Emergency Department Models of Care 2012 - NSW Health
Emergency Department Models of Care 2012 - NSW Health Emergency Department Models of Care 2012 - NSW Health
SECTION 5Other Community healthcare servicesThis section provides an overview of community models ofcare that provide access to unscheduled ambulatory care.Other initiatives that assist the community to accessunscheduled care include:■■■■The pilot program for Urgent Care CentresAdvice linesConnecting care programAfter Hours GP Clinics.These initiatives are detailed on the following pages.Key principles for delineating who needs to go to anED■■■■Only patients who need the specific services of theEmergency Department (ED) should be assessed andtreated in the EDOther services must not use the ED as an alternate careprovider to cover periods of closure, leave orunavailabilityPatients who need other speciality services should bereferred directly to that service ¬– the ED adds no valueto that patient’s journey and in many cases, simply addsunnecessary delays.There are specific groups of patients who would notrequire emergency care if they were better managedwith appropriate resources in the community setting byprimary health carers such as general practitioners,APAC teams or chronic disease case managers.Programs to identify these patients and to bettermanage them will improve access to emergency care forpatients who actually need it.PAGE 58 NSW HEALTH Models of Emergency Care
5.1 Urgent Care CentreThe Urgent Care Centre model of care is currently being piloted in five NSW hospitals. This model is considered to still bein draft as an evaluation is about to commence to assess the model for effectiveness and wider implementation. Themodel has been used in other countries as an alternative to ED and there is currently no evidence from Australia to supportwidespread implementation. Nonetheless, the model has been included and is based on international experience.What is the model?The UCC is a MOC that delivers ambulatory medical care outside of a hospital ED without ascheduled appointment (UCAOA, 2008).The UCC specialises in treating patients that require minor procedures such as suturing,fracture management and plastering. This can be achieved by offering easy access todiagnostic services such as radiology and pathology to assist timely diagnosis and treatmentThe UCC gives the ED an alternative model, distinct from the After-Hour GP clinic MOC, fornon-emergency patients who may otherwise present to ED. This model has been developedin the UK and the USA due to reduced availability in those countries of alternatives to EDcare. Reductions in ED patient numbers have been seen when UCCs are closely located to theED (Chalder et al, 2003). Both British and American studies put the numbers of attendancesthat might be treated in a primary care setting typically at 40% of ED attendances(Department of Health UK & NHS Gloucestershire, 2007).Why use the model?UCCs provide an alternative option and additional resources to treat patients with a minorinjury or illness in an efficient, convenient and timely manner. The intent is to see and treatpatients in a 60-minute time frame.Key principles Expedite the patient journey for patients with minor injury or illness that are urgent but notlife threatening■■■■■■■Use a quarantined space outside of the EDTreatment must commence earlyPatients are treated in a dedicated area by dedicated staffStrict inclusion and exclusion criteriaClinical protocols that promote early initiation of nursing careRapid access to appropriate imaging and pathologyEasy access to specialty outpatient, GP and community care referral.Benefits of the model Advantages of UCC include (Salisbury, 2003):■■■Short waiting times for treatmentLeveraging existing services such as radiology and pathologyReduced wait times for care and reduced length of stay in ED.Challenges ■ Locating a physical space for the UCC■■■The UCC may be used as an overflow area when the ED is busyStaffing the UCCEstablishing accountability with diagnostic services (radiology and pathology) for timelyaccess to services.Models of Emergency Care NSW HEALTH PAGE 59
- 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 and 42: Monitoring andevaluation■■■
- Page 43 and 44: Why use the model?Key principlesBen
- 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: Mental Health LiaisonNursesApproxim
- 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
5.1 Urgent <strong>Care</strong> CentreThe Urgent <strong>Care</strong> Centre model <strong>of</strong> care is currently being piloted in five <strong>NSW</strong> hospitals. This model is considered to still bein draft as an evaluation is about to commence to assess the model for effectiveness and wider implementation. Themodel has been used in other countries as an alternative to ED and there is currently no evidence from Australia to supportwidespread implementation. Nonetheless, the model has been included and is based on international experience.What is the model?The UCC is a MOC that delivers ambulatory medical care outside <strong>of</strong> a hospital ED without ascheduled appointment (UCAOA, 2008).The UCC specialises in treating patients that require minor procedures such as suturing,fracture management and plastering. This can be achieved by <strong>of</strong>fering easy access todiagnostic services such as radiology and pathology to assist timely diagnosis and treatmentThe UCC gives the ED an alternative model, distinct from the After-Hour GP clinic MOC, fornon-emergency patients who may otherwise present to ED. This model has been developedin the UK and the USA due to reduced availability in those countries <strong>of</strong> alternatives to EDcare. Reductions in ED patient numbers have been seen when UCCs are closely located to theED (Chalder et al, 2003). Both British and American studies put the numbers <strong>of</strong> attendancesthat might be treated in a primary care setting typically at 40% <strong>of</strong> ED attendances(<strong>Department</strong> <strong>of</strong> <strong>Health</strong> UK & NHS Gloucestershire, 2007).Why use the model?UCCs provide an alternative option and additional resources to treat patients with a minorinjury or illness in an efficient, convenient and timely manner. The intent is to see and treatpatients in a 60-minute time frame.Key principles Expedite the patient journey for patients with minor injury or illness that are urgent but notlife threatening■■■■■■■Use a quarantined space outside <strong>of</strong> the EDTreatment must commence earlyPatients are treated in a dedicated area by dedicated staffStrict inclusion and exclusion criteriaClinical protocols that promote early initiation <strong>of</strong> nursing careRapid access to appropriate imaging and pathologyEasy access to specialty outpatient, GP and community care referral.Benefits <strong>of</strong> the model Advantages <strong>of</strong> UCC include (Salisbury, 2003):■■■Short waiting times for treatmentLeveraging existing services such as radiology and pathologyReduced wait times for care and reduced length <strong>of</strong> stay in ED.Challenges ■ Locating a physical space for the UCC■■■The UCC may be used as an overflow area when the ED is busyStaffing the UCCEstablishing accountability with diagnostic services (radiology and pathology) for timelyaccess to services.<strong>Models</strong> <strong>of</strong> <strong>Emergency</strong> <strong>Care</strong> <strong>NSW</strong> HEALTH PAGE 59
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