Emergency Department Models of Care 2012 - NSW Health

Challenges ■ Dedicated physical space for sub-acute patients may not be currently available■Staff resistance to the Sub-acute MOC as staff may consider this patient cohort can bemanaged in short stay units. For patients who have been assessed and given a diagnosisin the community (i.e. they are not undifferentiated), and otherwise meet the sub-acuteMOC criteria, the short stay unit may be more appropriate.Case for implementationWhat you need to runthe modelTo assess the need for the implementation or refinement of this model in your ED, considerthe following:■■■■Does your ED suffer from inefficient patient flow?Are acute care beds being utilised by complex, low-acuity patients who do not requiremonitoring or the more intensive nursing care required for unstable patients in the acutearea?Do complex, low-acuity, non-ambulant patients delay access to treatment spaces in theFast Track model?Are patients in Fast Track breaching time targets?Physical space■Sub-acute should have a designated area of non-monitored beds. This can be co-locatedor away from acute care. For smaller departments, a sub-acute area may be combinedwith another area of the ED.Business rules■■■■■Develop inclusion and exclusion criteriaMonitor breaches of inappropriate patients being placed into Sub-acuteEnsure flow into and out of Sub-acute by assessing which patients can be placed into theSub-acute area from either the acute area or other MOC.Allocate appropriate staffing to ensure timely assessment and management of thesepatient.Ensure strong management and adherence to operational policies.Monitoring andevaluation■■■■■■Waiting time for treatment by triage categoryNational Emergency Access Target (4-hour target)Average ED length of stayTransfer of Care timePatient outcomes, incidents and complaintsStaff feedback.PAGE 36 NSW HEALTH Models of Emergency Care