BMC Health Services Research (Apr 2019)
The introduction of a Parkinson’s disease email alert system to allow for early specialist team review of inpatients
Abstract
Abstract Background Patients with Parkinson’s disease (PWP) have complex healthcare needs, and compared to the general population, are more likely to have an unplanned emergency department (ED) attendance to hospital, along with poorer outcomes. Innovative methods of notification, when patients have an ED attendance are needed to allow for earlier specialist team interventions. This study describes the introduction of an email alert (e-alert) for a specialist Parkinson’s team. In addition, the reason for admission, specialist team interventions, length of stay, frequency of readmission, discharge destination, mortality and the bed cost per ED attendance or admission episode will be explored. Methods The e-alert was developed in collaboration with academics, a Parkinson’s specialist team and hospital Information technology (IT) specialists, by employing existing software and IT system platforms. Patients were identified from an existing hospital patient administration and a specialist movement disorder database. Specific variables along with routine patient data were collected including demographics, clinical variables, specialist team interventions, reason for admission, length of stay, discharge destination, unscheduled readmission, mortality and bed cost per day. Results The initial programming and setup of the e-alert was estimated to be around £3000. In its first six months, the e-alert identified 75 ED attendances, with the most common reasons being, falls and infections. The overall mean LOS was 6.8 days, with 25/75 patients being readmitted within 28 days. The most common specialist team clinical interventions were changes in medication, assessment for postural hypotension, neuropsychiatric and swallowing assessments. The majority of patients (92%) were discharged to their normal place of residence. The crude mortality rate for the cohort was approximately twice that of the hospital average. The total ED and acute bed cost was estimated to be £354,805.88, with exponential rises in healthcare costs when LOS was greater than one day. Conclusions The Parkinson’s e-alert was found to a useful adjunct to existing hospital data systems in identifying PWP who have unplanned emergency attendances. Additionally, this system can also be employed as a service evaluation tool. However, further evaluation is needed to determine if this system can improve patient outcomes during their unplanned emergency attendance to hospital.
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