Emergency Department Models of Care 2012 - NSW Health

Key principles ■ This is not a stand-alone model of care: it requires the integration of patient flow systemsand the physical space to support and sustain it. This integration will include streaming tomodels of care within the ED (for example, ETZ, Fast Track, Sub-acute) as well asstreaming options outside of the ED (for example, Medical and Surgical Assessment Unitsand other inpatient wards, the Psychiatric Emergency Care Centre, Hospital in the Homeservices and Outpatients).■■■■■Reallocate the existing ED workforce and physical spaces to provide earlier seniorassessment and care of patients.It is essential to:- Assign a senior medical decision-maker for early assessment and disposition decisions toenable all patients to be safely assessed in the Streaming Zone- Limit the patient’s initial assessment by the Senior Medical Officer to < 10 minutes beforebeing streamed into a MOC.- Have robust Models of Care in place within and outside the ED for the ED SAS to streamto.Operate ED SAS at peak periods of demand in the ED – the model is designed to beflexible to meet the needs of individual EDs and different types of patient presentations.Include triage category 3 – 5 presentations and triage category 2 presentations asappropriate.Ensure a one-way directional flow of patients with no returning to the waiting room.Benefits of the model ■ Reduced triage times with a focus on quick assessment and assigning level of urgency■■■■■■■Early senior medical assessment and decision-making with a treatment planReduce the ED length of stay by providing better initial decision-making, improving timelyaccess to safe and quality ED careEarly initiation of appropriate investigationsReduced time to appropriate treatment, for example, time to antibiotics and analgesiaDevelopment of a definitive patient management plan in the Streaming Zone thatimproves the patient’s whole ED journey and will have a flow-on effect for the entire EDReduces the total time in ED for these patients (validated in 3 months of data from theWestmead Pilot Project and the subsequent implementation of the model, 2011).Senior decision-making at the beginning of the ED patient journey has the positive impactof more efficient bed utilisation within ED■■■■More meaningful and detailed risk stratification of patients from the time of arrival in theEDEarly streaming of patients to appropriate care areas inside and outside of the EDImproved patient and carer experienceThe creation of an organised and coordinated way of managing ED business to improvethe working environment.Models of Emergency Care NSW HEALTH PAGE 25