Emergency Department Models of Care 2012 - NSW Health

challenges, the key aspects of what is needed to implementthe model and the measures to assess the model’seffectiveness.Other model of care considerationsPaediatric emergency patientsThe Model of Care document is applicable to bothpaediatric and adult emergency patients. The principles andother information included in each model can be applied tothe care of the paediatric patient.For the majority of EDs, catering to a mix of paediatric andadult patients, the unique needs of paediatric patients andtheir families must be considered. The factors forconsideration in model selection and implementation are:1. The physical space and geographical layout of the ED.This will influence the care of paediatric patients in thedifferent models of care.In EDs with a separate and designated paediatric area,streaming to that area may be all that is required. Forother EDs, local guidelines will determine theapplicability of the model for paediatric patients andwhether they will be assessed and treated in an areathat also treats adult patients. For example, paediatricpatients streamed to a mixed Fast Track model forassessment and treatment.In considering the model for both paediatric and adultpatients, it is important to consider the emotional needsof a sick or injured child, and that they should beprotected from stressful situations in ED and wherepossible, exposure to adult patients.2. The skills and level of experience of staff in caring forpaediatric patients. In an ED it is necessary to have staffwith appropriate training and experience in theemergency management of children and adolescents –this includes medical and nursing staff. The skill level ofstaff is an essential component of any model of carethat caters to children and needs to be well thought-outwhen planning and implementing a model of care.The Australasian College for Emergency Medicine policy onHospital Emergency Department Services for Children canbe found at: http://www.acem.org.au/media/P11_Hosp_ED_Services_for_Children_-ACP-ACEM.pdf. The RoyalAustralasian College of Physicians also has guidelines onstandards for the care of children and adolescents in healthservices. 88 National Standards for the Care of Children and Adolescents in Health ServicesRACP, 2008: http://www.racp.edu.au/index.cfm?objectid=393E4ADA-CDAA-D1AFStaffing the ED Models of CareOperating multiple models of care in an ED requires goodgovernance and coordination, and sufficient numbers ofappropriately skilled staff to operate each model. A lack ofappropriately skilled staff can lead to failure of the modeland suboptimal clinical outcomes for the patient. Forsuccessful operation and staffing of multiple models, severalfactors need consideration.Clinical Leadership. To effectively staff multiple models ofcare in an Emergency Department requires clinicalleadership for effective governance, operation and safedelivery of care for patients. The ED medical and nursingleaders are responsible for the effective communication andcoordination of care across all ED models in place. Withmultiple models, it is essential that there is a wellcoordinated approach to delivery of care to avoid any onemodel operating effectively at the expense of other areas ofED, and to prevent models operating in isolation.Clinical Expertise. The models of care in this documentprovide guidance to the skill mix of staff required for eachmodel. To effectively operate multiple models in your ED,the staffing levels and skill mix requirements should bedetermined based upon analysis of activity data and thevolume of patients who will be treated.The skill mix and expertise of staff needs to match therequirements of each model to deliver care – providing theright skills in the right place to make the rightdecisions. There is recognition of the specialist emergencynursing skills available, such as the Nurse Practitioner,Clinical Initiatives Nurse, Advanced Clinical Nurse and theFirst Line Emergency Care (FLEC) trained nursing staff.This document also recognises the importance of theavailability of senior medical clinical skills for optimaldecision making and resource allocation at the earliest pointin the patient’s journey, supervision of ED clinical caredelivery, and the important additional roles of specialistsenior medical staff in supervision and training of juniorclinical staff.In providing clinical expertise in each model appropriatetraining and education of staff is essential and this requiresongoing and updated training as required. Establishing andmaintaining the skills and expertise of staff is critical toproviding safe and quality emergency care.PAGE 10 NSW HEALTH Models of Emergency Care