Emergency Department Models of Care 2012 - NSW Health

More documents

Recommendations

Info

■■The size of the MAU bed-base or co-location to another ward will determine the FullTime Equivalent (FTE) for dedicated Allied Health staffing. The MAU patient group (forexample, paediatrics, geriatrics, general medical patients) will inform the Allied Healthstaff selected to work in the MAU.7-day-per-week dedicated Allied Health Staff (especially Physiotherapy, OccupationalTherapy and Social Work staff) are recommended. FTE provisions should be made asnecessary for staff from pharmacy, dietetics, Speech Pathology, Allied Health Assistants,and play therapy.Support Staff:■■Clerical support and Clerical Support Officers (CSO) as per normal inpatient wardarrangementsDedicated porter/wardsperson/patient transport staff is recommended for units withgreater than 15 beds. These services have been shown to decrease delays in patienttransport and movements.Physical space■■Located close to or co-located to the ED but recognised as a separate unit.Within close proximity to diagnostic facilities and services (pathology, radiology andpharmacy). It has been shown that increased distance to diagnostic services reduces thelikelihood of immediate transfer of patients to MAU.Business rulesIt is recommended that the MAU business rules contain:■■Admission criteria (inclusive of any exclusion criteria)An example of admission criteria: The MAU is available for all adult patients who areconsidered to be a medical admission, require a period of assessment and diagnosticreview, are non-critical and stable and do not require resuscitation and stabilisation.■ An example of Exclusion Criteria is given here in Table 1.Table 1: Exclusion CriteriaExcluded PatientsCritical CareHigh Dependency AirwayUnstableNeurologicalSurgicalRenalSpeciality careComplex/Undifferentiatedpatients who are unstableMental HealthChallenging BehavioursOtherAny patient who is to be admitted to ICU, CCU, HDU or othercritical care unitsThreatened airway or any patient who requires BiPAP or CPAPResp rate 36/minO2Sat
■■■Patient Flow pathways and referral mechanisms (inclusive of inbound flows – community,ED Triage, within ED; and outbound flows – home environment (with or withoutcommunity services), inpatient ward, use of transit/patient discharge lounge).Access to diagnostic services. Priority access given to these services where appropriatefor MAU patients.Escalation plans for clinical issues (for example, the deteriorating patient), patient flowissues (entry/exit block), staffing issues (the number of medical/nursing/allied healthcover), and bed management issues (for example, outliers in MAU beds, no MAU bedsavailable).Hours of medical cover for the MAU, for example:■■Consultant on call 24 hours per day 7 days per week.The Medical Assessment Unit has direct Consultant cover from 8am to 5pm Monday toFriday, Registrar cover is provided from 8am to 10pm Monday to Friday and 8am to 5pmSaturday and Sunday, RMO/Intern 8am to 4.30pm, Weekend, Aged Care Consultant oncall, Intern (Winter weekend cover 8 hours per day).All other support is provided through the after-hours medical roster.Monitoring andevaluation■■■■■■■■■■■■Average Total Hours in ED for all MAU patients < 3 hoursAverage length of stay in the MAU (hours) < 48 hoursAverage length of stay of MAU patients transferred to a ward (days) < 7 daysUnplanned readmissions within 28 days of MAU discharge to home or from the MAU/inpatient ward to home < 10%Separations from the MAUAverage length of stay of MAU patients aged 65 yrs and over < 48 hours% patients transferred from the MAU within 48 hours% patients discharged home from MAU% patients discharged home from MAU within 48 hours% patients transferred to inpatient ward from MAU% patients admitted directly to the MAUUnplanned readmissions within 28 days for patients discharge from the MAU direct tohome.Models of Emergency Care NSW HEALTH PAGE 49
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 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 47 and 48: SECTION 4Streamlining access to acu
Page 49: Challenges ■ Identification of
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

Emergency Department Models of Care 2012 - NSW Health

Create successful ePaper yourself

Delete template?

Save as template?