Background Policies addressing ED crowding have failed to incorporate the public's perspectives; engaging the public in such policies is needed.
Objective This study aimed at determining the public's recommendations related to alternative models of care intended to reduce crowding, optimising access to and provision of emergency care.
Methods A Citizens' Jury was convened in Queensland, Australia, to consider priority setting and resource allocation to address ED crowding. Twenty-two jurors were recruited from the electoral roll, who were interested and available to attend the jury from 15 to 17 June 2012. Juror feedback was collected via a survey immediately following the end of the jury.
Results The jury considered that all patients attending the ED should be assessed with a minority of cases diverted for assistance elsewhere. Jurors strongly supported enabling ambulance staff to treat patients in their homes without transporting them to the ED, and allowing non-medical staff to treat some patients without seeing a doctor. Jurors supported (in principle) patient choice over aspects of their treatment (when, where and type of health professional) with some support for patients paying towards treatment but unanimous opposition for patients paying to be prioritised. Most of the jurors were satisfied with their experience of the Citizens' Jury process, but some jurors perceived the time allocated for deliberations as insufficient.
Conclusions These findings suggest that the general public may be open to flexible models of emergency care. The jury provided clear recommendations for direct public input to guide health policy to tackle ED crowding.
- emergency department management
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Contributors PAS, JAW, PB, EK, PL and AW conceived and designed the study, and obtained funding. PAS, PB, EK, RK and AW undertook the study; PAS, PB and EK presented the background and functioning of a citizen jury to the jurors, and AW and GF were independent content experts. RK undertook additional data collection from participants, supervised by EK and PAS. NM undertook data analysis and prepared a draft of this manuscript and all authors provided substantial input to this version of the manuscript.
Funding This research was supported by funding from an Australian Research Council Linkage Grant (#LP100200446), and Partner Organisations Queensland Health (Metro South Hospitals and Health Service), Southern Adelaide Local Health Network, Inc. and the National Institute for Health and Care Excellence (UK). RK received a full scholarship from this ARC grant plus a top-up grant for 2014 from the Australian Centre for Health Services Innovation (PostGraduate Scholarship PHD-000432, funded round 1-2013). PL is supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South London at King's College Hospital NHS Foundation Trust. The researchers were independent from the funders and all authors had full access to all of the data (including statistical reports and tables) in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis.
Competing interests PAS, NM, RK, PB, JAW, and EK report grants from Australian Research Council Linkage Grant, grants and non-financial support from Queensland Health, grants and non-financial support from Southern Adelaide Local Health Network, Inc., during the conduct of the study. RK reports personal fees from Australian Research Council Linkage Grant and the Australian Centre for Health Services Innovation, during the conduct of the study.
Ethics approval Griffith University and Flinders’ University Human Research Ethics Committees (MED/09/12/HREC; 6088 SBREC).
Provenance and peer review Not commissioned; externally peer reviewed.
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