Emergency Department Models of Care 2012 - NSW Health
Emergency Department Models of Care 2012 - NSW Health Emergency Department Models of Care 2012 - NSW Health
3.6 Early Treatment Zone2 hoursED Senior Assessment Streaming Early Treatment ZoneAcuteSub AcuteWhat is the model?The Early Treatment Zone (ETZ) is a multi-functional and flexible clinical area that may beutilised as:■■■A clinical area where the patient management plan from the streaming zone can beimplemented and completed with the patient then discharged within 2 hoursA clinical area where the patient management plan can be commenced prior to thepatient moving to another area in ED, e.g. into the acute areaAn internal waiting area for patients still requiring observation prior to discharge or whoare waiting for results of tests such as pathology■■■The promotion of unidirectional flow through the ED – following assessment in theStreaming Zone, patients can complete initial treatment in ETZ rather than going back tothe waiting room to await commencement of treatment. This process also helps patientsfeel they have progressed in the queue.An area where inpatient teams assess ED patients. This is particularly useful for ambulantpatients who do not need to occupy an ED bed for the purpose of a quick assessmentprior to admission, thereby preserving ED bed capacity. It should be noted that this areashould not be utilised in lieu of inpatient unit beds or other hospital locations foradmitting patients who do not require the services of the EDA buffer to maintain ED acute area bed capacity.Why use the model?The ETZ complements the ED SAS MOC as it provides an area for patients to be assessedand/or enables the continuation of investigations and treatment before transition to anothermodel of care, inpatient unit or home.Key principles ■ Designated area within the ED to commence treatment.■■Total LOS of patients within the Early Treatment Zone (ETZ) should be limited to < 2 hourswith the patient then moving to either another MOC or discharged home.Patients who require intensive nursing care are not suited to this model.Benefits of the model ■ Ability to commence treatment or continue investigations while a patient waits fortransition to the correct MOC.■■Improves patient flow through the ED.Allows the patient to progress through to a dedicated area of ED rather than back to thewaiting room.PAGE 28 NSW HEALTH Models of Emergency Care
Challenges ■ Establishing guidelines on how the ETZ will be flexed down, that is the time of acceptinglast patients into the model and where patients still in the ETZ will be transferred to whenit needs to close.■Locating a physical space that is close to the Streaming Zone.Staffing available to staff the model when it is flexed open.Case for implementationWhat you need to runthe modelTo assess the need for implementation of this model in your ED, consider the following:■Does your ED experience inefficient patient flows?■ Is your ED meeting waiting time to treatment targets (especially in categories 3–5)?■ What is the average length of stay for patients in the ED (especially in categories 3–5)?■■■■■■Staff■■What proportion of patients in your ED did not wait for assessment and treatment?Is your ED meeting National Emergency Access Targets (4-hour targets)?Is your ED meeting Transfer of Care times?Does your ED experience overcrowding in the waiting room?Is your ED implementing an Early ED SAS model and requires an appropriate area forongoing patient management and assessment?Does your ED return patients to the waiting room while awaiting test results anddisposition decisions?Senior nursing staff with clearly defined roles and responsibilitiesIdentify if existing staff positions can be realigned to work in the ETZ or if new staff arerequired.Physical space■■The ETZ should be separate from the acute area in the ED and ideally close to theStreaming Zone or triage.The physical requirements will depend on the volume of patients likely to be managed inthe area and how to maintain an effective flow through the ED.Consider■■■The proximity to key areas of the ED including radiology and pathologyThe number of treatment spaces needed to optimise the use of the areaWorkspace and write-up areas for clinicians.Business rules■■■■Develop a policy for the management of the ETZ. This should include a set of inclusion/exclusion criteria to stream patients from Triage or the Streaming Zone to the ETZ.Limit treatments to those with short treatment timelines (< 2 hrs) before they aredischarged home or to another MOC.Develop guidelines that outline the operation of the model including opening and closingprocesses, staffing and the acceptance time of last patients.Ensure strong management and policing of operational policies.Models of Emergency Care NSW HEALTH PAGE 29
- 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 and 14: In determining your skill mix requi
- 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: Monitoring andevaluation■Waiting
- 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
- Page 65 and 66: SECTION 7Self-Assessment ToolsInclu
- Page 67 and 68: NHS Gloucestershire 2006, UK Urgent
3.6 Early Treatment Zone2 hoursED Senior Assessment Streaming Early Treatment ZoneAcuteSub AcuteWhat is the model?The Early Treatment Zone (ETZ) is a multi-functional and flexible clinical area that may beutilised as:■■■A clinical area where the patient management plan from the streaming zone can beimplemented and completed with the patient then discharged within 2 hoursA clinical area where the patient management plan can be commenced prior to thepatient moving to another area in ED, e.g. into the acute areaAn internal waiting area for patients still requiring observation prior to discharge or whoare waiting for results <strong>of</strong> tests such as pathology■■■The promotion <strong>of</strong> unidirectional flow through the ED – following assessment in theStreaming Zone, patients can complete initial treatment in ETZ rather than going back tothe waiting room to await commencement <strong>of</strong> treatment. This process also helps patientsfeel they have progressed in the queue.An area where inpatient teams assess ED patients. This is particularly useful for ambulantpatients who do not need to occupy an ED bed for the purpose <strong>of</strong> a quick assessmentprior to admission, thereby preserving ED bed capacity. It should be noted that this areashould not be utilised in lieu <strong>of</strong> inpatient unit beds or other hospital locations foradmitting patients who do not require the services <strong>of</strong> the EDA buffer to maintain ED acute area bed capacity.Why use the model?The ETZ complements the ED SAS MOC as it provides an area for patients to be assessedand/or enables the continuation <strong>of</strong> investigations and treatment before transition to anothermodel <strong>of</strong> care, inpatient unit or home.Key principles ■ Designated area within the ED to commence treatment.■■Total LOS <strong>of</strong> patients within the Early Treatment Zone (ETZ) should be limited to < 2 hourswith the patient then moving to either another MOC or discharged home.Patients who require intensive nursing care are not suited to this model.Benefits <strong>of</strong> the model ■ Ability to commence treatment or continue investigations while a patient waits fortransition to the correct MOC.■■Improves patient flow through the ED.Allows the patient to progress through to a dedicated area <strong>of</strong> ED rather than back to thewaiting room.PAGE 28 <strong>NSW</strong> HEALTH <strong>Models</strong> <strong>of</strong> <strong>Emergency</strong> <strong>Care</strong>
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