Emergency Department Models of Care 2012 - NSW Health
Emergency Department Models of Care 2012 - NSW Health 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
In determining your skill mix requirements for the ED, youcan refer to the NSW Health Emergency DepartmentWorkforce Research Project 9 and ED Workforce AnalysisTool 10 and other specific resources 11 .9 NSW Department of Health, 2010, NSW Health Emergency Department WorkforceResearch Project: Final Report. 2010 http://www.health.nsw.gov.au/pubs/2010/ed_workforce_research.html10 NSW Health 2011, Emergency Department Workforce Analysis Tool, 2nd Editionhttp://www.health.nsw.gov.au/pubs/2011/edwat_ed2.html11 ACEM recommendations http://www.acem.org.au/media/policies_and_guidelines/G23_Constr_Workforce.pdfModels of Emergency Care NSW HEALTH PAGE 11
- 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 and 10: ■■■patients who need only a s
- Page 11: SECTION 3Emergency Department Model
- 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 35 and 36: What you need to runthe modelStaff
- 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 45 and 46: What you need to runthe modelStaff
- 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
In determining your skill mix requirements for the ED, youcan refer to the <strong>NSW</strong> <strong>Health</strong> <strong>Emergency</strong> <strong>Department</strong>Workforce Research Project 9 and ED Workforce AnalysisTool 10 and other specific resources 11 .9 <strong>NSW</strong> <strong>Department</strong> <strong>of</strong> <strong>Health</strong>, 2010, <strong>NSW</strong> <strong>Health</strong> <strong>Emergency</strong> <strong>Department</strong> WorkforceResearch Project: Final Report. 2010 http://www.health.nsw.gov.au/pubs/2010/ed_workforce_research.html10 <strong>NSW</strong> <strong>Health</strong> 2011, <strong>Emergency</strong> <strong>Department</strong> Workforce Analysis Tool, 2nd Editionhttp://www.health.nsw.gov.au/pubs/2011/edwat_ed2.html11 ACEM recommendations http://www.acem.org.au/media/policies_and_guidelines/G23_Constr_Workforce.pdf<strong>Models</strong> <strong>of</strong> <strong>Emergency</strong> <strong>Care</strong> <strong>NSW</strong> HEALTH PAGE 11
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