Emergency Department Models of Care 2012 - NSW Health
Emergency Department Models of Care 2012 - NSW Health Emergency Department Models of Care 2012 - NSW Health
3.1 Triage and registrationResuscitation/traumaAcuteED Senior Assessment StreamingQuick Triage triage Registration & RegistrationSub Acute< 5 minutesEDSSU2 hoursFast trackUrgent Care CentreWhat is the preferredmodel?Triage and registration is streamlined to facilitate an efficient process that does not itselfcreate a barrier to further assessment and clinical care. Only essential triage functions shouldoccur at the point of triage: the determination of patient acuity and level of urgency, basicfirst aid if needed, and referral to the most appropriate area for treatment. This can includemodels of care both within the ED and within the hospital.This is followed by a quick registration by a clerical officer co-located with the triage nursewhich is an essential element of the process. Full registration of patients can then becompleted by clerical staff at the bedside or another ED location.Why use the preferredmodel?By focusing on the core role of triage and limiting triage assessments to under 5 minutes,the time spent waiting to be triaged can be reduced and timely patient access to careimproved. This can also reduce the pressure on triage staff, reducing workload by limitingredundant assessments or treatment interventions.Key principles ■ Triage is the first point of contact for the patient on arrival in ED.■■■To reduce queuing, co-locate triage and registration or use mobile registration by clericalstaff.Promote ‘quick triage’ by:- Limiting triage to an under 5 minute encounter- Removing patient interventions at triage apart from basic first aid- Avoiding duplication of processes by multiple care providers (doctors, nurses), such asnon-decision-makers taking a detailed medical history.- Facilitating the timely movement of patients to the next clinical process by maintainingavailable bed or treatment spaces in the ED.Adopt a flexible approach to triage with documented plans for peak periods or surges indemand.PAGE 12 NSW HEALTH Models of Emergency Care
Benefits of the model ■ Improved patient and staff experience■■■■■Reduced waiting time to be triagedA faster triage processEarly streaming to Models of CareReduced unnecessary workload for the triage nurseMobile (bedside) clerical registration allows clinical care to be prioritised over clericalprocesses.Challenges ■ Physical barriers to co-locating clerical registration and triage■■■■The lack of existing capacity to support quick triage (i.e. space to move the patient to)The existing health service culture of requesting additional interventions at triageInadequate clinical resources in smaller EDs lead to increased pressure on the triage nurseto undertake detailed assessments at triage and commence clinical care.Inflexible local processes whereby patients are not referred to more appropriate hospitalor community services.Case for implementationWhat you need to runthe modelTo assess the successful implementation of this model in your ED, consider the following:■■■■■■■Staff■■■Triage is a fundamental component of ED management; all presenting patients undergotriage. The exception is triage bypass for a specific cohort of patients, for example, whenpre-arrangements have been made to transfer patients directly to the cardiac catheterlaboratory.What competency frameworks are in place for triage staff?What staff have achieved competency to work at triage?What are the expectations of staff working at triage?Are there flexible and documented processes in place to manage peak periods or surgesof demand at triage (for example, additional staff available to triage for short periods oftime during the peaks)?What models of care are in place to support a quick triage process?What capacity do you have to support a quick triage process?Triage should be undertaken by suitably trained and skilled Registered Nurses as per‘PD2008_009 Triage of Patients in NSW Emergency Departments’.Each hospital or LHD should have local protocols for triage competence. It isrecommended at a minimum that the Emergency Triage Education Kit (ETEK) iscompleted in conjunction with a period of supervision.Fluctuations in triage demand will require EDs to assess if one or two triage staff arerequired to meet demand for short periods. This needs to be a detailed and standardisedpractice.Business rules■■■■Guidelines on what activities should and should not be undertaken at triage should be inplace.Well-documented processes should be in place for triage and registration that areunderstood by all Emergency Department staff.Develop monitoring guidelines to assess if quick triage is being undertaken by staff.ED processes and available capacity are in place to enable a quick triage and avoid‘defensive’ triage practices, for example carrying out a lengthy and detailed triage duringbusy periods when a patient may be required to wait.Models of Emergency Care NSW HEALTH PAGE 13
- 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 and 12: SECTION 3Emergency Department Model
- Page 13: In determining your skill mix requi
- 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
- Page 63 and 64: 5.3 Connecting CareWhat is the mode
Benefits <strong>of</strong> the model ■ Improved patient and staff experience■■■■■Reduced waiting time to be triagedA faster triage processEarly streaming to <strong>Models</strong> <strong>of</strong> <strong>Care</strong>Reduced unnecessary workload for the triage nurseMobile (bedside) clerical registration allows clinical care to be prioritised over clericalprocesses.Challenges ■ Physical barriers to co-locating clerical registration and triage■■■■The lack <strong>of</strong> existing capacity to support quick triage (i.e. space to move the patient to)The existing health service culture <strong>of</strong> requesting additional interventions at triageInadequate clinical resources in smaller EDs lead to increased pressure on the triage nurseto undertake detailed assessments at triage and commence clinical care.Inflexible local processes whereby patients are not referred to more appropriate hospitalor community services.Case for implementationWhat you need to runthe modelTo assess the successful implementation <strong>of</strong> this model in your ED, consider the following:■■■■■■■Staff■■■Triage is a fundamental component <strong>of</strong> ED management; all presenting patients undergotriage. The exception is triage bypass for a specific cohort <strong>of</strong> patients, for example, whenpre-arrangements have been made to transfer patients directly to the cardiac catheterlaboratory.What competency frameworks are in place for triage staff?What staff have achieved competency to work at triage?What are the expectations <strong>of</strong> staff working at triage?Are there flexible and documented processes in place to manage peak periods or surges<strong>of</strong> demand at triage (for example, additional staff available to triage for short periods <strong>of</strong>time during the peaks)?What models <strong>of</strong> care are in place to support a quick triage process?What capacity do you have to support a quick triage process?Triage should be undertaken by suitably trained and skilled Registered Nurses as per‘PD2008_009 Triage <strong>of</strong> Patients in <strong>NSW</strong> <strong>Emergency</strong> <strong>Department</strong>s’.Each hospital or LHD should have local protocols for triage competence. It isrecommended at a minimum that the <strong>Emergency</strong> Triage Education Kit (ETEK) iscompleted in conjunction with a period <strong>of</strong> supervision.Fluctuations in triage demand will require EDs to assess if one or two triage staff arerequired to meet demand for short periods. This needs to be a detailed and standardisedpractice.Business rules■■■■Guidelines on what activities should and should not be undertaken at triage should be inplace.Well-documented processes should be in place for triage and registration that areunderstood by all <strong>Emergency</strong> <strong>Department</strong> staff.Develop monitoring guidelines to assess if quick triage is being undertaken by staff.ED processes and available capacity are in place to enable a quick triage and avoid‘defensive’ triage practices, for example carrying out a lengthy and detailed triage duringbusy periods when a patient may be required to wait.<strong>Models</strong> <strong>of</strong> <strong>Emergency</strong> <strong>Care</strong> <strong>NSW</strong> HEALTH PAGE 13
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