Emergency Department Models of Care 2012 - NSW Health
Emergency Department Models of Care 2012 - NSW Health Emergency Department Models of Care 2012 - NSW Health
3.10 Emergency Department Short Stay Units2 hoursEarly Treatment ZoneED Senior Assessment StreamingAcuteTriageRegistrationED SSUSub AcuteWhat is the model?Emergency Department Short Stay Units (ED SSU) refer to designated units, co-located withthe ED, which have been developed for the short-term care of ED patients who requireobservation, specialist assessment and diagnostics and whose length of hospital stay isdeemed to be limited (for example less than 24 hours).The clinical and operational governance of the ED SSU resides with the ED Director and NurseManager or their delegates. The ED SSU should have clearly defined policies and proceduresfor management of clinical conditions within specific time limits. The ED SSU should bephysically quarantined from other hospital units and have an attending doctor assigned 24hours a day (Juan et al, 2006). This fosters a culture of only transferring patients that fit thestrict criteria for admission, for example, patients that, at the time of their presentation to theemergency department, have a predicted short length of stay and high probability of homedischarge.The criteria for admission to an ED SSU will vary between institutions but should be consistentwith the following principles:■■■There should be a focused goal for the period of observation.ED SSU should target patients with a range of low to moderate risk symptom complexeswho, with optimal diagnostic support, can be discharged within a 4–24 hour period.The use of clear diagnostic or management pathways to minimise clinical risk for patients,for example, for low to moderate risk chest pain.The size of each ED SSU will be defined depending on local practices and clinicalmanagement strategies/pathways.PAGE 40 NSW HEALTH Models of Emergency Care
Why use the model?Key principlesBenefits of the modelThe ED SSU model has been developed to provide a short period of assessment, course oftherapy or observations for a group of patients who no longer require ED care. In the pastthese patients would have remained in an ED or been admitted to an inpatient unit.These units are designed to provide short-term (< 24 hours) assessment and/or therapy forselect conditions in order to streamline the episode of care. ED SSU front-loads resources toprovide an intensive period of evaluation, treatment and supervision. The ultimate aim is toimprove patient care, and improve flow through ED, thereby improving ED bed access andreducing inpatient LOS for these patients.The EDSSU is designed for patients who require hospital treatment, observation and/orfurther assessment but are not likely to require a hospital stay of more than 24 hours. Itprovides:■■■■■■■Improved patient flow for the ED to increase its capacity, reduce patient length of stayand assist in reducing long ambulance off-load timesA more comfortable environment for patients than the EDA safety net function against inappropriate discharge.A shorter LOS for this patient group than would occur with inpatient admission to ahospital ward.Key functions of an EDSSU are:- Observation- Specialist assessment and diagnosis- Short-term high-level management of patient conditionsEDSSUs are not:- Temporary ED overflow areas- Used to keep patients that are awaiting an inpatient bed- Overflow areas for other specialty servicesED SSU must:- Be separate from the ED bed base- Be managed by the ED Director (or a delegate who is an emergency medicine specialist).Successful Australian models have emphasised an emergency physician in charge;however, joint management with a consultant from another specialty (if applicable) hasbeen described elsewhere.- Have dedicated medical and nursing staff with ED experience available 24 hours a day- Have defined number beds with clinical services (oxygen, suction, patient ablutionfacilities)- Have specific admission and discharge criteria and policies.EDSSU allows the ED and hospital to function more efficiently by:■■■■■Increasing ED patient turnoverReducing ED LOS for medical patientsImproving patient flow through the EDFacilitating timely ambulance off loadIncreasing the overall hospital bed capacity which saves hospital bed days.Models of Emergency Care NSW HEALTH PAGE 41
- 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 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: Monitoring andevaluation■■■
- 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
3.10 <strong>Emergency</strong> <strong>Department</strong> Short Stay Units2 hoursEarly Treatment ZoneED Senior Assessment StreamingAcuteTriageRegistrationED SSUSub AcuteWhat is the model?<strong>Emergency</strong> <strong>Department</strong> Short Stay Units (ED SSU) refer to designated units, co-located withthe ED, which have been developed for the short-term care <strong>of</strong> ED patients who requireobservation, specialist assessment and diagnostics and whose length <strong>of</strong> hospital stay isdeemed to be limited (for example less than 24 hours).The clinical and operational governance <strong>of</strong> the ED SSU resides with the ED Director and NurseManager or their delegates. The ED SSU should have clearly defined policies and proceduresfor management <strong>of</strong> clinical conditions within specific time limits. The ED SSU should bephysically quarantined from other hospital units and have an attending doctor assigned 24hours a day (Juan et al, 2006). This fosters a culture <strong>of</strong> only transferring patients that fit thestrict criteria for admission, for example, patients that, at the time <strong>of</strong> their presentation to theemergency department, have a predicted short length <strong>of</strong> stay and high probability <strong>of</strong> homedischarge.The criteria for admission to an ED SSU will vary between institutions but should be consistentwith the following principles:■■■There should be a focused goal for the period <strong>of</strong> observation.ED SSU should target patients with a range <strong>of</strong> low to moderate risk symptom complexeswho, with optimal diagnostic support, can be discharged within a 4–24 hour period.The use <strong>of</strong> clear diagnostic or management pathways to minimise clinical risk for patients,for example, for low to moderate risk chest pain.The size <strong>of</strong> each ED SSU will be defined depending on local practices and clinicalmanagement strategies/pathways.PAGE 40 <strong>NSW</strong> HEALTH <strong>Models</strong> <strong>of</strong> <strong>Emergency</strong> <strong>Care</strong>
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