Redesigning clinical processes is an iterative process that seeks to reduce care variance and improve quality, safety and satisfaction for patients. The aim of this project was to optimise multidisciplinary collaboration, management and integration of clinical processes for people with Parkinson's Disease (PD) in one Emergency Department (ED).
The retrospective evaluation study design explored the outcomes of a clinical process redesign project. The project included: a pre-post medical record audit, a nurse survey and patient and carer telephone interviews.
The pre-post ED medical record audit revealed in favour of the post group a median reduction of 175 minutes (IQR 0:40 - 19:40) in length of stay, a 21% improvement in timely PD medication administration and 13% improvement in correctly prescribed PD medications. Patients and carers (n = 47) were satisfied with their ED experience, clinicians' knowledge and management and healthcare decision engagement. Nurses (n = 30) reported improved knowledge, confidence and management in caring for PD patients.
This project led to enhanced multidisciplinary engagement and positive patient, clinician and service outcomes. Redesign principles can provide a pragmatic approach to improve the integration of care, change clinician behaviour, and reduce adverse outcomes within any clinical setting.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Australasian Emergency Care
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Living with Parkinson's disease.Deloitte Access Economics, Sydney2015
- Parkinson's prevalence in the United Kingdom.Parkinson's UK, London2012
- Quality of life in patients with Parkinson's diseases.Act Neur Sup Red. 2013; : 55
- Parkinson disease: a global view. Research reports.Spring, 2008: 9-11
- Economics D.A. Living with Parkinson's disease – challenges and positive steps for the future, Sydney. 2011: 1-79
- Emergency presentations of Parkinson's disease: early recognition and treatment are crucial for optimum outcome.Postgrad Med J. 2011; 87: 125-131
- A systematic review of interventions to reduce hospitalisation in Parkinson's disease.Parkinsonism & Related Disorders. 2016; 24: 3-7https://doi.org/10.1016/j.parkreldis.2016.01.011
- Reasons for hospitalization in Parkinson's disease:A case-control study..Parkinsonism and Related Disorders. 2014; 20: 488-492https://doi.org/10.1016/j.parkreldis.2014.01.022
- Comparison of hospitalizations, emergency room visits, fractures, and falls among parkinson disease patients who initiated therapy with selegiline or rasagiline: A retrospective study.Value Health. 2013; 16: A105https://doi.org/10.1016/j.jval.2013.03.498
- Inpatient management of Parkinson disease: current challenges and future directions.Neurohospitalist. 2012; 2 ([published online first: 01.01.12]): 28-35https://doi.org/10.1177/1941874411427734
- Deterioration of Parkinson's disease during hospitalization: survey of 684 patients.BMC Neurology. 2012; : 12
- Missing dosages and neuroleptic usage may prolong length of stay in hospitalized Parkinson's disease patients.PloS one. 2015; (10:e0124356)
- Managing hospitalised patients with Parkinson's disease: are we getting it right?.Age Ageing. 2015; 44: i5https://doi.org/10.1093/ageing/afv029.21
- The utilisation of one district hospital emergency department by people with Parkinson's disease.Australas Emerg Nurs J. 2017; 20 ([published online first: 12.01.17]): 1-5
- The effects of care bundles on patient outcomes: a systematic review and meta-analysis.Implement Sci. 2017; 12 ([published online first: 01.12.17]): 142https://doi.org/10.1186/s13012-017-0670-0
- B4.1.3. The care bundle approach.Australian Government, Canberra2018
- Effectiveness of bundled behavioural interventions to control healthcare-associated infections: a systematic review of the literature.J Hosp Infect. 2007; 66: 101-108
- Using care bundles to improve health care quality. IHI Innovation Series white paper.Institute for Healthcare Improvement, Cambridge, MA2012
- Process redesign for time-based emergency admission targets.J Health Organ Manage. 2016; 30 ([published online first: 30.09.16]): 939-949https://doi.org/10.1108/jhom-08-2015-0114
- How to begin a quality improvement project.Clin J Am Soc Nephrol. 2016; 11 ([published online first: 27.03.16]): 893-900https://doi.org/10.2215/cjn.11491015
- Utilizing six sigma lean strategies to expedite emergency department CT scan throughput in a tertiary care facility.J Am Coll Radiol. 2017; 14 ([published online first: 08.11.16]): 78-81https://doi.org/10.1016/j.jacr.2016.06.032
- Parkinson's Australia submission to National Health & Hospitals Reform Commission.Parkinson's Australia, Australia2008: 1-16
- Parkinson's disease in adults NICE guideline [NG71].National Institute for Health and Care Excellence, 2017
- What is a bundle?.Institute for Healthcare Improvement, Boston2018
- A systematic review of the use of the consolidated framework for implementation research.Implement Sci. 2016; 11https://doi.org/10.1186/s13012-016-0437-z
- Specifying and reporting complex behaviour change interventions: the need for a scientific method.Implement Sci. 2009; 4: 40
- Implementation strategies: recommendations for specifying and reporting.Implement Sci. 2013; 8https://doi.org/10.1186/1748-5908-8-139
- Framework of policy recommendations for implementation of evidence-based practice: a systematic scoping review.BMJ Open. 2013; : 3https://doi.org/10.1136/bmjopen-2012-001881
- What are effective strategies for the implementation of care bundles on ICUs: a systematic review.Implement Sci. 2015; 10https://doi.org/10.1186/s13012-015-0306-1
- Interdisciplinary teamwork for the treatment of people with Parkinson's Disease and their families.Curr Neurol Neurosci Rep. 2014; 14: 493https://doi.org/10.1007/s11910-014-0493-1
- Parkinson's nurses-affordable, local accessible and expert care: a guide for commissioners in England/Northern Ireland/Scotland/Wales.Parkinson's UK, London2011
- ACT Health – Chronic Care Program Parkinson's Disease Service evaluation report.Canberra Hospital and Health Services, Canberra2014: 1-23
- Evaluation of a Regional Australian Nurse-Led Parkinson's Service using the context, input, process and product evaluation model.Clin Nurse Spec. 2016; 30: 264-270https://doi.org/10.1097/NUR.0000000000000232
- Reasons for admission to hospital for Parkinson's disease.Intern Med J. 2006; 36: 524-526
- A discrete event simulation model to evaluate the use of community services in the treatment of patients with Parkinson's disease in the United Kingdom.BMC Health Serv Res. 2017; 17: 50https://doi.org/10.1186/s12913-017-1994-9
- Discharge planning in chronic conditions: an evidence-based analysis.Ont Health Technol Assess Ser. 2013; 13 ([published online first: 30.10.13]): 1-72
- Providing better support to people with Parkinson's in the community and preventing unnecessary hospital admissions.Parkinson's UK, London2016
- Clinical problems in the hospitalized Parkinson's disease patient: systematic review.Mov Disord. 2010; 26: 197-208
- Clinical pathways: effects on professional practice, patient outcomes, length of stay and hospital costs.Cochrane Database Syst Rev. 2010; ([published online first: 20.03.10]): Cd006632https://doi.org/10.1002/14651858.CD006632.pub2
Published online: March 21, 2019
Accepted: February 19, 2019
Received: September 10, 2018
© 2019 College of Emergency Nursing Australasia. Published by Elsevier Ltd. All rights reserved.