Profiling wound management in the emergency department: A descriptive analysis

Rachel Cross1,2,Natasha Jennings2, William McGuiness1, Charne Miller1

1La Trobe University, Alfred Clinical School, 99 Commercial Road Melbourne, Victoria, 3004, Australia. r.cross@latrobe.edu.au
2The Alfred Hospital, Emergency and Trauma Centre, 99 Commercial Road Melbourne, Victoria, 3004, Australia.

Background: In Australia, wound and skin conditions are among the top 10 patient presentations to emergency departments. Yet the service profile of wound, skin and ulcer presentations to emergency departments is an area that lacks an existing published commentary. Knowledge of these presentations would inform the allocation of resources, staff training, and, in turn, patient outcomes.

Aim: The aim of this study was to describe the frequency of wound, skin and ulcer patient presentations to one ED, to profile the most common types of wounds seen, and to appraise the discharge and referral status of this patient population. This study was conducted in one Australian emergency department.

Methods: A retrospective descriptive review was conducted of all emergency presentations including discharge and referral statuses for skin, wound and ulcer related conditions from 1st January 2014 until 31st December 2014.

Results: A total of 4231 patients presented to the emergency department for a wound, skin or ulcer complaint. Management for these conditions accounted for 7% of the total emergency presentations. Wound conditions were the most prevalent (n=3658; 86%), followed by skin (n=539; 12.7%) and decubitus ulcer and pressure area (n=34; 0.8%). Males were more likely to present for all three conditions. For all conditions, discharge to home was the most common destination. Following discharge to home, over half all patients were referred to the local medical officer.

Conclusions: The current workload for the management of wound, skin and ulcer presentations to the emergency department would suggest that these patients contribute a significant financial burden to the ED. The implications for appropriate wound management in the ED are, therefore, significant. Nursing workforce models, education and training needs to reflect the skill set required to respond to wound, skin and ulcer conditions to ensure that high quality skin and wound care continues outside of the emergency department.

Biography

Rachel Cross is a Lecturer in the School of Nursing and Midwifery for La Trobe University, Victoria, Australia. Rachel also works in a clinical capacity in one large emergency and trauma centre in Victoria. Rachel has worked in clinical and educational roles in both local and international emergency and acute care settings. Rachel’s research area of interest is patient safety at the point of emergency department discharge and the influence for the transition of patient care. Rachel is currently undertaking her PhD examining handover and clinical deterioration in emergency care transitions.