Emergency Department Models of Care 2012 - NSW Health

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Case for implementationTo assess the need to implement this model to support your ED, consider the following:■Does your ED experience inefficient patient flow?■ Do patients experience a long length of stay (especially in category 3–5)?■ Are there delays to commencing treatment times (especially in category 3–5)?■■■What is the proportion of did-not-waits in your ED?Is your ED meeting the 4-hour National Emergency Access Target?Are ambulance transfer of care times delayed?An Urgent Care Centre (UCC) Model of Care and Implementation Toolkit have beendeveloped to assist EDs to implement this model. More detail about the UCC andimplementation toolkit can be accessed from ARCHI at www.archi.net.au and ECI atwww.ecinsw.com.au.5.2 Healthdirect Australia advice lineWhat is the model?Why use the model?Healthdirect Australia is a free 24-hour telephone health triage, information and advice servicefor NSW and other states. The service is staffed by Registered Nurses who have access tosophisticated computerised decision support systems which help them address consumerhealth concerns in a safe and consistent way, and provide appropriate advice based on thelatest clinical evidence.The services available through Healthdirect include:■■■■The telephone triage, health advice and information lineThe Pregnancy, Birth & Baby Helpline.HealthInsite, Australia`s Internet gateway to reliable health information onlineThe After-Hours GP Helpline.This telephone advice service enables people to make decisions about their own or theirfamily’s health by providing expert advice and up-to-the-minute information. The service canalso act as a 24-hour referral service, directing people to the most appropriate care option.The aim of the service is to:■■■■■■Improve links between the public and health care services so they can be advised to attendthe most appropriate health services (for example, visiting a GP rather than the hospitalemergency department)Provide easier access to health information and advice without increasing pressure on otherhealth servicesProvide more consistent evidence-based reliable health care advice using a computeriseddecision support system and proven clinical protocolsImprove community health in the long-term because of better access to health promotion,prevention and early interventionAllow after-hours health advice for the community, particularly for minor ailmentsImprove health information and advice for disadvantaged groups, such as Aboriginal andTorres Strait Islander people, people in rural and remote Australia, people with disabilitiesand elderly people.More information about Healthdirect can be found here:http://www.healthdirect.org.au/about-us/about-healthdirect-australiaPAGE 60 NSW HEALTH Models of Emergency Care
5.3 Connecting CareWhat is the model?Connecting Care is a program aimed at delivering more effective health management forpeople aged 16 years and over with a chronic disease. The program is focused on a number ofpredetermined diseases that are targeted as being of high or very high risk of unplannedhospital or ED presentation.Connecting Care links health services to improve how a patient manages their chronic conditionby better ‘Care Coordination and Health Coaching’ to develop a ‘Shared Care Plan’ for thepatient and their Local Medical Officer and health service providers. (NSW MoH, ConnectingCare Program Severe Chronic Disease Management, 2006)Why use the model?The program is aimed at delivering an integrated, patient-focused, whole person service for apatient’s clinical and non-clinical functional deficits. By managing a patient’s chronic diseaseappropriately, Connecting Care aims to reduce the amount of patients presenting to the ED byhelping patients:■■■■■understand their health condition(s) betterunderstand more about their medicines and how to take themimprove their health at home and in the communityaccess the services they need, andbetter connect patients with their specialist(s), doctor and other health service providers.(NSW MoH, Connecting Care Program Severe Chronic Disease Management, 2006)Key Features ■ Priority of five diseases: Diabetes, Congestive Heart Failure, Coronary Artery Diseases,Chronic Obstructive Pulmonary Disease and Hypertension5.4 After-hours GP clinic■■■■■■■■■A proactive, coordinated approach to chronic disease management.Proactive identification, assessment, enrolment and monitoringStrong support for multidisciplinary care, care planning and care coordination.Recognition of General Practitioners as main medical care providerStrong support for patient self-managementNew regional Chronic Disease Management ServicesNew information and communication technology systems.New statewide Health Contact Centre capacityNew funding, organisational and governance structure.What is the servicemodel?Why use this service?The after-hours GP clinic is co-located to the Emergency Department and gives the communityaccess to a GP outside normal working hours in a safe hospital environment – these clinics maybe fully bulk-billed.The service is aimed at providing an alternative for patients seeking after-hours healthcare andtreatment. This service is suited to people who work full time and cannot get to a GP withinusual business hours. (NSW MoH, After hours GP clinics 2011)The after-hours GP clinic can be useful for patients as well as EDs.For patients with minor illnesses seeking treatment at the hospital, it will improve their accessto healthcare as the GP clinic will have a shorter wait time than the ED — as it does not dealwith serious illness and major trauma.Models of Emergency Care NSW HEALTH PAGE 61
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NSW MINISTRY OF HEALTH73 Miller Str
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Executive SummarySince the publicat
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1.2 A review of Emergency Modelsof
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■■■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 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: 5.1 Urgent Care CentreThe Urgent Ca
Page 65 and 66: SECTION 7Self-Assessment ToolsInclu
Page 67 and 68: NHS Gloucestershire 2006, UK Urgent
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Emergency Department Models of Care 2012 - NSW Health

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