Emergency department models of care in Queensland: a multisite cross-sectional study (original) (raw)
Related papers
Implementation of a model of emergency care in an Australian hospital
Emergency Nurse, 2017
Aim Emergency departments are characterised by a fast-paced, quick turnover and high acuity workload, therefore appropriate staffing is vital to ensure positive patient outcomes. Models of care are frameworks in which safe and effective patient-to-nurse ratios can be ensured. The aim of this study was to implement a supportive and transparent model of emergency nursing care that provides structure-regardless of nursing staff profile, business or other demands; improvement to nursing workloads; and promotes individual responsibility and accountability for patient care. Method A convergent parallel mixed-method approach was used. Quantitative data were analysed using descriptive statistics and the qualitative data used a thematic analysis to identify recurrent themes. Results Data post-implementation of the model of emergency nursing care indicate improved staff satisfaction in relation to workload, patient care and support structures. Conclusion The development and implementation of a model of care in an emergency department improved staff workload and staff's perception of their ability to provide care.
Emergency medicine Australasia : EMA, 2018
To evaluate the impact of the Australian National Emergency Access Target (NEAT) policy introduced in 2012 on ED performance. A longitudinal cohort study of NEAT implementation using linked data, for 12 EDs across New South Wales (NSW), Australian Capital Territory (ACT) and Queensland (QLD) between 2008 and 2013. Segmented regression in a multi-level model was used to analyse ED performance over time before and after NEAT introduction. The main outcomes measures were ED length of stay ≤4 h, access block, number of ED presentations, short-stay admission (≤24 h), >24 h admissions, unplanned ED re-attendances within 7 days and 'left at own risk' (including 'did not wait for assessment'). Two years after NEAT introduction, ED length of stay ≤4 h increased in NSW and QLD (odds ratio [OR] = 2.48 and 3.24; P < 0.001) and access block decreased (OR = 0.41 and 0.22; P < 0.001), but not in ACT (OR = 1.28; P > 0.05). ED presentations increased over time before and ...
Emergency NP Model of Care in an Australian Emergency Department
The Journal for Nurse Practitioners, 2015
This study aimed to evaluate the effectiveness of nurse practitioner service on key emergency department indicators. A pragmatic randomized controlled trial was conducted. Patients were randomly assigned to standard emergency department care or nurse practitioner care. The outcome measures reported were comparisons on key service indicators. There were 260 patients enrolled in the study, 128 receiving standard emergency department medical care and 130 receiving nurse practitioner care. There were no significant differences between the 2 groups regarding waiting times, length of stay, numbers of patients who left, patient representations within 48 hours, and the use of evidence-based guidelines.
Re-engineering an Australian emergency department: Can we measure success?
Journal of Quality in Clinical Practice, 1999
In 1996, in response to perceived deficiencies of the Emergency Department, Sir Charles Gairdner Hospital made emergency medicine a key strategic initiative. Major staffing and functional changes occurred as a result, including creation of the first Chair in Emergency Medicine in Australasia. We present a before and after study, using a range of measured variables, including the accepted Australian Council on Healthcare Standards emergency medicine clinical indicators. Clinically, there were great improvements in waiting times, time to thrombolysis in acute myocardial infarction, complaint rate, and misdiagnosed fracture rate. Increased throughput of short stay patients in a reopened observation ward greatly shortened average length of stay for patients with a range of acute conditions. Data also indicated significant improvements in teaching and research. We conclude that with firm commitment from hospital management, re-engineering an emergency department can be shown to improve the quality-of-care.
Australian health review : a publication of the Australian Hospital Association, 2014
Objective To implement and evaluate strategies for improving access to emergency department (ED) care in a tertiary hospital. Methods A retrospective pre-post intervention study using routinely collected data involving all patients presenting acutely to the ED of a major tertiary hospital over a 2-year period. Main outcome measures were changes in: the percentage of patients exiting the ED (all patients, patients discharged directly from the ED, patients admitted to inpatient wards); mean patient transit times in the ED; inpatient mortality rates; rates of ED 'did not wait' and re-presentations within 48h of ED discharge; and selected safety indicators. Qualitative data on staff perceptions of interventions were also gathered. Results Working groups focused on ED internal processes, ED-inpatient unit interface, hospital-wide discharge processes and performance monitoring and feedback. Twenty-five different reforms were enacted over a 9-month period from April to December 201...
Emergency Medicine Australasia, 2015
Study Objective: To identify current ED models of care and their impact on care quality, care effectiveness, and cost. Methods: A systematic search of key health databases (Medline, CINAHL, Cochrane, EMbase) was conducted to identify literature on Emergency Department (ED) models of care. Additionally, a focussed review of the contents of 11 international and national emergency medicine, nursing and health economic journals (published between 2010 and 2013) was undertaken with snowball identification of references of the most recent and relevant papers. Articles published between 1998 and 2013 in the English language were included for initial review by three of the authors. Studies in underdeveloped countries and not addressing the objectives of this study were excluded. Relevant details were extracted from the retrieved literature, and analysed for relevance and impact. The literature was synthesised around the study's main themes. Results: Models described within the literature mainly focused on addressing issues at the input, throughput or output stages of ED care delivery. Models often varied to account for site specific characteristics (e.g. onsite inpatient units) or to suit staffing profiles (e.g. extended scope physiotherapist), ED geographical location (e.g. metropolitan or rural site), and patient demographic profile (e.g. paediatrics, older persons, ethnicity). Only a few studies conducted cost effective analysis of service models. Conclusion: Whilst various models of delivering emergency health care exist, further research is required in order to make accurate and reliable assessments of their safety, clinical effectiveness and cost effectiveness.
Emergency Medicine Australasia, 2009
Congestion of emergency health services in Australia has become a matter of prominence not only in the scientific literature but also in the public media. In addition recent major incidents such as the tsunamis in south Asia and the terrorist attacks in the USA, Europe and Bali, together with the threat of pandemic infectious disease, have highlighted the need for an organised approach to emergency health care. However each day in Australia more than 17,000 people attend hospital Emergency Departments and over 7,000 are treated and transported by ambulance services (1). There has been no single emergency event in Australian history which goes close to replicating this daily burden of acute illness and injury. Appropriate management of this daily workload is critical to addressing not only the current challenges but also facilitates surge capacity in the event of all but the most catastrophic incidents. The aim of this paper is to describe the Queensland Emergency Medical System (QEMS) and the structural and organisational arrangements which have been developed over the last fifteen years with a view to encouraging discussion regarding a more structured approach across Australia to system wide design, development, monitoring and evaluation for emergency health services. The term Emergency Medical System (EMS) originated in the USA in the 1960s. There are variations in the terminology (Emergency Medical Services and Emergency Medical Services System or EMSS) and in the scope implied by the name. In some circumstances the term is restricted to pre-hospital care and in others to the whole
Emergency Presentations to Northern Territory Public Hospitals: Demand and Access Analysis
Australian Health Review, 2003
This study aims to quantify trends in emergency presentations to Northern Territory (NT) public hospitals over thepast five years with respect to demand and access. Retrospective analysis was undertaken on data extracted from theNT Module of Caresys and the Hospital Morbidity Data System. There has been a 4.6% decrease in presentations tothe five public hospitals between 1996 and 2001 compared to a 9.4% growth in the population. Despite the apparentdecline in total presentations, the acuity of patients has increased dramatically over the same period. Access analysis ofpresentations seen within the recommended triage time revealed considerable variability, especially for triage categories2, 3 and 4. The access block problem, discrepancies in recorded waiting time and irregularities among the regionalhospitals within the triage system have also been identified. Recommendations including improved access to inpatientbeds and admission to wards were developed in response to the changing ...
BMJ open, 2018
Pressure continues to grow on emergency departments in the UK and throughout the world, with declining performance and adverse effects on patient outcome, safety and experience. One proposed solution is to locate general practitioners to work in or alongside the emergency department (GPED). Several GPED models have been introduced, however, evidence of effectiveness is weak. This study aims to evaluate the impact of GPED on patient care, the primary care and acute hospital team and the wider urgent care system. The study will be divided into three work packages (WPs). WP-A; Mapping and Taxonomy: mapping, description and classification of current models of GPED in all emergency departments in England and interviews with key informants to examine the hypotheses that underpin GPED. WP-B; Quantitative Analysis of National Data: measurement of the effectiveness, costs and consequences of the GPED models identified in WP-A, compared with a no-GPED model, using retrospective analysis of Ho...
Emergency Medicine Australasia, 2015
To determine 1) the magnitude of the increase in Emergency Department (ED) demand in Western Australia (WA) from 2007-2013, and 2) whether primary care type patients seeking care in ED is the main reason for the increase. Methods We conducted a population-based longitudinal study examining trends in ED demand, stratified by area of residence, age group, sex, Australasian Triage Scale (ATS) category and discharge disposition. The outcome measures were annual number and rate of ED presentations. We calculated average annual growth, and agespecific and age-standardised rates. We assessed the statistical significance of trends, overall and within each category, using the Mann-Kendall trend test and ANOVA. We also calculated the proportions of growth in ED demand that were attributable to changes in population and utilisation rate. Results From 2007 to 2013, ED presentations increased by an average 4.6% annually from 739,742 to 945,244. The rate increased 1.4% from 354.1 to 382.6 per 1,000 WA population (p=0.02 for the seven-year trend). Most increase occurred in metropolitan WA, age 45+ yrs, ATS 2 and 3, and admitted cohorts. About three-quarters of this increase was due to population change (growth and ageing) and one-quarter due to increase in utilisation. Conclusion Our study reveals a 4.6% annual increase in ED demand in WA in 2007-2013, mostly due to an increase in people with urgent and complex care needs, and not a 'demand transfer' from primary care. This indicates that a system-wide integrated approach is required for demand management.