Publication:
Integrated care in the emergency department: A complex adaptive systems perspective

dc.contributor.author Nugus, Peter en_US
dc.contributor.author Carroll, Katherine en_US
dc.contributor.author Hewett, David en_US
dc.contributor.author Short, Alison en_US
dc.contributor.author Forero, Roberto en_US
dc.contributor.author Braithwaite, Jeffrey en_US
dc.date.accessioned 2021-11-25T12:23:57Z
dc.date.available 2021-11-25T12:23:57Z
dc.date.issued 2010 en_US
dc.description.abstract Emergency clinicians undertake boundary-work as they facilitate patient trajectories through the Emergency Department (ED). Emergency clinicians must manage the constantly-changing dynamics at the boundaries of the ED and other hospital departments and organizations whose services emergency clinicians seek to integrate. Integrating the care that differing clinical groups provide, the services EDs offer, and patients’ needs across this journey is challenging. The journey is usually accounted for in a linear way – as a “continuity of care” problem. In this paper, we instead conceptualize integrated care in the ED using a complex adaptive systems (CAS) perspective. A CAS perspective accounts for the degree to which other departments and units outside of the ED are integrated, and appropriately described, using CAS concepts and language. One year of ethnographic research was conducted, combining observation and semi-structured interviews, in the EDs of two tertiary referral hospitals in Sydney, Australia. We found the CAS approach to be salient to analyzing integrated care in the ED because the processes of categorization, diagnosis and discharge are primarily about the linkages between services, and the communication and negotiation required to enact those linkages, however imperfectly they occur in practice. Emergency clinicians rapidly process large numbers of high-need patients, in a relatively efficient system of care inadequately explained by linear models. A CAS perspective exposes integrated care as management of the patient trajectory within porous, shifting and negotiable boundaries. en_US
dc.identifier.issn 0277-9536 en_US
dc.identifier.uri http://hdl.handle.net/1959.4/51340
dc.language English
dc.language.iso EN en_US
dc.rights CC BY-NC-ND 3.0 en_US
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/3.0/au/ en_US
dc.source Legacy MARC en_US
dc.subject.other Emergency departments en_US
dc.subject.other Australia en_US
dc.subject.other Complex adaptive systems en_US
dc.subject.other Integrated care en_US
dc.title Integrated care in the emergency department: A complex adaptive systems perspective en_US
dc.type Journal Article en
dcterms.accessRights metadata only access
dspace.entity.type Publication en_US
unsw.accessRights.uri http://purl.org/coar/access_right/c_14cb
unsw.identifier.doiPublisher http://dx.doi.org/10.1016/j.socscimed.2010.08.013 en_US
unsw.relation.faculty Medicine & Health
unsw.relation.ispartofissue 11 en_US
unsw.relation.ispartofjournal Social Science & Medicine en_US
unsw.relation.ispartofpagefrompageto 1997-2004 en_US
unsw.relation.ispartofvolume 71 en_US
unsw.relation.originalPublicationAffiliation Nugus, Peter, Centre for Clinical Governance Research in Health, Faculty of Medicine, UNSW en_US
unsw.relation.originalPublicationAffiliation Carroll, Katherine en_US
unsw.relation.originalPublicationAffiliation Hewett, David en_US
unsw.relation.originalPublicationAffiliation Short, Alison, Centre for Clinical Governance Research in Health, Faculty of Medicine, UNSW en_US
unsw.relation.originalPublicationAffiliation Forero, Roberto, Clinical School - South Western Sydney, Faculty of Medicine, UNSW en_US
unsw.relation.originalPublicationAffiliation Braithwaite, Jeffrey, Centre for Clinical Governance Research in Health, Faculty of Medicine, UNSW en_US
unsw.relation.school Clinical School South West Sydney Area Health Service *
unsw.subject.fieldofresearchcode 110305 Emergency Medicine en_US
unsw.subject.fieldofresearchcode 111717 Primary Health Care en_US
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