Emergency Departments (ED) are integral to providing rapid access to care for those with acute medical needs. However, with decreased hospital capacity and increased numbers of ED patients with complex needs, the end result is ED crowding with associated long waiting times, patient dissatisfaction, stressed healthcare professionals, and issues with safety and efficiency of patient management. Nationally and internationally a number of quality improvement initiatives coupled with time-sensitive targets have been introduced to improve the transition and timeliness of care in the ED. There is emerging evidence to support the implementation of dedicated Health and Social Care Professionals (HSCP) teams in the ED to improve patient and process outcomes. However, there is heterogeneity across existing studies regarding the populations studied, the interventions delivered and the outcomes evaluated. The overall aim of this study is to determine and measure the impact of early assessment and intervention by a HSCP team in the ED in enhancing the quality of patient care by safely avoiding a hospital admission, reducing duration of ED stay, improving the patient ED experience and optimising overall patient flow. A mixed-methods approach will be adopted including: 1) a review of the existing evidence relating to the effectiveness of HSCP interventions, 2) world café style focus groups with stakeholders including ED patients and their families, HSCPs and pre-hospital staff to explore problems with current models of care and how they believe the situation could be improved with HSCP early intervention, and, 3) analysis of routine observational data from the ED department at University Hospital Limerick (UHL) to describe the flow of ‘target’ patients in the ED. Taken together, these outputs will inform: 4) the development and pilot of a structured and systematic HSCP intervention for target populations in the ED setting that will be evaluated using a controlled before-after study design.
