Emergency Department Models of Care 2012 - NSW Health

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SECTION 6Monitoring measuresThe aim of reviewing and introducing new models of care into Emergency Departments is to provide faster access to safe andquality emergency care, to assist hospitals to meet the National Emergency Access Targets and to improve the patientexperience. As with the monitoring of all care delivery services, it is important for hospitals to monitor the level of performanceof each emergency care model for effectiveness.A number of monitoring measures are already in place as part of the Key Performance Indicators and Service Measures for the2011/12 Service Agreements and these are included above in each description of a Model of Care. A number of additionalmeasures have been identified, including from the Australasian College for Emergency Medicine Quality Framework forEmergency Departments (available at: http://www.acem.org.au/media/P28_v03_Quality_Framework_for_EDs.pdf), and theseare also included above. These measures are, in some cases, specific to the principles of each model and, in other cases,include broader patient flow measures that facilitate an understanding of what effect the model has on the whole ED and thewhole of hospital and how the model supports the ideal patient journey.Where possible, data will be collected using existing systems such as FirstNet. Where data cannot be collected from this source,there may be a requirement for manual audits or data collection. Table 1 below provides a matrix of monitoring measures thatare applicable to each model. This list of measures is not exhaustive, but gives an indication of the measures that can becollected and used across a number of models of care.Table 2: Monitoring measures for model of care effectivenessTriage &RegistrationClinicalInitiatives NurseResuscitation &TraumaAcute CareSub-acuteEarly ED SeniorAssessmentStreamingEarly TreatmentZoneFast Track2 : 1 : 1ESSUNational Emergency Access Targets ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ED presentations treated withinbenchmark times (%): Categories1,2,4 & 5Transfer of Care time < 30 minutes(%)Presentations staying in ED > 24hours✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓✓ ✓ ✓ ✓ ✓ED Length of Stay ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓Mental health presentations stayingin ED > 24 hours✓ ✓ ✓ ✓ ✓Did Not Wait ✓ ✓ ✓ ✓Patient satisfaction ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓Staff Satisfaction ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓PAGE 62 NSW HEALTH Models of Emergency Care
SECTION 7Self-Assessment ToolsIncluded as part of this 2012 Models of Emergency Caredocument is a self-assessment tool for each Model of Care.The purpose of the tool is to allow Local Health Districts toassess if a MOC is appropriate for their ED or if animplemented MOC is functioning at its full potential. It isintended to be used at an ED level, taking a consultativeapproach to allow for the robust evaluation of the model.The Self-Assessment tool assesses four domains related tothe model:1. Implementation considerations2. Staffing levels, training and competencies3. Guidelines, policies and clinical pathways to supportoperation of the model4. Monitoring measures to enable ongoing assessment andquality improvement.Each of the four domains has specific questions based onthe principles of the emergency care model, and theessential elements to facilitate and/or influence theireffective operation and the delivery of timely and qualitycare for patients.The Self-Assessment rates how well a Model Of Care isimplemented and operating, and the appropriateness of anew MOC for implementation in an ED. Results of theassessment are linked to pre-populated responses based onthe model principles, and these responses provide a set ofpotential actions for an ED to improve the functioning ofthe model of care. To get best value out of the tool andactions for improvement it is essential to answer thequestions honestly and with the best available data tosupport these answers.stakeholders may be included depending on their role inthe particular model being assessed. A number of key stepsare central to completing the self assessment effectively tomaximise the time taken and results. These steps are:■■■Review the tool to understand the data/informationrequired to enable you to answer the questionseffectively.Host a meeting with the key staff in ED to identifysources of data for each question, and to agree aprocess of review of summarised responses andassociated actions.Gather performance data, procedures, clinical pathwaysand any other information to support review of themodel.Once completed, the Self-Assessment generates a summaryreport outlining actions against each question. This report isdesigned to be used by your ED to formulate an action planfor improvement. The action plan should include all keytasks, assigned task owners, and defined timelines forcompletion. Referring back to the Models of Caredocument is essential to assist your ED to understand whatit is to be achieved to maximise the full potential of themodel.The Self-Assessment tools for eachmodel can be found at ARCHI at www.archi.net.au and ECI atwww.ecinsw.com.au/self_assessment_checklistCompleting the self-assessment and evaluating theeffectiveness of the models in your ED, you will have aclearer picture of what works well, and you can identifypriority areas for improvement to assist with improvingpatient flow.When completing the Self-Assessment it is suggested thatincluded in the consultation are the ED Director, NursingUnit Manager, senior medical and nursing staff. AdditionalModels of Emergency Care NSW HEALTH PAGE 63
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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
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SECTION 3Emergency Department Model
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Emergency Department Models of Care 2012 - NSW Health

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