Exploring solutions : addressing non-urgent emergency department presentations : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Nursing, Massey University, Albany, New Zealand

Abstract

Background: The Emergency Department (ED) plays a crucial role in delivering healthcare, focusing on the rapid assessment and treatment of serious illnesses or injuries, often providing life-saving resuscitation and stabilisation. However, EDs face increasing pressure from rising patient volumes, increased acuity and limited resources. This growing demand highlights the need for innovative strategies to optimise ED operations and improve patient outcomes. Patients presenting to the ED with non-urgent concerns need to be managed through more appropriate pathways.

Aim: This study aims to analyse the characteristics of non-urgent ED presentations and propose a novel care pathway to address the healthcare needs of this patient group effectively.

Methods: A mixed-methods approach was employed, combining qualitative and quantitative data. Five focus groups with healthcare professionals provided qualitative insights into non-urgent presentations. A quantitative patient database review spanning eight years (65,000-90,000 annual ED presentations) was conducted to identify trends and inform the new pathway development. The stage-gate process was used to guide the development and refinement of the proposed care pathway, ensuring systematic evaluation and iteration at each stage based on stakeholder feedback and data insights.

Findings: Analysis revealed a priority non-urgent patient group defined by specific criteria: ‘walk-ins’ to the ED, self-referred, Australasian Triage Scale (ATS) four or five, not redirected to urgent care and presenting within six months of a prior ED visit. These individuals predominantly resided in high-deprivation areas, were aged 20–69 years, had low-acuity diagnoses and high ED attrition rates. Using these findings, the Coordination, Assessment, Treatment and Community Hauora (CATCH) model was developed. This pathway integrates ED based nurse practitioners undertaking assessment and treatment alongside patient navigators who empower patients and connect them with appropriate healthcare services. Unlike the conventional ED model, grounded in critical care and triage principles, the CATCH model is tailored to address non-urgent care needs.

Conclusion: This research identifies a distinct non-urgent patient group presenting to the ED and introduces a targeted care pathway leveraging nurse practitioners and patient navigators. Future studies could implement the CATCH model to evaluate its real-world effectiveness in improving care and reducing ED demand.