Emergency Department Models of Care 2012 - NSW Health

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Key principles ■ All members of the patient care team both within the ED and specialty inpatient teamsare provided with key timeframes in order to achieve the 4-hour target.■ED, inpatient teams and hospital executive and support service teams will workcollaboratively to meet these timeframes for each stage of the 2 : 1 : 1 process.2 hours or less is allocated for:■■■■The ED to assess and provide clinical management and/or stabilisation of the patientsED to determine if admission is likelyAn inpatient referral to be madeAn inpatient bed requested1 hour or less is allocated for:■Inpatient units to accept the patient1 hour or less is allocated for:■The patient to be transferred to the ward, or the patient to be discharged home ortransferred to another facility.Benefits of the model ■ Improved access within 4 hours for patients admitted to an inpatient unit via the EDChallenges ■ Ensuring sufficient available ED resources, such as space and staff, to enable theproductive use of the first 2 hours of the patient’s time, and minimise unproductivewaiting between care periods■■Staff from all areas of the hospital adhering to the 4-hour time frameEngagement from the diagnostic services, specialist units and ward staff to make eachgroup accountable to the performance timeframes.Case for implementationWhat you need to runthe modelTo assess the need for implementation this model in your ED, consider the following:■■■■Staff■Does your ED and hospital experience inefficient patient flow?Is your hospital meeting the 4-hour National Emergency Access Target?Does your ED have good engagement with inpatient teams?Does your ED experience delays in diagnostic turnaround times and inpatient review?Ensure strong hospital executive management which adheres to, promotes and supportsadherence by all units and staff to the hospital’s operational policies. This MOC seeks toinvolve all hospital staff members (hospital executive, medical, nursing, allied health andsupport services) from the ED to inpatient wards.Information■Data must be collected, analysed and shared to find and fix the causes of blocks anddelays within the system which prevent staff from being able to achieve the requiredperformance within the required timeframes.Business rules■Develop business rules to ensure all Department Heads are accountable for eliminatingsystem blockages and constraints■ Develop business rules to ensure all staff are accountable for adherence to the 2 : 1 : 1timeframes■■Review on a regular basis patient length of stay in ED and inpatient areas:- To recognise best practice principles which can be shared throughout the hospital- To identify constraints in the hospital system to assist with hospital executivedetermination of actions required to alleviate constraints.Implement guidelines to ensure flow is consistent through the ED and though otherhospital services and inpatient units.PAGE 38 NSW HEALTH Models of Emergency Care
Monitoring andevaluation■■■■■■National Emergency Access Target (4 hour target)ED LOSTargets at each point of the 2 : 1 : 1 processPatient outcomesAdverse events and patient complaintsStaff feedback.Models of Emergency Care NSW HEALTH PAGE 39
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 37 and 38: 3.8 Sub-acute2 hoursED Senior Asses
Page 39: 3.9 2 : 1 : 12:1:1This model requir
Page 43 and 44: Why use the model?Key principlesBen
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

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