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Improving emergency care pathways: an action research approach
  1. Ruth Endacott1,2,
  2. Simon Cooper2,
  3. Rod Sheaff1,
  4. Jacqueline Padmore1,
  5. Gillian Blakely1
  1. 1Faculty of Health, University of Plymouth, Plymouth, UK
  2. 2School of Nursing & Midwifery, Monash University, School of Nursing and Midwifery, Australia
  1. Correspondence to Professor Ruth Endacott, Faculty of Health, University of Plymouth, 8 Portland Villas, Drake Circus, Plymouth PL4 8AA, UK; ruth.endacott{at}


Background Clinicians and managers across specialities are under pressure to review treatment and referral pathways to enable evidence-based practice, improve patient flow and provide a seamless service. This study outlines the processes and outcomes of an action research study conducted to reduce inappropriate attendances and unplanned pressures on Emergency Department (ED) staff in an English hospital during 2006–2008.

Methods Action research, comprising three action/reflection cycles conducted with participants, was used. Data were collected using retrospective patient record review (n=35 200) interviews with staff members (n=28), observation of patient pathways (n=38 patients) and measurement of team climate (n=31) with literature reviews also informing each cycle of data collection.

Results ED attendance and hospital emergency admission data were largely similar to the national picture with regards to time/day of attendance and seasonal variation. However, in the ‘adult majors’ subgroup, mean attendance on a Monday was significantly higher than the rest of the week (p<0.001) and 36% were self-referrals. Observation data revealed that patients were informally assessed by reception staff and directed to majors or minors; this practice was replaced by reinstatement of triage. Patients identified as ‘inappropriate’ were managed inconsistently, irrespective of department workload. ED attendance decreased as the project progressed and the number of attendees resulting in hospital admission rose slightly.

Conclusions Study data suggest that inappropriate attendances decreased; however, data collection exposed gaps in the existing management information systems and inconsistencies in working practices in the ED. Action research can have a practical value besides contributing to knowledge.

  • (MeSH terms)
  • emergency medicine
  • clinical pathway
  • delivery of healthcare
  • emergency care systems
  • emergency departments
  • admission avoidance
  • wounds
  • research

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  • Funding Department of Health, New Ways of Working programme.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the University of Plymouth.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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