Adult patients with constipation presenting to the emergency department: Can care be improved?
Adult patients with constipation presenting to the emergency department: Can care be improved?.
Emergency Medicine Australasia,.
This study aimed to establish the demographic profile of adult patients presenting with constipation and constipation-related issues to an Australian tertiary hospital ED, investigate ED management and referral pathways in this cohort and determine satisfaction of these aspects of care from a patient's perspective.
This is a single-centre study conducted in an Australian tertiary hospital ED which sees 115 000 presentations annually. ED presentations of adults aged 18–80 years with symptoms of constipation were evaluated through retrospective electronic medical record audit and follow-up by survey 3–6 months after their ED presentation.
The patients presenting to the ED with constipation had a median age of 48 years (IQR 33.5–63.5) and arrived self-referred by private transport. Median length of stay was 292 min. 22% of patients reported they had previously attended the ED for the same issue within the previous year. Diagnosis of chronic constipation was inconsistent, with limited supporting documentation. Constipation was largely managed with aperients. Four in five patients were satisfied with ED care; however, 3–6 months post-ED visit, 92% of patients reported ongoing bowel-related issues, reflecting the chronic course of functional constipation.
This is the first study to investigate the management of constipation in adult patients in an Australian ED setting. It is important that ED clinicians recognise that functional constipation is a chronic condition and many patients have persistent symptoms. There are opportunities for quality-of-care improvements including diagnostics, treatment, and referral post-discharge to allied health, nursing and medical specialist services. Key findings
- Patients attending the ED with constipation symptoms have long visits (median 292 min), persistent symptoms and one in five represent with the same issue.
- Assessing patients against the Rome III criteria could help to identify patients with chronic conditions and prompt patient education and post-discharge referral.
- There are opportunities for quality of care improvements in diagnostics, treatment and referral post-discharge to allied health, nursing and medical specialist services, particularly for patients with chronic constipation symptoms.