4Fs project streamlines patient care

A research project investigating the assessment and treatment of conditions which share common neurological symptoms is improving the way patients are managed during their hospital stay.

Focusing on the four clinical conditions of seizure (fits), syncope (faints), falls and funny turns (TIA), the 4F project aimed to develop and establish standard clinical guidelines that allow patients access to safe, timely and appropriate care, and avoid unnecessary hospital admissions.

Project lead, Jodie Huntley-Forde said the four conditions (the 4Fs) overlap and are often confused which results in a ‘one-size-fits-all’ approach to management.

“These conditions are a group of largely traumatic events that force patients to present to the emergency department, but often resolve by the time of presentation. This leads to significant difficulty with a diagnosis,” Jodie said.

Until now there has been no standard management approach to these conditions, except for TIA, and there is a high hospital admission rate despite a lack of evidence that this improves health outcomes.

Metro North Executive Director Medicine Stream and Project Sponsor, Assoc Prof Jeffrey Rowland said the evidence shows these diagnostic groups are often low risk and can be safely managed as an outpatient with appropriate investigation and follow-up.

“However, there are some patients who are deemed high risk upon medical review and are at risk of subsequent events, and these patients should be admitted and receive appropriate and safe inpatient overnight care,” he said.

Data sourced during the study showed that on average 4F patients spent up to five hours in the ED while experiencing more than four clinical tests during their presentation. Furthermore, just under 65 percent of 4F presentations result in admission to an inpatient or short stay unit. Of those admitted to an inpatient unit, 20 percent stay for less than 24 hours.

“The 4F project promotes the concept that patients presenting to the ED after experiencing one of the 4Fs should receive a streamlined, fast track evaluation and treatment pathway,” Jodie said.

Through extensive consultation with stakeholders across The Prince Charles, The Royal Brisbane and Women’s, Caboolture and Redcliffe Hospitals, the 4F Project developed a suite of evidence-based clinical pathways designed to identify suitable patients that can be discharged from the Emergency Department and directed toward ambulatory follow up care. The focus of the pathways was on minimising the duration of hospital care by providing faster assessments, earlier tests and rapid access to outpatient treatments.

“Having a clear treatment pathway for these four conditions, will ensure patients receive the right care in the right place at the right time,” Jodie said.

“The guidelines support clinicians to avoid hospital admission when it is safe for the patient. The science behind the way we manage these conditions has not changed because of the pathway; it just about streamlining the processes around it.”

To date, the Seizure and Falls pathways have been implemented at two Metro North sites. This has resulted in a reduction in the amount of time patients spend in the emergency department (on average 30 minutes), less patients required an admission to hospital (4% reduction), and most importantly a reduction in wait times for some tests or specialist reviews.