Emergency Department Models of Care 2012 - NSW Health

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Figure 1: The Ideal Patient Journey with streaming to models of care within ED and external to ED.2 hours 1 hour 1 hour2:1:1The 2:1:1 model requires available staff and resources to move the patient into the next stage of the processResuscitation/trauma 2 hoursEarly Treatment ZoneHomeAcuteED Senior Assessment StreamingQuick Triage triage Registration & RegistrationSub AcuteInpatient ward< 5 minutesClinical Initiatives NurseFast track2 hoursHiTH, ComPacks,Rehabilitation forchronic conditionsInpatient short stayunits MAU, PECC, SAUUrgent Care CentreED SSUPAGE 8 NSW HEALTH Models of Emergency Care
SECTION 3Emergency Department Models of CareThe following section describes all the Models of Care inthe ideal ED patient journey. It provides detailed informationabout the current ED models, developed to improve patientflow through the ED and explains how they work, thebenefits and challenges, the case for change andmonitoring measures for success.The Models of Care are relevant to all EDs that are levelthree and above. While they may not be applicable to EDswith no onsite medical staff, the principles are the same forall NSW EDs. These principles are that: EDs cater toemergency patients – patients who would be better servedby an alternative care provider should be referred directly tothat provider; the ED should not be used as an alternativewhen other services are unavailable; care should bestreamlined; and there should be no duplication ofassessment and treatment.The information in each MOC will help the ED and hospitalto understand:■■■■■The key principles of the model.The key requirements to operate the model.Considerations to help understand why your ED woulduse the model.Benefits and challenges of using the model.The monitoring measures that can be used to assess themodel effectiveness and success.The following descriptions should be used as a guide tounderstand the potential options available to improvepatient flow and clinical outcomes in your ED. The modelsare set out in tables and provide the user with essentialinformation to determine if the model is suitable for yourED. The MOC tables include the following sections:■■What is the model? This section explains how the modelfunctions. Use this to determine if the characteristics ofthe model meet the needs of your ED to improvepatient flow and clinical outcomes.Why use the model? This section details the reasonswhy the ED would implement this model by highlightingkey areas of ED that the model can improve. Use thisinformation to determine if the model can assist yourED to improve patient flow and clinical outcomes.■■■■■■Key principles. This section explains in more detail theessential requirements of the model to functioneffectively. Without these principles in place thelikelihood of the model failing is high. Determine if yourED can successfully adhere to the principles. Also usethis section as a reference when determining businessrules, policies and processes for the model in your ED.Benefits of the model. This section reveals the expectedbenefits of the model and provides examples ofpotential improvements that you may expect if themodel is implemented correctly. Analyse your currentperformance data to determine if these benefits canimprove patient flow, clinical outcomes andperformance measures in your ED.Challenges. This section highlights key challenges thathave been experienced by others when implementingthe model. Use this as a guide when designing yourimplementation plan to mitigate potential issues thatmay arise.Case for implementation. This section includes questionsto support the need of the ED to implement the MOC.Use these questions as a reference to determine if thereis readiness in your ED to implement the model. Theycan also be used when designing your implementationplan or when assessing if your model has beenimplemented correctly.What you need to run the model. This section explainsthe essential requirements to run the model successfullyin your ED. This includes the physical space, staffing andbusiness rules of the model. It is important to use thissection as a reference when designing yourimplementation plan and when assessing if your modelhas been implemented correctly.Monitoring measures. This section outlines suggestedmonitoring measures that your hospital can use toevaluate the effectiveness of the model. Use thesemeasures when implementing or assessing anestablished MOC as they will help to determine theeffectiveness and highlight any weakness of the model.After considering each component of the model, yourEmergency Department should have a clear understandingof how the model works, the potential benefits andModels of Emergency Care NSW HEALTH PAGE 9
Page 2 and 3: NSW MINISTRY OF HEALTH73 Miller Str
Page 4: Executive SummarySince the publicat
Page 7 and 8: 1.2 A review of Emergency Modelsof
Page 9: ■■■patients who need only a s
Page 13 and 14: In determining your skill mix requi
Page 15 and 16: Benefits of the model ■ Improved
Page 17 and 18: 3.2 Clinical Initiatives NurseResus
Page 19 and 20: ■■Demonstrated ability to inter
Page 21 and 22: Predictive planning■■■■■
Page 23 and 24: 3.4 Acute Care2 hoursED Senior Asse
Page 25 and 26: What you need to runthe modelStaff
Page 27 and 28: Key principles ■ This is not a st
Page 29 and 30: Monitoring andevaluation■Waiting
Page 31 and 32: Challenges ■ Establishing guideli
Page 33 and 34: 3.7 Fast trackED Senior Assessment
Page 37 and 38: 3.8 Sub-acute2 hoursED Senior Asses
Page 39 and 40: 3.9 2 : 1 : 12:1:1This model requir
Page 41 and 42: Monitoring andevaluation■■■
Page 43 and 44: Why use the model?Key principlesBen
Page 47 and 48: SECTION 4Streamlining access to acu
Page 49 and 50: Challenges ■ Identification of
Page 51 and 52: ■■■Patient Flow pathways and
Page 53 and 54: Case for implementationWhat you nee
Page 55 and 56: Operating Principles■■■■■
Page 57 and 58: Case for implementationWhat you nee
Page 59 and 60: Mental Health LiaisonNursesApproxim
Page 61 and 62:
5.1 Urgent Care CentreThe Urgent Ca
Page 63 and 64:
5.3 Connecting CareWhat is the mode
Page 65 and 66:
SECTION 7Self-Assessment ToolsInclu
Page 67 and 68:
NHS Gloucestershire 2006, UK Urgent
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