Emergency Department Models of Care 2012 - NSW Health
Emergency Department Models of Care 2012 - NSW Health Emergency Department Models of Care 2012 - NSW Health
Business rules■■■■■■Develop a policy for the management of the Fast Track Zone. This should include a set ofinclusion/exclusion criteria to stream patients from Triage to Fast Track.Inclusion/exclusion criteria should include those patients who (at Triage) are non-complex(single system problem), have limited care or clinical management requirements and arelikely to be treated and discharged home within 2 hours.Limit treatments to those with short treatment timelines (< 2 hrs) and stat therapies.Avoid treatments such as IV infusions that have the potential to block the area.Avoid complex patients with multiple co-morbidities that require multiple investigations.Ensure the flow through the unit is constant. Patients should not wait within theassessment area for review. Those who need to wait for re-evaluation should do so in awaiting or results pending area.Ensure strong management and policing of operational policiesMonitoring andevaluation■■Waiting time for treatment by triage categoryTotal time in ED (the aim is discharge within 2 hours of presentation)■ Implement monitoring systems to track each patient through Fast Track – breaches over 2hours should be monitored and patients managed through the system■■■■■■Admitted patients from fast trackUnplanned returns to ED within 48 hrs.Did not wait rates.National Emergency Access Target (4-hour target).Patient incidents and complaintsStaff feedbackPAGE 34 NSW HEALTH Models of Emergency Care
3.8 Sub-acute2 hoursED Senior Assessment Streaming Early Treatment ZoneTriageRegistrationSub AcuteWhat is the model?Sub-acute Model Of Care is a designated area in the ED for patients:■■■Who are low acuity and do not require an acute bed or cardiac monitoringWho can be high-complexity (with multiple co-morbidities), resource-intensive and requiremultiple investigations, consults and/or procedures, and are therefore not eligible for FastTrack or an Urgent Care Centre, and/orWho are non-ambulant and need to be cared for on a bed for treatment.NOTE: It is essential that careful attention is paid to the selection of patients suitable for asubacute model – they are to be low risk patients with vital signs within normal parameters,and not require cardiac monitoring.Why use the model?The Sub-acute MOC is used to treat undifferentiated patients who are neither unstable nordo they require intensive observation (therefore, their management in the acute area of theED is not needed). However, they are not suitable for ambulatory areas. These patients mayhave complex medical problems but do not present with an acutely life-threatening illness orinjury.The LOS for these patients is usually greater than 2 hours; hence, they are inappropriate forallocation to Fast Track and Urgent Care Models of Care as it would likely cause bottlenecksand reduce flow through those areas.Key principles ■ Dedicated space in the ED for sub-acute patients.■■An area used for complex patients that require > 2 hours to determine a managementplan in which time they need to be managed on a bed, for example, an undifferentiatedpatient that does not fit an acute bed criteria but is too complex to be assessed andtreated in a Fast Track Zone.Support patient flow through the ED by not blocking access to monitored beds in theacute area or Fast Track treatment areas with patients that take a long time to assess ortreat.Benefits of the model ■ Allows this group of patients to receive dedicated care in an appropriate environment■■Supports patient flow through the ED by placing this patient group into the mostappropriate beds, minimising the block to rapid assessment units such as fast track/UCCor to acute beds that have cardiac monitoringProvides an environment where patients are assessed and treated away from the acutearea of the EDModels of Emergency Care NSW HEALTH PAGE 35
- 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 and 30: Monitoring andevaluation■Waiting
- Page 31 and 32: Challenges ■ Establishing guideli
- Page 33 and 34: 3.7 Fast trackED Senior Assessment
- Page 35: What you need to runthe modelStaff
- 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
3.8 Sub-acute2 hoursED Senior Assessment Streaming Early Treatment ZoneTriageRegistrationSub AcuteWhat is the model?Sub-acute Model Of <strong>Care</strong> is a designated area in the ED for patients:■■■Who are low acuity and do not require an acute bed or cardiac monitoringWho can be high-complexity (with multiple co-morbidities), resource-intensive and requiremultiple investigations, consults and/or procedures, and are therefore not eligible for FastTrack or an Urgent <strong>Care</strong> Centre, and/orWho are non-ambulant and need to be cared for on a bed for treatment.NOTE: It is essential that careful attention is paid to the selection <strong>of</strong> patients suitable for asubacute model – they are to be low risk patients with vital signs within normal parameters,and not require cardiac monitoring.Why use the model?The Sub-acute MOC is used to treat undifferentiated patients who are neither unstable nordo they require intensive observation (therefore, their management in the acute area <strong>of</strong> theED is not needed). However, they are not suitable for ambulatory areas. These patients mayhave complex medical problems but do not present with an acutely life-threatening illness orinjury.The LOS for these patients is usually greater than 2 hours; hence, they are inappropriate forallocation to Fast Track and Urgent <strong>Care</strong> <strong>Models</strong> <strong>of</strong> <strong>Care</strong> as it would likely cause bottlenecksand reduce flow through those areas.Key principles ■ Dedicated space in the ED for sub-acute patients.■■An area used for complex patients that require > 2 hours to determine a managementplan in which time they need to be managed on a bed, for example, an undifferentiatedpatient that does not fit an acute bed criteria but is too complex to be assessed andtreated in a Fast Track Zone.Support patient flow through the ED by not blocking access to monitored beds in theacute area or Fast Track treatment areas with patients that take a long time to assess ortreat.Benefits <strong>of</strong> the model ■ Allows this group <strong>of</strong> patients to receive dedicated care in an appropriate environment■■Supports patient flow through the ED by placing this patient group into the mostappropriate beds, minimising the block to rapid assessment units such as fast track/UCCor to acute beds that have cardiac monitoringProvides an environment where patients are assessed and treated away from the acutearea <strong>of</strong> the ED<strong>Models</strong> <strong>of</strong> <strong>Emergency</strong> <strong>Care</strong> <strong>NSW</strong> HEALTH PAGE 35
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