Emergency Department Models of Care 2012 - NSW Health

3.5 Early Emergency Department Senior Assessment and Streaming2 hoursED Senior Assessment Streaming Early Treatment ZoneAcuteSub AcuteWhat is the model?Early ED Senior Assessment and Streaming (ED SAS) is a flexible Model Of Care that canoperate during peak periods of demand. The MOC is an assessment and treatment processthat focuses on determining an early diagnosis, clinical management plan and dispositiondecision for patients. An important component of the model is the streaming zone, althoughthe model functions most effectively with three key core components. These componentsare:1. Triage and registration:■■Triage assessment that is limited to < 5 minutes to establish the patient’s level of urgencyonly. Interventions are limited to first aid only.An essential element of the process is the quick registration by a clerical officer co-locatedwith the triage nurse. Full registration of patients can then be completed by clerical staffat the bedside.2. Streaming Zone (physical space and appropriate staff):■■■Early clinical decision-making by a senior ED Physician and early streaming of patients toappropriate care areas within or outside of the ED in < 10 minutes.The Senior ED physician is preferably an ED Staff Specialist, senior ED Registrar or seniorCareer Medical Officer.The Streaming Coordinator (nurse) is an essential part of the streaming zone. They areresponsible for maintaining the overall oversight and general management of theStreaming Zone and ensuring that patient flow is maintained.3. The Early Treatment Zone (ETZ) is a multi-functional and flexible clinical area that may beutilised in the following way:■■■A clinical area where the patient management plan formulated in the streaming zone canbe implemented and completed with the patient then discharged within 2 hours.A clinical area where the patient management plan can be commenced prior to thepatient moving to another area in ED, for example, into the acute area.An internal waiting/results pending area for patients still requiring observation prior todischarge or who are waiting for test results, such as pathology.Why use the model?Use this MOC to improve the flow through the ED, reduce waiting times and reduce time topatient treatment.High quality clinical decision-making as early as possible in the patient journey will moreefficiently allocate ED and hospital resources from the outset. This is achieved by promotingearly diagnosis and the development of a clinical management plan or disposition decision bya senior medical decision-maker.PAGE 24 NSW HEALTH Models of Emergency Care