Effectiveness of a Disability Liaison Officer service in a metropolitan emergency department

IF 1.7 4区医学 Q2 EMERGENCY MEDICINE

Emergency Medicine Australasia Pub Date : 2024-10-18 DOI:10.1111/1742-6723.14513

Elizabeth O'Shannessy BOccThy, MPH, Carly Talarico BA, BHSc, MPH, MHA, Douglas McCaskie BSpPath, GDipHRM, MHA, Ali Lakhani BBA, MA, MES, PhD, Christine Koolstra CCRN, Janine Standen BSpPath, MHA, Karen Roberts ClinScD (OT), MOT, BAppSc(OT), De Villiers Smit MBChB, FACEM, MBA (Exec), Biswadev Mitra MBBS, MHSM, PhD, FACEM

{"title":"Effectiveness of a Disability Liaison Officer service in a metropolitan emergency department","authors":"Elizabeth O'Shannessy BOccThy, MPH, Carly Talarico BA, BHSc, MPH, MHA, Douglas McCaskie BSpPath, GDipHRM, MHA, Ali Lakhani BBA, MA, MES, PhD, Christine Koolstra CCRN, Janine Standen BSpPath, MHA, Karen Roberts ClinScD (OT), MOT, BAppSc(OT), De Villiers Smit MBChB, FACEM, MBA (Exec), Biswadev Mitra MBBS, MHSM, PhD, FACEM","doi":"10.1111/1742-6723.14513","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Objectives</h3>\n \n <p>To identify the influence of a Disability Liaison Officer (DLO) service in the ED setting on people with disability (PWD). For this project, PWD included adults with communication disability, intellectual disability or autism spectrum disorder.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>This was a single-centre retrospective cohort study, at an adult major referral ED in Melbourne, Australia. Patients were eligible for inclusion if they were ≥18 years of age, presented to the ED between 1 April 2022 and 30 April 2023, and had a disability alert in their electronic medical record. Eligible patients were divided into two cohorts: (i) patients managed using standard ED care and (ii) patients managed using DLO model. ED length of stay (LOS) was the main outcome measure.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>After adjusting for baseline differences in age, initial GCS and disability type, the DLO service was associated with earlier disposition from the ED (adjusted hazard ratio [aHR] 1.44; 95% confidence interval [CI]: 1.23–1.69; <i>P</i> < 0.001). For the subgroup of patients discharged directly from the ED, the association of DLO service and earlier disposition remained statistically significant (aHR 2.47; 95% CI: 1.83–3.33; <i>P</i> < 0.001). Among patients admitted to the emergency short stay unit (aHR 1.67; 95% CI: 0.99–2.80; <i>P</i> = 0.06), and those admitted to inpatient wards (aHR 0.89; 95% CI: 0.65–1.23; <i>P</i> = 0.50), there was no significant association of the DLO service with time to disposition.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>The DLO service was associated with a reduction in ED LOS for PWD. Further assessment of the service using patient- and carer-reported outcome measures and cost-effectiveness studies are indicated.</p>\n </section>\n </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 1","pages":""},"PeriodicalIF":1.7000,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11744425/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Emergency Medicine Australasia","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/1742-6723.14513","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"EMERGENCY MEDICINE","Score":null,"Total":0}

引用次数: 0

Abstract

Objectives

To identify the influence of a Disability Liaison Officer (DLO) service in the ED setting on people with disability (PWD). For this project, PWD included adults with communication disability, intellectual disability or autism spectrum disorder.

Methods

This was a single-centre retrospective cohort study, at an adult major referral ED in Melbourne, Australia. Patients were eligible for inclusion if they were ≥18 years of age, presented to the ED between 1 April 2022 and 30 April 2023, and had a disability alert in their electronic medical record. Eligible patients were divided into two cohorts: (i) patients managed using standard ED care and (ii) patients managed using DLO model. ED length of stay (LOS) was the main outcome measure.

Results

After adjusting for baseline differences in age, initial GCS and disability type, the DLO service was associated with earlier disposition from the ED (adjusted hazard ratio [aHR] 1.44; 95% confidence interval [CI]: 1.23–1.69; P < 0.001). For the subgroup of patients discharged directly from the ED, the association of DLO service and earlier disposition remained statistically significant (aHR 2.47; 95% CI: 1.83–3.33; P < 0.001). Among patients admitted to the emergency short stay unit (aHR 1.67; 95% CI: 0.99–2.80; P = 0.06), and those admitted to inpatient wards (aHR 0.89; 95% CI: 0.65–1.23; P = 0.50), there was no significant association of the DLO service with time to disposition.

Conclusions

The DLO service was associated with a reduction in ED LOS for PWD. Further assessment of the service using patient- and carer-reported outcome measures and cost-effectiveness studies are indicated.

Abstract Image

查看原文本刊更多论文

大都市急诊科残疾人联络官服务的有效性。

目的确定在急诊室环境中提供残疾联络官（DLO）服务对残疾人（PWD）的影响。在本项目中，残疾人包括患有交流障碍、智力障碍或自闭症谱系障碍的成年人：这是一项单中心回顾性队列研究，在澳大利亚墨尔本的一家成人主要转诊急诊室进行。患者年龄≥18 岁，在 2022 年 4 月 1 日至 2023 年 4 月 30 日期间到急诊室就诊，且电子病历中有残疾警报，即符合纳入条件。符合条件的患者被分为两组：(i) 使用标准急诊室护理管理的患者；(ii) 使用 DLO 模式管理的患者。主要结果指标为急诊室住院时间（LOS）：调整年龄、初始 GCS 和残疾类型的基线差异后，DLO 服务与更早离开急诊室有关（调整后危险比 [aHR] 1.44；95% 置信区间 [CI]：1.23-1.69；P＜0.05）：1.23-1.69; P 结论：DLO服务与缩短残疾人的急诊室生命周期有关。有必要使用患者和护理人员报告的结果指标和成本效益研究对该服务进行进一步评估。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Emergency Medicine Australasia 医学-急救医学

CiteScore

3.70

自引率

13.00%

发文量

217

审稿时长

6-12 weeks

期刊介绍： Emergency Medicine Australasia is the official journal of the Australasian College for Emergency Medicine (ACEM) and the Australasian Society for Emergency Medicine (ASEM), and publishes original articles dealing with all aspects of clinical practice, research, education and experiences in emergency medicine. Original articles are published under the following sections: Original Research, Paediatric Emergency Medicine, Disaster Medicine, Education and Training, Ethics, International Emergency Medicine, Management and Quality, Medicolegal Matters, Prehospital Care, Public Health, Rural and Remote Care, Technology, Toxicology and Trauma. Accepted papers become the copyright of the journal.