Emergency Department Models of Care 2012 - NSW Health

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4.2 Surgical Assessment UnitWhat is the model?A SAU is a specialised unit (e.g. surgical beds converted to SAU beds) that provides a fasttrackroute for the assessment of acute adult surgical patients.The SAU reviews and/or admits stable patients from the ED, direct admissions from theOutpatients Department and Visiting Medical Officers Rooms, inter-hospital transfers, andweekend and public holiday presentations.The SAU provides a focal point for emergency surgical admissions in the hospital, providingrapid assessments by senior medical staff followed by prompt investigations and treatmentor discharge.The service enables all surgical specialties (excluding obstetrics and gynaecology,neurosurgery and cardiothoracic) to be assessed and admitted or discharged.To support improved care of emergency surgery patients, Emergency Surgery Guidelineshave been developed by NSW Health and define the principles underpinning the redesign ofemergency surgery in NSW. The benefits of emergency surgery redesign include improvedpatient outcomes, enhanced patient and surgical team satisfaction and increased traineesupervision in emergency surgery. The guidelines can be found at: http://www.health.nsw.gov.au/policies/gl/2009/pdf/GL2009_009.pdfWhy use the model?The SAU is used to address the challenge of reducing delays for the assessment of surgicalpatients, and promoting senior medical review early in the patient’s care.Key principles ■ Reduce delayed surgical assessment and decision-making for unscheduled generalsurgical patients■■■■■■■■Cater for acute surgical admissions from the ED, clinics, inter-hospital transfers and theDay Only wardA patient’s stay in the ED is as short as possiblePatients are admitted directly into the Surgical Assessment Unit (SAU) after the surgicalconsultant has accepted careFocal point for rapid assessment of surgical patients for plan of care:Coordination of further assessment and diagnostic testsObservationPreparation for theatre.Develop surgical admission and discharge officers.Benefits of the model ■ Reduced access block for surgical patients (Westmead hospital reduced their access blockby up to 43% in 2007)■Improved flow for all patients presenting for treatment in the ED by freeing up ED bedsof surgical patients.Challenges ■ Establishing guidelines between surgical staff and ED on how surgical patients will bemanaged.■This Model of Care does not have strong governance.PAGE 50 NSW HEALTH Models of Emergency Care
Case for implementationWhat you need to runthe modelTo assess the need to implement this model to support your ED and reduce assessmentdelays for unscheduled surgical patients from outpatients, referring hospitals and VMOrooms, consider the following:■■■■Staff■■Do surgical patients experience delays and an extended length of stay in ED?Is your Hospital meeting the National Emergency Access Targets (4-hour targets)?What is the proportion of surgical admissions from your ED?Are non-ED surgical patients (i.e. stable patients, with a surgical problem requiringinpatient admission or further surgical assessment, who do not require the specificservices of the ED) referred to, and admitted via your ED thus inefficiently using EDresources?Medical staff – a senior surgical staff member allocated as the surgical admissions anddischarge officer.Dedicated nursing staff, including a Clinical Nurse Consultant (CNC). The CNC role is toliaise with the Nursing Unit Manager, the Patient Flow Manager, and the EmergencyDepartment to monitor and coordinate patient progress. It is also imperative that theCNC facilitates acceptance of suitable surgical patients in the SAU, that is, patients whodo not meet the exclusion criteria.Physical space■■The SAU should be a dedicated area.Existing surgical ward beds can be converted into an SAU.Business rules■■■■■Develop a policy to manage patients in the SAU – this should include a set of inclusion/exclusion criteria to stream patients from the ED, clinics, inter-hospital transfers and theDay Only ward.Exclusions would include surgical patients with a critical condition.Formulate strict inclusion and exclusion criteria to maintain the patient flow through boththe ED and SAU.Develop protocols to facilitate senior nurse-initiated assessment and referrals fordiagnostic tests and standard assessments for possible surgery, in conjunction with asurgical admission and discharge medical officer.Monitor the complaint/conditions and clinical management regimes that are handled inthe SAU area.Monitoring andevaluation■■■■■■% ED patients with an ED LOS < 4 hours% of admitted surgical patients with ED LOS < 4 hoursLOS in SAU% transferred out of SAU within 24 hours% discharged to home from SAU < 24 hours% SAU patients transferred to inpatient wards.Models of Emergency Care NSW HEALTH PAGE 51
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 and 50: Challenges ■ Identification of
Page 51: ■■■Patient Flow pathways and
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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