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Title: Improving the management of people at risk of frequent potentially avoidable visits to the ED – a systems thinking approach.
Author: Murray, M.
Malakellis, M.
Wong Shee, Anna
McNamara, Kevin
Versace, Vincent
Alston, L.
Allender, S.
Issue Date: 2022
Conference Name: Western Alliance Seventh Annual Symposium 2022: Reconnecting through rural and regional research
Conference Date: November 21-22
Conference Place: Dunkeld, Vic.
Abstract: Background/aim: Frequent potentially avoidable presentations (FPAP) to the emergency department (ED) are a ‘wicked’ system-level problem globally, driven by a complex web of factors with multiple organisations and stakeholders involved. The aim of this study was to understand the drivers of frequent potentially avoidable ED presentations and to identify opportunities for intervention within the system. Population/setting: Representatives from key stakeholder groups who operate within the health system in the Ballarat region. Methods: This project utilised a systems approach, which views complex ‘problems’ such as FPAP, as part of a wider, dynamic system. Perspectives of the stakeholders that use, or operate within, the system were incorporated using Group Model Building (GMB), a participatory process that seeks to guide decision-making for complex problems. Three 3-hour online GMB workshops were held with key stakeholders between October, and December 2021. The stakeholder group was guided through a series of participatory tasks to examine participants’ mental models of the interdependent causes and effects of FPAP, and to identify priority action areas. Results: A causal loop diagram identifying complex and interrelated factors that drive FPAPs was developed through the GMB process. Factors influencing the management of people at risk of FPAP to the ED were categorised into four major themes: (1) access to services; (2) coordination; (3) patient needs; and (4) knowledge and skills. Nine major action areas were also identified, many of which related to care and service coordination. Conclusion: The GMB process resulted in a detailed discussion around implementing actions across nine identified action areas, as and suggested outcome measures to determine effectiveness of proposed interventions, patient reported outcome measures, and health service providers’ confidence and self-efficacy in managing complex patients. Translational impact/implications for future practice: This research has helped align stakeholders’ perceptions of systems goals and the strategies that could be used for integrating care, and has identified important dynamics and resources (e.g., existing coordinators across multiple organisations). It also stimulated ongoing dialogue and collaboration across between participants to address FPAPs. Future actions will involve the development of working groups with appropriate governance structures to facilitate the implementation and evaluation of improvement activities.
Internal ID Number: 01993
Type: Conference
Appears in Collections:Research Output

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