Re-engineering an Australian emergency department: Can we measure success? (original) (raw)
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Emergency department models of care in Queensland: a multisite cross-sectional study
Australian health review : a publication of the Australian Hospital Association, 2018
The acuity and number of presentations being made to emergency departments (EDs) is increasing. In an effort to safely and efficiently manage this increase and optimise patient outcomes, innovative models of care (MOC) have been implemented. What is not clear is how these MOC reflect the needs of patients or relate to each other or to ED performance. The aim of this study was to describe ED MOC in Queensland, Australia. Situated within a larger mixed-methods study, the present study was a cross-sectional study. In early 2015, leaders (medical directors and nurse managers) from public hospital EDs in Queensland were invited to complete a survey detailing ED activity, staffing profiles, treatment space, MOC and National Emergency Access Target (NEAT) performance. Routinely collected ED information system data was also used. Twenty of the 27 EDs invited participated in the study (response rate 74%). An extensive array of MOC were identified that were categorised into those that facilit...
In the past few years, Australia has embarked on major health care reforms extending across all states and territories. While reform implementation has slowed, increased funding and targets have had some impact on the public hospital sector. However, evidence linking national reforms to improved performance in public hospitals is meager. This absence is even more pronounced in the case of regional hospital performance. This study evaluates whether national reforms have led to an improvement in emergency department (ED) access (an important hospital performance measure) in a regional hospital in Central Australia, Alice Springs Hospital. The evaluation identified moderate improvement in ED access as a result of investment in infrastructure and workforce, and the introduction of ED targets. Clinical leadership and support from the hospital management and the federal government have been critical to the improvement. However, infrastructure and workforce funding must be accompanied by clinical redesign activities for improvement to be sustained. The evaluation also identified that reform funding has to be equitable within a hospital, and be provided on a long-term basis in order to be effective. In the context of a paucity of research on the impact of national healthcare reforms on regional and remote hospital performance, this evaluation sheds some light on pathways that are critical for improvement in ED access. This information will assist policy makers and managers in the development and implementation of programs to improve ED performance in regional hospitals. However, further research is required to test the findings from this evaluation and assess the impact of other components of national healthcare reforms on hospital performance improvement, such as hospital governance and payment systems.
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 Journal, 1999
Objectives-To demonstrate how emergency department triage scale and thrombolysis indicator data can be used to document the impact of a substantial increase in resource allocation. Methods-Descriptive study in an emergency department of an adult tertiary hospital in Perth, Australia during similar periods of the year both before and after a substantial increase in emergency department staff, equipment, and system resources. The study group comprised a total of 11 048 emergency department attendances and all cases of emergency department initiated thrombolysis or acute angioplasty. Outcome was measured using numbers seen and percentage seen within indicator threshold time together with admission rates in each of the five triage categories as well as by using time from presentation to initiation of reperfusion treatment in acute myocardial infarction. Results-The proportion of patients seen within the prescribed indicator time increased by 16.4% (95% confidence interval 14.4% to 18.2%). The increase was most pronounced in triage category 2 (32.7%). Median time to thrombolysis fell by 30 minutes to 37 minutes (p = 0.0002). Conclusions-Use of the Australasian national triage scale and time to thrombolysis clinical indicator data allows a quantitative assessment of the impact of increased emergency department resource allocation.
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.
Clinical audit of emergency unit before and after establishment of the emergency medicine department
JPMA. The Journal of the Pakistan Medical Association, 2012
To assess the deficiencies and potential areas through a medical audit of the emergency departments, in six general hospitals affiliated to Shahid Beheshti University of Medical Sciences at Tehran, Iran, after preparing specific wards-based international standards. A checklist was completed for all hospitals which met our eligibility criteria mainly observation and interviews with head nurses and managers of the emergency medicine unit of the hospitals before (2003) and after (2008) the establishment of emergency departments there. Domains studied included staffing, education and continuing professional development (CPD), facility (design), equipment, ancillary services, medical records, manuals and references, research, administration, pre-hospital care, information systems, disaster planning, bench-marking and hospital accreditation. Education and CPD (p = 0.042), design and facility (p = 0.027), equipment (p = 0.028), and disaster (p = 0.026) had significantly improved after the ...
Internal Medicine Journal, 2013
Background: Emergency department (ED) crowding caused by access block is an increasing public health issue and has been associated with impaired healthcare delivery, negative patient outcomes and increased staff workload.AimTo investigate the impact of opening a new ED on patient and healthcare service outcomes.MethodsA 24‐month time series analysis was employed using deterministically linked data from the ambulance service and three ED and hospital admission databases in Queensland, Australia.ResultsTotal volume of ED presentations increased 18%, while local population growth increased by 3%. Healthcare service and patient outcomes at the two pre‐existing hospitals did not improve. These outcomes included ambulance offload time: (Hospital A PRE: 10 min, POST: 10 min, P < 0.001; Hospital B PRE: 10 min, POST: 15 min, P < 0.001); ED length of stay: (Hospital A PRE: 242 min, POST: 246 min, P < 0.001; Hospital B PRE: 182 min, POST: 210 min, P < 0.001); and access block: (Hos...
Collegian, 2014
Australian emergency departments are experiencing an increasing demand for their services. Patient throughput continues to expand resulting in overcrowding and access block where patients cannot gain entry to appropriate hospital beds. This is despite both state and federal governments implementing numerous schemes to address the complex causes of stress on emergency departments. This paper explores the current literature and highlights the key strategies adopted by different emergency departments to reduce delays and streamline patient flow, including: waiting room nurses; streaming; rapid assessment teams; short stay units and care coordination programmes. Many of these initiatives have proven successful at reducing the number of people representing to the emergency department, addressing time delays and improving the management of existing resources and patient flow. More recent changes include increasing the scope of practice and workload for triage nurses. With the recent introduction of the National Emergency Access Target, which requires that most patients presenting to Australian emergency departments are reviewed and transferred or discharged from the department within 4 h, traditional roles of nurses in the emergency department are changing and expanding to meet the needs of modern healthcare systems.
Emergency Department Performance Indexes Before and After Establishment of Emergency Medicine
2013
Introduction: Emergency department performance index (EPI) greatly influences the function of other hospital’s units and also patient satisfaction. Recently, the Iranian Ministry of Health has defined specific national EPI containing five indexes. In the present study, the performance indexes of emergency department (ED) in one educational hospital has been assessed before and after establishment of emergency medicine. Methods: In the present cross-sectional study the ED of Shohadaye Tajrish Hospital, Tehran, Iran has been assessed during one-year period from March 2012 to February 2013. The study was divided into two six-month periods, before and after establishment of emergency medicine. Five performance indexes including: the percentage of patients were disposed during 6-hour, leaved the ED in a 12-hour, had unsuccessful cardiopulmonary resuscitation (CPR), discharged against medical advice, and the mean time of triage were calculated using data of department of medical records on daily patients’ files. Then, Mann-Whitney U test was used to make comparisons at P<0.05. Results: The aver-age triage time decreased from 6.04 minutes in the first six months to 1.5 minutes in the second six months (P=0.06). The percentage of patients leaving the ED in a 12-hour decreased from 97.3% to 90.4% (P=0.004). However, the percentage of disposed patients during 6-hour (P=0.2), unsuccessful CPR (P=0.34) and discharged against medical advice (P=0.42) did not differ between the two periods. Conclusion: It seems that establishment of emergency medicine could be able to improve ED performance indexes such as time to triage and leave in a 12-hour period.