Understanding the effect of clinician dependent versus evidence-based pathway for the management of Salmonella-like symptoms in an emergency department
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Ranse J, Luther M, Ranse K. (2014). Understanding the effect of clinician dependent versus evidence-based pathway for the management of Salmonella-like symptoms in an emergency department; paper presented at the 12th International Conference for Emergency Nurses, Perth, Australia, 9th October.
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Understanding the effect of clinician dependent versus evidence-based pathway for the management of Salmonella-like symptoms in an emergency department
- 1. Understanding the effect of clinician dependent versus pathways for the management of Salmonella-like symptoms in an emergency department Mr Jamie Ranse, Mr Matt Luther, Dr Kristen Ranse Supported by an ACT Health Practice Development Scholarship
- 2. background • May 2013 Salmonella-like symptom surge • ‘Disaster’ declared • Just-in-time pathway introduced Aim • Understanding the effect of clinician dependent management versus pathways for Salmonella-like symptoms
- 3. methods • Design • Setting • Data collection • Data analysis • Protection of human participants
- 4. results • Number of patients • Demographics
- 5. results • Length of stay • Disposition
- 6. discussion • Length of stay • Disposition • Just-in-time pathways • Future public health emergencies • Use when patients present with Salmonella-like symptoms on a daily basis • Teachable moment
- 7. Understanding the effect of clinician dependent versus pathways for the management of Salmonella-like symptoms in an emergency department Mr Jamie Ranse, Mr Matt Luther, Dr Kristen Ranse Supported by an ACT Health Practice Development Scholarship
Editor's Notes
- On Monday the 13th of May 2013, a surge in patients with vomiting and diarrhoea presented to an Emergency Department (ED) in Canberra. Contract tracing identified a focal point between patients, and pathology samples identified Salmonella as the responsible agent. On the following Wednesday, upon a hospital based disaster being declared, a just-in-time evidence-based pathway was introduced to ensure consistency in patient management. This research aims to describe the effect of this pathway (intervention) versus clinician dependent (control) management of such patients. Thurs evening restaurant opening night Fri-Sun some gastro type presentations, nil cluster identified Mon night cluster identified, SA cohort Tue morning Calvary IC, PH and CDC notified from ED CHCACT Tue 1400 code yellow, cohort in SSU Tue 1700 code brown, discharge packs created, ID informed of AB selection Wed morning PH gastro pathways created, consistency achieved Thurs presentations begin to decrease, code brown cancelled followed by code yellow Fri event concluded
- Design This research was retrospective in design, utilising a descriptive study design (Polit, 2008). Setting Canberra, in the Australian Capital Territory, is an inland city of approximately 380,000 people. Canberra has two major metropolitan EDs. One of these is Calvary Hospital. Calvary Hospital is a 334 bed hospital, the public ED has approximately 45,000 presentations per annum. Population and sample A non-probability purposive sampling technique was used and included all patients that presented to the Calvary Hospital ED during May 2013. The sample included all presentations from the above population that presented with Salmonella-like symptoms, and included a total of 110 persons. Data collection Data was collected from the Emergency Department Information System. For the sample included in this study, information was obtained regarding presentation; date, time, complaint, length of stay, disposition and demographic information. Data analysis Patient characteristics, such as age and gender are described using descriptive statistics. A Mann-Whitney test was used to compare continuous data and a Fisher exact test was used to compare categorical data, between the two groups. Protection of human participants The researcher employed by the institution where this research took place had access to identifiable data pertaining to patients presentations. Identifiable characteristics, such as name and address of patients was removed by this researcher. A de-identifiable dataset was used for data analysis by the other researchers. This manuscript reports on population based patient characteristics rather than individual patient characteristics to enhance anonymous of participants. Additionally, this research received ethics approval from the Calvary Health Care ACT Human Research Ethics Committee (20-2013).
- Number of Patients Over an eight-day period, 110 patients presented with salmonella-like symptoms. Demographics Of the 110 patients who presented with salmonella-like-symptoms, 47 (42.7%) were male and 63 (57.3%) were female, with a median age of 30 years (IQR: 20-42). Both age (U=1277.5; p=0.65) and gender (p=0.84) were statistically similar between the two groups. Length of stay Does not include the LOS of those patients who were admitted to hospital. Only included the LOS for those patients that were managed in the ED and discharged home. This is because the LOS of those who were admitted was long Overall, the mean length of stay in minutes (±SD) was 735 (±1112). However, the mean length of stay in minutes was statistically different between the two groups, with the control being 975 (±1280) and the intervention being 230 (±251) (U=496.5; p<0.001).