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To describe diagnostic categories and comorbidities associated with increased risk of readmission within 28 days among older adults.
Retrospective observational study of all hospital admissions following ED attendance by patients aged ≥ 60 years between July 2020 and June 2023. Index and subsequent 28-day readmission were identified using ED data and hospital discharge records. ED diagnosis, Australian Refined Diagnosis-Related Group (AR-DRG) discharge codes, and ICD-10-AM comorbidities were extracted. Multivariate logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for associations with 28-day readmission. The study and findings have been reported against the STROBE-RECORD guideline.
Of the 28,730 initial patient visits, 7.9% re-presented within 28 days. The most common ED diagnoses at initial and readmission were chest pain (5.4% vs. 4.6%), falls (5.2% vs. 4.1%), dyspnoea (3.5% vs. 3.1%), abdominal pain (3.1% vs. 3.3%) and cerebrovascular accident (1.7% vs. 1.7%). The most frequent AR-DRGs were respiratory infections/inflammations, kidney and urinary signs/symptoms, and other digestive system disorders. Key ICD-10-AM codes associated with a higher likelihood of readmission within 28 days were obstructive/reflux uropathy (OR 2.66, 95% CI 1.78–3.96), urinary retention (OR 1.84, 95% CI 1.38–2.46), chronic ischaemic heart disease (OR 1.57, 95% CI 1.10–2.25), delirium (OR 1.35, 95% CI 1.07–1.71) and disorders of fluid, electrolyte, and acid–base balance (OR 1.29, 95% CI 1.09–1.54).
Nearly 8% of older adults are readmitted within 28 days. Our described approach offers a potential framework to identify at-risk groups and intervene to reduce avoidable representations and/or admissions.
The results reported here create the opportunity for clinicians to identify areas for improvement in clinical practice, care coordination, and service delivery. Our approach and methodology can be replicated in other health services.
No patient or public contribution.
The aim of this study was to examine the perceptions and experiences of emergency nurses managing acute pain in critically ill patients.
Qualitative descriptive study.
Non-participant observations (n = 46, 157 h across 10 shifts) and semi-structured interviews (n = 30) were conducted at two Australian metropolitan emergency departments from November to December 2020. Transcribed data were analysed using reflexive thematic analysis.
The qualitative analysis yielded three main themes and eight subthemes: (i) being in the resuscitation area in which participants detail learning to work in the resuscitation area; influences in managing critically ill patients and confidence in acute pain management; (ii) prioritising pain management identified the challenges in optimising pain management and balancing departmental demands; and (iii) between being and doing and how nurse–patient interactions and care behaviours impacted on optimising pain management and comfort in the resuscitation area.
Emergency nurses were primarily responsible for the continuity of patient care and optimisation of pain control for critically ill patients. Confidence in managing acute pain in critically ill patients was variable. While nurses actively sought ways to provide a reassuring presence and comfort to critically ill patients, this was limited by unpredictable workloads, availability of staff and communication challenges.
These study findings may assist in the development of policy and formal education of emergency nurses transitioning into the resuscitation area and the management of acute pain in critically ill patients.
Pain is under-assessed and managed in critically ill patients, and this could stem from emergency nurses' practices. The findings could inform interventions to enhance pain management and practices.
No patient or public contribution.
This study adhered to the COREQ criteria.
To understand the current evidence base regarding holistic nursing assessments performed by registered nurses in residential aged care homes in Australia, and identify the gaps in knowledge and potential areas for future research.
A scoping review informed by JBI guidelines and the PRISMA extension for Scoping Reviews.
The electronic databases Medline, EMBASE, CINAHL, Scopus and ProQuest Central were searched, alongside citation chaining and manual journal searches. Limits of English language and publication after the year 2000 were applied. Studies were screened against pre-defined eligibility criteria. Data were extracted and analysed using descriptive statistics and a narrative synthesis.
A total of 3987 studies were identified, of which 28 were categorised as comprehensive or multimodal assessment programmes, standalone assessment tools or assessment infrastructure papers. Key outcomes described included staff factors and resident emergency department transfers or hospitalisations. The key feature of existing nursing assessments across studies was education, which was generally associated with improved staff knowledge, confidence and efficiency. Apart from this, there was large heterogeneity among assessment interventions with inconsistent effects. Few studies focused on residents with dementia or palliative care needs.
There is currently no standardised, systematic approach to the holistic assessment of residents by registered nurses in Australia. This gap in assessment is especially evident for residents with dementia or palliative care needs.
This research highlights the need to develop standardised holistic nursing assessments to bridge this gap in practice.
No Patient or Public Contribution.
To canvas the contemporary contextual forces within the Australian residential aged care sector and argue for new research and innovation. There is a pressing need to provide systematised, high-quality and person-centred care to our ageing populations, especially for those who rely on residential care. This paper advances a warrant for establishing a new systematic framework for assessment and management that serves as a foundation for effective person-centred care delivery.
Position paper.
This paper promulgates the current dialogue among key stakeholders of quality residential aged care in Australia, including clinicians, regulatory agencies, researchers and consumers. A desktop review gathered relevant literature spanning research, standards and guidelines regarding current and future challenges in aged care in Australia.
This position paper explores the issues of improving the quality and safety of residential aged care in Australia, including the lingering impact of COVID-19 and incoming reforms. It calls for nurse-led research and innovation to deliver tools to address these challenges.
The paper proposes an appropriate holistic, evidence-based nursing framework to optimise the quality and safety of residential aged care in Australia.
This study did not include patient or public involvement in its design, conduct, or reporting.
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