendances, Urgent Care contacts (general practice (GP) out of hours, walk in and Urgent Care centres) and calls to the telephone triage service NHS direct. INTERVENTION NHS 111, a new 24 h 7 day a week telephone service for non-emergency health problems, operated by trained non-clinical call handlers with clinical support from nurse advisors, using NHS Pathways software to triage calls to different services and home Care. MAIN OUTCOMES Changes in use of emergency and Urgent Care services. RESULTS NHS 111 triaged 277 163 calls in the first year of operation for a population of 1.8 million. There was no change overall in emergency ambulance calls, emergency department attendances or Urgent Care use. There was a 19.3% reduction in calls to NHS Direct (95% CI -24.6% to -14.0%) and a 2.9% increase in emergency ambulance incidents (95% CI 1.0% to 4.8%). There was an increase in activity overall in the emergency and Urgent Care system in each site ranging 4.7-12%/month and this remained when assuming that NHS 111 will eventually take all NHS Direct and GP out of hours calls. CONCLUSIONS In its first year of operation in four pilot sites NHS 111 did not deliver the expected system benefits of reducing calls to the 999 ambulance service or shifting patients to Urgent rather than emergency Care. There is potential that this type of service increases overall demand for Urgent Care.
