Traditional emergency department or emergency nurse led minor injury unit: predicting patient choice for delivery of minor injury care’

Abstract

Background The unsustainable demand upon Emergency Departments and the challenges of recruiting and retaining emergency care doctors has frequently resulted in policy and local service commissioners changing the way emergency care is delivered. Such reconfiguration has frequently involved centralisation of Emergency Departments and diversification of services delivering minor injury care to Emergency Nurse Practitioner led Minor Injury Units. Despite the reconfiguration of emergency care, including minor injury services, existing research has yet failed to explore patient choice of a minor injury service (Emergency Department or Emergency Nurse led Minor Injury Unit) and how patient characteristics may influence such choice. In addition, there is also a deficiency of research exploring the rationale behind such choices. This paucity of investigation into how patients may react to a change in minor injury services is addressed by this study. Aim To explore the preference of individuals attending a traditional Emergency Department versus an Emergency Nurse Practitioner led Minor Injury Unit and identify demographic and socio-economic factors that predict preference. Method The study implemented an observational design, specifically that of a cross-sectional survey. Between May 2016 and March 2017, the study recruited n=500 patients attending an Emergency Department with a minor injury or illness, the participants were surveyed by means of a self-designed questionnaire. Data analysis involved scrutiny of descriptive statistics and the implementation of correlation analysis between the dependent variable ‘choice of minor injury service’ and a suite of appropriate independent demographic and socio-economic variables. The statistically significant (p = < .05) independent variables were taken forward into logistic regression analysis to investigate their ability to predict ‘choice of minor injury service’. Correlation analysis was also run on the same variables to explore the relationship between ‘reasons for choice of minor injury service’. Results The results of the logistic regression analysis using the variables of age and level of deprivation found every year of age, the odds of choosing an Emergency Nurse Practitioner led Minor Injury Unit increased by 1.2% (95% CI 1.011-1.024). The results also demonstrated that for every level of deprivation (Welsh Index Multiple Deprivation) the odds of choosing an Emergency Nurse led minor injury unit increased by 10% (95% CI 1.100 – 1.023). That is the patients from areas of lower deprivation were more likely to choose an Emergency Department for the treatment of their minor injury. Finally, a statistically significant correlation was found between age and reasons for choosing an Emergency Nurse Practitioner led Minor Injury Unit. That is, patients in the younger age group (18-32 years) would choose an Emergency Nurse Practitioner led Minor Injury Unit due to shorter waiting times, whilst patients over 50 years of age chose an Emergency Nurse Practitioner Led minor Injury Unit as they had greater trust in the clinical capabilities of an Emergency Nurse Practitioner. Discussion The findings of this study highlight the importance of acknowledging local context when implementing health service reconfiguration. The study promotes the need for service commissioners to understand how patient characteristics may affect choice of minor injury service. The findings of the study suggest that any future local patient engagement and communication strategy regarding reconfiguration of local minor injury services needs to target and connect with the younger age groups and those from areas of lower deprivation. The findings also suggest that such strategies may need to target the younger patients with more purposeful messages such as the ‘hook’ of shorter waiting times in Emergency Nurse Practitioner led Minor Injury Units and how the Emergency Nurse Practitioners provide care equitable to a doctor