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  • Fits, faints, falls and funny turns: cost and capacity savings in Queensland from the accelerated transient attack pathway initiative (ATAP).

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    Author(s)
    Blythe, Robin
    Kularatna, Sanjeewa
    White, Nicole
    Graves, Nicholas
    Clark, Kevin
    Middleton, Hayley
    Grimley, Rohan
    Griffith University Author(s)
    Kularatna, Sanjeewa M.
    Grimley, Rohan
    Year published
    2019
    Metadata
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    Abstract
    Background: falls, seizures, syncope and transient ischaemic attacks (TIA) are common presentations to emergency departments sharing overlapping clinical features and diagnostic uncertainties. These transient attacks can be markers of serious adverse outcomes and are associated with high admission rates. We evaluated the effects of an integrated suite of pathways for transient attacks designed to improve adherence to best practices and reduce costs through fewer admissions. Methods: a suite of clinician-designed pathways based on initial presenting diagnosis was developed to support ambulant care in a large hospital in ...
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    Background: falls, seizures, syncope and transient ischaemic attacks (TIA) are common presentations to emergency departments sharing overlapping clinical features and diagnostic uncertainties. These transient attacks can be markers of serious adverse outcomes and are associated with high admission rates. We evaluated the effects of an integrated suite of pathways for transient attacks designed to improve adherence to best practices and reduce costs through fewer admissions. Methods: a suite of clinician-designed pathways based on initial presenting diagnosis was developed to support ambulant care in a large hospital in Queensland, Australia. We performed a set of regression analyses to identify the differences in total cost and length of stay (LOS) before and after implementation. We conducted a Monte Carlo simulation to estimate the cost savings of the freed capacity in the patient cohort. Results: pathway implementation was associated with reduced admitted LOS and costs. Falls patients admitted LOS declined by 32.5%, and admission costs by 19.5%. Syncope, seizure, and TIA patients admitted LOS declined by 22% with no change in admitted costs. Despite a small increase in 90-day representations, total emergency department LOS was unchanged. Emergency department costs were similar between falls and non-falls patients. The Monte Carlo analysis showed that the most likely outcome was a cost savings in freed capacity of $71 per patient episode. Conclusion: the ATAP suite of pathways was associated with reduction in LOS, release of capacity and reduction in costs. Further study is needed to evaluate mechanisms and clinical outcomes in this vulnerable population.
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    Journal Title
    Age Ageing
    Volume
    48
    Issue
    5
    DOI
    https://doi.org/10.1093/ageing/afz086
    Subject
    Clinical sciences
    falls
    geriatrics
    health economics
    older people
    stroke
    Publication URI
    http://hdl.handle.net/10072/388654
    Collection
    • Journal articles

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