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[]
["Emergency Models of Care - Self Assessment Tool"]
["Purpose: \nThe following assessment tool is designed to assess the effectiveness of current emergency care models in place in your ED. The tool assesses four domains related to the model: \n1. Implementation considerations; \n2. Staffing levels, training and competencies; \n3. Guidelines, policies and clinical pathways to support operation of the model; and \n4. Monitoring measures to enable ongoing assessment and quality improvement. \nEach of the four domains has a selection of questions based on the principles of the emergency care model, and the essential elements to facilitate/influence their effective operation and delivery of timely and quality care for patients. \nBy completing the self assessment and assessing the models in your ED, you will have a clearer picture of where the model works well, and you can identify priority areas to improve operation of the model to assist with improving patient flow.\nInstructions:\nThe Self Assessment Tool is complementary to the Models of Care document and should be used in conjunction with that document. \nWho completes the Self Assessment? \nThe Self Assessment is intended to be completed by a nominated Emergency Department Project Officer / staff member in consultation with the relevant staff within the ED. It is suggested that included are: ED Director, Nursing Unit Manager, senior medical and nursing staff.\nWhat do you need to prepare to complete the Self Assessment?\nBefore completing the self assessment it is important to:\n• Review the tool to understand the data/information required to enable you to answer the questions effectively. \n• Hold a meeting with the key staff in ED to discuss and agree the current processes and what occurs when the model is operating, identify the sources of data for each question, and to agree a process of review of summarised responses and associated actions.\n• Gather performance data, procedures, clinical pathways and any other information to support review of the model.\n"]
["Step by step guide to completing the self assessment:\nStep 1: Click on the ‘Fast track MOC questions’ tab. \nThe tool provides a series of questions to be answered. It is essential to answer the questions honestly as each answer is linked to a specific action that should be undertaken to improve the effectiveness of your ED Model of Care.\nStep 2: Respond to each question by clicking the drop down list in the rating column at the end of the question. There are four possible answers to each question - these are ratings A, B, C and D. \nExamples of a question about processes and possible answers are:\nQ: Are these processes applied at all times as per the guideline?\nA - The ED has a documented process that is in place and followed.\nB - The ED has a documented process in place that is followed some of the time.\nC - The ED does not have well documented or well defined processes. OR The processes are in place but are not always followed.\nD - The ED has no standardised or well defined processes in place.\nChoose the answer that best reflects what's happening in your ED.\nStep 3: Once you have answered all questions click on the ‘Summary Report tab’. This tab will provide you with summarised answers to the questions with a set of actions to assist you to make necessary improvements. \n\nWhat do you do with the information once you have completed the Self Assessment?\nOnce you have completed the Self Assessment and generated the summary report, it is important to meet again with the key staff in ED to validate responses and formulate an action plan. \nThe summary report provides actions against each question and is designed to be used by your ED to formulate an action plan. The action plan will include the actions be outlined in the Summary Report and you may include additional actions pertinent to your ED. The action plan should include all with clear guidance for required tasks, assigned owners of the tasks and defined timelines for completion.\nIn addressing the areas for improvement in your ED model of care, it is essential to refer back to the Models of Care document to assist your ED to understand what it is you are aiming to achieve in relation to the key principles, features and monitoring measures for each model.\n"]

{"sheet":"Triage and Reg  MOC questions","index":1,"n_rows":25,"n_cols":3,"rows_kept":25,"cut":false,"hidden":false,"merged":[[0,0,0,2]]}
["Triage & Registration"]
[null,"Assessment domains","Rating"]
[null,"Implementation of the Model"]
[1,"Is Triage collocated with registration at the front of ED to allow for efficient processing of patients?","A - The ED has dedicated spaces/resources as included in the guidelines and principles to allow the model to operate at all times."]
[2,"Is there a process in enable registration at the bedside if not completed when patient is triaged?","B - The ED has dedicated spaces/resources to allow the model to operate some of the time.  "]
[3,"Is there clear and prominent signage directing people to triage and registration?","C - The triage area is immediately accessible and with signage posted. The signage is not according to NSW Health and ACEM recommendations and patients and carers frequently experience difficulty locating triage on arrival in ED. "]
[4,"Has the ED reviewed activity data, including modes of presentation, to understand the peak periods of demand and to inform a flexible approach and level of staffing required at triage?","C - The ED has reviewed some activity data/patient cohorts/available resources to support the implementation of the model. "]
[null,"Staff Competencies"]
[5,"Is there is a competency framework in place and applied for all staff who work at triage,  for example use of the Emergency Training Education Kit (ETEK), and a formalised mentoring program for staff new to the role of triage?","A - All staff working in this area have completed a package that is accredited and recognised by ACEM/emergency care professional bodies."]
[6,"What proportion of staff rostered in the role of triage have successfully completed the ETEK (or similar accredited program) and been mentored in their role? ","A - All staff have been trained and accredited in this area."]
[7,"Does your ED roster a second triage trained staff member for those shifts known to require the flexible triage model to meet peaks in demand? ","D - No staff have been trained or accredited in this area."]
[null,"Guidelines"]
[8,"Is triage time limited to less than 5 mins for 90% of triage episodes?","A - The ED has well established monitoring processes in place and is meeting all targets."]
[9,"Are there guidelines in place to direct the care/interventions that should be carried out at triage?","C - The ED does not have well documented or well defined guidelines in our ED. The guidelines are in place but are not always followed.   "]
[10,"Is there a process in place to monitor the triage process and waiting times?","D - The ED does not have standardised monitoring processes in place. "]
[11,"Are models of care well established and documented to support streaming from triage, for example the process and inclusion criteria for referral to Fast Track and models outside of ED such as PECC?","C - The model of care is set up but will be limited in its operation depending on activity and available resource - in busy periods the model does not operate as per the guidelines. "]
[12,"Are these models in operation as per the guidelines and ED processes, for example the hours of operation are adhered to for the Fast Track and ED SAS models?","C - The model of care is set up but will be limited in its operation depending on activity and available resource - in busy periods the model does not operate as per the guidelines. "]
[13,"Are documented processes in place to support a flexible approach to triage at times of peak demand? ","D - The ED has no standardised or well defined processes in place. "]
[14,"Are these processes applied at all times as per the guideline?","B - The ED has a documented process in place that is followed some of the time.  "]
[null,"Monitoring Measures"]
[15,"Does the ED carry out regular triage audits to evaluate the triage process and practices, for example a chart audit to review patient presentation documentation and allocated triage category for appropriateness?  ","A - The ED has well established monitoring processes in place which are reviewed at meetings monthly/as required/as scheduled."]
[16,"Are monitoring measures in place to regularly assess the effectiveness of triage processes, for example the occasions where flexible plans were implemented to support periods of peak demand?","A - The ED has well established monitoring processes in place which are reviewed at meetings monthly/as required/as scheduled."]
[17,"Are monitoring measures established and in place to assess the time taken complete a triage episode and associated activities carried out at triage?","D - The ED does not have standardised monitoring processes in place. "]
[18,"Are monitoring measures in place to assess the impact of waits for triage and initial assessment, for example patient complaints and DNWs? ","C - The ED does not have feedback processes in place. The feedback processes are in place but are not always completed or reviewed"]
[19,"Is there a process in place in your ED to feedback results of any monitoring or audits?","D - The ED does not have standardised monitoring and feedback processes in place. "]

{"sheet":"Summary report ","index":2,"n_rows":25,"n_cols":4,"rows_kept":25,"cut":false,"hidden":false,"merged":[[0,0,0,3]]}
["Triage & Registration - Summary "]
["#","Questions ","Answers to questions","Action required"]
[null,"Implementation of the model "]
[1,"Is Triage collocated with registration at the front of ED to allow for efficient processing of patients?",{"$f":"'Triage and Reg  MOC questions'!C4","v":"A - The ED has dedicated spaces/resources as included in the guidelines and principles to allow the model to operate at all times."},{"$f":"VLOOKUP($C4,Lists!$B$2:$C$500,2,FALSE)","v":"Continue to evaluate demand pressures on the ED and model of care by determining the volume of patients that are seen in the model and evaluate if the physical space and resources are sufficient.\nEvaluate the performance of the model to determine efficiency. This should be undertaken by assessing performance data and conducting satisfaction surveys of staff and patients. Use this data to inform/identify any requisite changes to improve the physical layout of the model or include additional resources to improve the efficiency of the model.\n"}]
[2,"Is there a process in enable registration at the bedside if not completed when patient is triaged?",{"$f":"'Triage and Reg  MOC questions'!C5","v":"B - The ED has dedicated spaces/resources to allow the model to operate some of the time.  "},{"$f":"VLOOKUP($C5,Lists!$B$2:$C$500,2,FALSE)","v":"Evaluate the performance data of the model to determine if the physical space and resources are adequate to run the model efficiently. This should be undertaken by assessing performance data and conducting satisfaction surveys of staff and patients. This has the potential to improve the physical layout of the model or include additional resources to improve the efficiency of the model.\n\nNeed to determine why the model is not operating continuously, is there a lack of:\na) Physical space to operate the model continuously - Undertake a staffing survey to determine if the current physical space has any impact on the function of the model. Questions should investigate: ease of access to the model, is the area large enough to cater for volume of patients, is the physical space adequate to assess the current volume of patients. \nb) Demand for the model to operate the model continuously -  you will need to evaluate the demand requirements for the model. This involves correlating the volume of patients and the time of day to determine peak periods of demand. If the demand does not support the model to run continuously, align the models operating times with peak demand periods.\nc) Staffing resources to operate the model continuously -  is there a sufficient amount of staff to run the model continuously, if yes, determine if a) or b) is the cause of the model not running continuously. If there is not enough staff, evaluate rostering schedules to reorganise staff to make them available to work in the model continuously. If there is an insufficient skill mix of staff to run the model consider retraining or up skilling staff to work in the model. You can refer to the ED-WAT to understand alternative staffing options.      "}]
[3,"Is there clear and prominent signage directing people to triage and registration?",{"$f":"'Triage and Reg  MOC questions'!C6","v":"C - The triage area is immediately accessible and with signage posted. The signage is not according to NSW Health and ACEM recommendations and patients and carers frequently experience difficulty locating triage on arrival in ED. "},{"$f":"VLOOKUP($C6,Lists!$B$2:$C$500,2,FALSE)","v":"Refer to the  NSW Health PD2010_075 Emergency Department Patients Awaiting Care and GL2009_010 Technical Series 2 - Wayfinding for Health Facilities for guidance on appropriate signage for your ED. Review the gaps in signage recommended and modify as required.  \nPut in place measures to monitor the effectiveness of signage for triage. Include data from satisfaction surveys of staff and patients, and any adverse events/complaints  to assess the effectiveness of signage. \nPrevent the posting of distracting or misleading signage in the waiting room. \nReview recommended signage using the Practical steps to improving Emergency Department signage guide.\nhttp://internal.health.nsw.gov.au/pubs/2008/ed_signage.html. "}]
[4,"Has the ED reviewed activity data, including modes of presentation, to understand the peak periods of demand and to inform a flexible approach and level of staffing required at triage?",{"$f":"'Triage and Reg  MOC questions'!C7","v":"C - The ED has reviewed some activity data/patient cohorts/available resources to support the implementation of the model. "},{"$f":"VLOOKUP($C7,Lists!$B$2:$C$500,2,FALSE)","v":"Determine what activity data/patient cohorts/available resources have not been reviewed and determine why the data has not been reviewed. Nominate staff member(s) that will take responsibility of reviewing the data.  \nEstablish regular data review periods and compare activity data against KPIs and available resources - Compare patient cohorts against current clinical pathways and determine if there is a need to expand or update clinical pathways.\nThe reviews should be used to assess the models performance and potential need to change - expand and refine the model. \nFacilitate an ongoing review process of activity data/patient cohorts/available resources:\n- regular (biannually or as changes in performance are seen).\n- revealed to staff to foster a culture of transparency and to promote inclusion of all the staff in the management of the model.\n- used to improve how the model functions.\n- used to compare KPI data and available resources.\n- used to influence clinical pathway development.\nEstablish guidelines to use the reviews to improve the model by linking in with the above activities.    \n   "}]
[null,"Staff Competencies"]
[5,"Is there is a competency framework in place and applied for all staff who work at triage,  for example use of the Emergency Training Education Kit (ETEK), and a formalised mentoring program for staff new to the role of triage?",{"$f":"'Triage and Reg  MOC questions'!C9","v":"A - All staff working in this area have completed a package that is accredited and recognised by ACEM/emergency care professional bodies."},{"$f":"VLOOKUP($C9,Lists!$B$2:$C$500,2,FALSE)","v":"Continue to provide ongoing training programs to existing and new ED staff.\nEvaluate the training programs regularly for effectiveness. \nPut in place feedback processes that allow for continuous improvement of programs. \nCollaborate with ED colleagues and periodically review any training programs that have been introduced/revised for their potential to be used to support education of staff in your ED."}]
[6,"What proportion of staff rostered in the role of triage have successfully completed the ETEK (or similar accredited program) and been mentored in their role? ",{"$f":"'Triage and Reg  MOC questions'!C10","v":"A - All staff have been trained and accredited in this area."},{"$f":"VLOOKUP($C10,Lists!$B$2:$C$500,2,FALSE)","v":"Continue to provide ongoing training to existing and new ED staff. \nRegularly monitor the staff who have been trained in this area and put in place feedback processes that allow for continuous improvement of training programs and their frequency. \nPut in place measures that allow staff to feedback the effectiveness of the program.\n"}]
[7,"Does your ED roster a second triage trained staff member for those shifts known to require the flexible triage model to meet peaks in demand? ",{"$f":"'Triage and Reg  MOC questions'!C11","v":"D - No staff have been trained or accredited in this area."},{"$f":"VLOOKUP($C11,Lists!$B$2:$C$500,2,FALSE)","v":"Analyse the needs of staff in your ED to understand the training requirements. \nDevelop and implement an education program to increase the number of staff trained and accredited in this area. This could be achieved by contacting other EDs to source current programs that are in place. Collaborate with Professional Colleges, Nursing, Medical and other educators to source training programs and to support the implementation and completion of training staff appropriately. Examples of these programs include the NSW Health Transition to Emergency Nursing Program,  and the Emergency Triage Education Kit (ETEK).  \nOnce your program is in place:\nRegularly evaluate the training program for effectiveness.\nPut in place measures that allow staff to feedback the effectiveness of the program."}]
[null,"Guidelines"]
[8,"Is triage time limited to less than 5 mins for 90% of triage episodes?",{"$f":"'Triage and Reg  MOC questions'!C13","v":"A - The ED has well established monitoring processes in place and is meeting all targets."},{"$f":"VLOOKUP($C13,Lists!$B$2:$C$500,2,FALSE)","v":"Continue to monitor the processes and performance of the model using the measures included. \nUndertake an evaluation of the monitoring process to determine:\n- how often the monitoring processes are reviewed, it should be at least every quarter.\n- if results of the monitoring process are fed back to staff to disseminate performance data. Regular feedback loops should be established to disseminate this information. \n- if current process of the model need to be changed to improve the functioning of the model. The efficiency of the model should be continuously reviewed so improvements can be implemented before performance begins to fall"}]
[9,"Are there guidelines in place to direct the care/interventions that should be carried out at triage?",{"$f":"'Triage and Reg  MOC questions'!C14","v":"C - The ED does not have well documented or well defined guidelines in our ED. The guidelines are in place but are not always followed.   "},{"$f":"VLOOKUP($C14,Lists!$B$2:$C$500,2,FALSE)","v":"Carry out a review/analysis of the current guidelines and relevant processes with feedback from staff to understand why they are not followed consistently.\nIdentify the gaps/issues with the guidelines and what must change to improve their use.\nBased on feedback revise and develop guidelines that can facilitate standardised practice to reduce variation and improve the appropriateness of treatment. \nProvide education and appropriate guidance in the use of the guidelines for all staff.  \nPut in place feedback processes to enable staff to feedback in a timely manner and include the revision and monitoring in ED meetings regularly to allow transparency of the process. \nContinue the monitoring process to check for effectiveness and allow for continuous quality improvement and currency of guidelines. \nGain support from the ED and hospital Executive for implementation and use of the guidelines.  "}]
[10,"Is there a process in place to monitor the triage process and waiting times?",{"$f":"'Triage and Reg  MOC questions'!C15","v":"D - The ED does not have standardised monitoring processes in place. "},{"$f":"VLOOKUP($C15,Lists!$B$2:$C$500,2,FALSE)","v":"Consider the monitoring measures you will need to effectively monitor the model.\n Refer to the model of care document to guide your decision making and to understand the data requirements. \nEstablish monitoring measures to determine the effectiveness of the model. Monitoring measures should be purposeful, clearly defined and easy to interpret. Examples include; \n• Operational indicators: eg patient wait times, LOS, off-stretcher times, NEAT and patient turnaround times.\n• Clinical indicators: relates to patient safety more specifically and measures the ‘clinical management or outcome of care’ of patients, such as time to analgesia, time to antibiotics, morbidity, mortality rates, adverse events, patient satisfaction and complaints.\nOnce data requirements been determined, establish the monitoring measures and nominate staff(s) who will have responsibility for collecting data for review. \nAgree on a timeline for the implementation of monitoring measures.  \nThe monitoring measures should be discussed at meetings on a regular (predetermined) basis. "}]
[11,"Are models of care well established and documented to support streaming from triage, for example the process and inclusion criteria for referral to Fast Track and models outside of ED such as PECC?",{"$f":"'Triage and Reg  MOC questions'!C16","v":"C - The model of care is set up but will be limited in its operation depending on activity and available resource - in busy periods the model does not operate as per the guidelines. "},{"$f":"VLOOKUP($C16,Lists!$B$2:$C$500,2,FALSE)","v":"Analyse the data to determine peak periods of demand that would support the model of care. The model should operate in this period. \nSelect a team of staff to undertake a review of the model to determine if the business rules, operational arrangements and processes of the Model have been implemented as per the implementation tool kit or ED Models of care document and if staff are adhering to them. \nThis evaluation should reveal key areas that need improving which can be linked to operation of the model and requisite changes.  \nEstablish a team that is accountable for driving changes. This should include education programs for staff to implement business rules, operational arrangements and process as per the implementation toolkit. This team should be bound to established time frames to achieve these goals. "}]
[12,"Are these models in operation as per the guidelines and ED processes, for example the hours of operation are adhered to for the Fast Track and ED SAS models?",{"$f":"'Triage and Reg  MOC questions'!C17","v":"C - The model of care is set up but will be limited in its operation depending on activity and available resource - in busy periods the model does not operate as per the guidelines. "},{"$f":"VLOOKUP($C17,Lists!$B$2:$C$500,2,FALSE)","v":"Analyse the data to determine peak periods of demand that would support the model of care. The model should operate in this period. \nSelect a team of staff to undertake a review of the model to determine if the business rules, operational arrangements and processes of the Model have been implemented as per the implementation tool kit or ED Models of care document and if staff are adhering to them. \nThis evaluation should reveal key areas that need improving which can be linked to operation of the model and requisite changes.  \nEstablish a team that is accountable for driving changes. This should include education programs for staff to implement business rules, operational arrangements and process as per the implementation toolkit. This team should be bound to established time frames to achieve these goals. "}]
[13,"Are documented processes in place to support a flexible approach to triage at times of peak demand? ",{"$f":"'Triage and Reg  MOC questions'!C18","v":"D - The ED has no standardised or well defined processes in place. "},{"$f":"VLOOKUP($C18,Lists!$B$2:$C$500,2,FALSE)","v":"A team of senior clinicians need to be convened to review the needs of the ED, and develop, agree and document the processes for the model. The group should refer to the MOC and implementation tool kit when establishing the models. The processes should consider operational, staffing and flow of patients through the model. \nPut in place measures to enable ongoing feedback on new processes and their effectiveness - this should be discussed at staff meetings.."}]
[14,"Are these processes applied at all times as per the guideline?",{"$f":"'Triage and Reg  MOC questions'!C19","v":"B - The ED has a documented process in place that is followed some of the time.  "},{"$f":"VLOOKUP($C19,Lists!$B$2:$C$500,2,FALSE)","v":"Determine when processes are not being followed and carry out a review to determine why - processes may not be relevant or out of date, or it could be a result of resource constraints. \nReview performance data to determine if processes are efficient to run the model. If performance data is below the recommended target, review the documented processes of the model, review the models of care document and implementation toolkit information (if relevant) and document new processes to run the model effectively. \nPut in place measures to enable ongoing feedback on current processes and their effectiveness - this should be discussed at staff meetings."}]
[null,"Monitoring Measures"]
[15,"Does the ED carry out regular triage audits to evaluate the triage process and practices, for example a chart audit to review patient presentation documentation and allocated triage category for appropriateness?  ",{"$f":"'Triage and Reg  MOC questions'!C21","v":"A - The ED has well established monitoring processes in place which are reviewed at meetings monthly/as required/as scheduled."},{"$f":"VLOOKUP($C21,Lists!$B$2:$C$500,2,FALSE)","v":"Continue to collect, monitor and report/review monthly data about performance and patient outcomes.  Review the monitoring measures that are being collected for relevance and ability to provide adequate information about the effectiveness of the model and ED operations.   \nContinue with the feedback loops to all staff to disseminate data and review these periodically for effectiveness in communication.\nEstablish regular evaluation periods (eg biannually) to examine the effectiveness of the models and to determine if the models business rules are being adhered to by staff. "}]
[16,"Are monitoring measures in place to regularly assess the effectiveness of triage processes, for example the occasions where flexible plans were implemented to support periods of peak demand?",{"$f":"'Triage and Reg  MOC questions'!C22","v":"A - The ED has well established monitoring processes in place which are reviewed at meetings monthly/as required/as scheduled."},{"$f":"VLOOKUP($C22,Lists!$B$2:$C$500,2,FALSE)","v":"Continue to collect, monitor and report/review monthly data about performance and patient outcomes.  Review the monitoring measures that are being collected for relevance and ability to provide adequate information about the effectiveness of the model and ED operations.   \nContinue with the feedback loops to all staff to disseminate data and review these periodically for effectiveness in communication.\nEstablish regular evaluation periods (eg biannually) to examine the effectiveness of the models and to determine if the models business rules are being adhered to by staff. "}]
[17,"Are monitoring measures established and in place to assess the time taken complete a triage episode and associated activities carried out at triage?",{"$f":"'Triage and Reg  MOC questions'!C23","v":"D - The ED does not have standardised monitoring processes in place. "},{"$f":"VLOOKUP($C23,Lists!$B$2:$C$500,2,FALSE)","v":"Consider the monitoring measures you will need to effectively monitor the model.\n Refer to the model of care document to guide your decision making and to understand the data requirements. \nEstablish monitoring measures to determine the effectiveness of the model. Monitoring measures should be purposeful, clearly defined and easy to interpret. Examples include; \n• Operational indicators: eg patient wait times, LOS, off-stretcher times, NEAT and patient turnaround times.\n• Clinical indicators: relates to patient safety more specifically and measures the ‘clinical management or outcome of care’ of patients, such as time to analgesia, time to antibiotics, morbidity, mortality rates, adverse events, patient satisfaction and complaints.\nOnce data requirements been determined, establish the monitoring measures and nominate staff(s) who will have responsibility for collecting data for review. \nAgree on a timeline for the implementation of monitoring measures.  \nThe monitoring measures should be discussed at meetings on a regular (predetermined) basis. "}]
[18,"Are monitoring measures in place to assess the impact of waits for triage and initial assessment, for example patient complaints and DNWs? ",{"$f":"'Triage and Reg  MOC questions'!C24","v":"C - The ED does not have feedback processes in place. The feedback processes are in place but are not always completed or reviewed"},{"$f":"VLOOKUP($C24,Lists!$B$2:$C$500,2,FALSE)","v":"Review the monitoring requirements of the ED to determine the feedback processes to be commenced in the ED and to hospital staff external to ED.\nIn consultation with staff develop and agree feedback processes to be implemented, this should include the who, what where and how of providing feedback and the timing of feedback with escalation processes as necessary.\nAgree a timeline for implementation with staff and collaborate to develop an implementation plan and begin the processes of feedback. \nAssign the responsibility/accountability of these processes to a key staff member in ED. \nCommunicate any changes to staff prior to commencement of new feedback processes.  \nFor all feedback processes that include staff external to ED ensure consultation with this group and agreement of processes.\nReview the feedback processes every few months for effectiveness, loop closure and follow up actions to enable a continued and effective process for monitoring and improvement.\n"}]
[19,"Is there a process in place in your ED to feedback results of any monitoring or audits?",{"$f":"'Triage and Reg  MOC questions'!C25","v":"D - The ED does not have standardised monitoring and feedback processes in place. "},{"$f":"VLOOKUP($C25,Lists!$B$2:$C$500,2,FALSE)","v":"Review the monitoring requirements of the ED to determine the feedback processes to be commenced in the ED and to hospital staff external to ED. \nIn consultation with staff develop and agree feedback processes to be implemented, this should include the:\n- who\n- what \n- where, and \n- how of providing feedback and the timing of feedback with escalation processes as necessary.\nAgree a timeline for implementation with staff and collaborate to develop an implementation plan and begin the process of feedback. \nAssign the responsibility/accountability of these processes to a key staff member in ED. \nCommunicate any changes to staff prior to commencement of new feedback processes.  \nFor all feedback processes that include staff external to ED ensure consultation with this group and agreement of processes.\nReview the feedback processes every few months for effectiveness, loop closure and follow up actions to enable a continued and effective process for monitoring and improvement.\n"}]

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[]
[null,"Rating Criteria","Actions"]
[]
[null,"Staff Competencies - staff trained ","Staff Competencies - staff trained "]
[null,"A - All staff have been trained and accredited in this area.","Continue to provide ongoing training to existing and new ED staff. \nRegularly monitor the staff who have been trained in this area and put in place feedback processes that allow for continuous improvement of training programs and their frequency. \nPut in place measures that allow staff to feedback the effectiveness of the program.\n"]
[null,"B - More than 75% of staff have been trained and accredited in this area.","Analyse the needs of staff requiring training in this area.\nEvaluate the training program for effectiveness.\nContinue to provide ongoing training to existing and new ED staff. \nPut in place monitoring and feedback processes that allow staff to feedback the effectiveness of the program.  \nRegularly monitor the staff who have been trained in this area and put in place feedback processes that allow for continuous improvement of training programs and their frequency. "]
[null,"C - Less than 75% of staff have been trained and accredited in this area.","Analyse the needs of staff in your ED to understand the training requirements. \nPlan and implement an education program to increase the number of staff trained and accredited in this area, review the need for Nursing, Medical and other educators to support the enhanced training efforts.\nRegularly evaluate the training program for effectiveness.\nPut in place measures that allow staff to feedback the effectiveness of the program."]
[null,"D - No staff have been trained or accredited in this area.","Analyse the needs of staff in your ED to understand the training requirements. \nDevelop and implement an education program to increase the number of staff trained and accredited in this area. This could be achieved by contacting other EDs to source current programs that are in place. Collaborate with Professional Colleges, Nursing, Medical and other educators to source training programs and to support the implementation and completion of training staff appropriately. Examples of these programs include the NSW Health Transition to Emergency Nursing Program,  and the Emergency Triage Education Kit (ETEK).  \nOnce your program is in place:\nRegularly evaluate the training program for effectiveness.\nPut in place measures that allow staff to feedback the effectiveness of the program."]
[]
[null,"Staff Competencies - education programs","Staff Competencies - education programs "]
[null,"A - All staff working in this area have completed a package that is accredited and recognised by ACEM/emergency care professional bodies.","Continue to provide ongoing training programs to existing and new ED staff.\nEvaluate the training programs regularly for effectiveness. \nPut in place feedback processes that allow for continuous improvement of programs. \nCollaborate with ED colleagues and periodically review any training programs that have been introduced/revised for their potential to be used to support education of staff in your ED."]
[null,"B - More than 75% of staff are trained and accredited using a package /program that is recognised by ACEM/Emergency care professional bodies.","Analyse the needs of staff in your ED to understand the training requirements. \nEvaluate the training program for effectiveness.\nContinue to provide ongoing training programs to existing and new ED staff. \nPut in place monitoring and feedback processes that allow staff to feedback the effectiveness of the program.  \nRegularly monitor the staff who have been trained in this area and put in place feedback processes that allow for continuous improvement of training programs and their frequency. \nCollaborate with ED colleagues and periodically review any training programs that have been introduced/revised for their potential to be used in your ED."]
[null,"C - The ED uses a locally developed education and training program, there is no associated competency assessment or ongoing review.","Analyse the needs of staff in your ED to understand the training requirements. \nReview the locally developed program against other accredited programs for completeness/appropriateness.\nPlan and implement an education program to increase the number of staff trained and accredited in this area, review the need for Nursing, Medical and other educators to support the enhanced training efforts.\nReview competency assessment framework/criteria in place in other areas/EDs/created by professional bodies and implement a competency assessment framework in your ED.  \nCollaborate with ED colleagues and periodically review any training programs that have been introduced/revised for their potential to be used in your ED.\nRegularly monitor the staff who are trained using the new program and put in place monitoring and feedback processes to allow for continuous improvement of training programs."]
[null,"D - The ED does not use any training and competency program in our ED.","Analyse the needs of staff in your ED to understand the training requirements.  \nDevelop and implement an education program to increase the number of staff trained and accredited in this area, collaborate with Professional Colleges, Nursing, Medical and other educators to source training programs and to support the implementation and completion of training staff appropriately.\nReview competency assessment framework/criteria in place in other areas/EDs/created by professional bodies and implement a competency assessment framework in your ED.  \nCollaborate with ED colleagues and periodically review any training programs that have been introduced/revised for their potential to be used in your ED.\nRegularly monitor the staff who are trained using the new program and put in place monitoring and feedback processes to allow for continuous improvement of training programs."]
[]
[null,"Guidelines","Guidelines "]
[null,"A - The ED has documented guidelines in place and followed.","The guidelines are in place and followed. \nPut in place review processes to facilitate the inclusion of best practice, contemporary guidelines in place in your ED. \nEstablish feedback loops with all staff to enable timely and appropriate feedback of all guidelines for effectiveness and relevance.  "]
[null,"B - The ED has  documented guidelines in place that are followed some of the time.  ","Carry out a review of the current guidelines with feedback for staff to understand why they are not followed.\nBased on feedback revise and develop guidelines that can facilitate standardised practice to reduce variation and improve the appropriateness of treatment. \nPut in place feedback processes to enable staff to feedback in a timely manner and include the revision and monitoring in ED meetings regularly to allow transparency of the process. \nContinue the monitoring process to check for effectiveness and allow for continuous quality improvement and currency of guidelines. \nGain support from the ED and hospital Executive for implementation and use of the guidelines.  "]
[null,"C - The ED does not have well documented or well defined guidelines in our ED. The guidelines are in place but are not always followed.   ","Carry out a review/analysis of the current guidelines and relevant processes with feedback from staff to understand why they are not followed consistently.\nIdentify the gaps/issues with the guidelines and what must change to improve their use.\nBased on feedback revise and develop guidelines that can facilitate standardised practice to reduce variation and improve the appropriateness of treatment. \nProvide education and appropriate guidance in the use of the guidelines for all staff.  \nPut in place feedback processes to enable staff to feedback in a timely manner and include the revision and monitoring in ED meetings regularly to allow transparency of the process. \nContinue the monitoring process to check for effectiveness and allow for continuous quality improvement and currency of guidelines. \nGain support from the ED and hospital Executive for implementation and use of the guidelines.  "]
[null,"D - The ED does not have standardised guidelines in place. ","Analyse the current practices in the ED/hospital to understand what processes/guidelines staff are currently following.\nBased on this understanding work with a key group of ED/hospital stakeholders to develop guidelines that are acceptable to all groups of staff.\nSet out the key objectives for and outcomes from the use of the guidelines and clearly articulate these to staff through education sessions and meetings to facilities a transparent approach.\nAgree a timeline for implementation with staff and collaborate to develop an implementation plan. \nPut in place monitoring measures and a feedback process to facilitate timely feedback and continuous improvement. \nPut in place a regular review and monitoring process, including results in all staff meetings to enable transparency.  \nGain support from the ED and hospital Executive for implementation and use of the guidelines.  "]
[]
[null,"Processes","Processes"]
[null,"A - The ED has a documented process that is in place and followed.","Continue to review performance data to determine if current processes are effective in improving/maintaining the performance of the ED. \nIf performance data is below the recommended target, review the documented processes of the model, review the models of care document and implementation toolkit information (if relevant) and document new processes to enable the model to run effectively. \nPut in place measures to enable ongoing feedback on current processes and their effectiveness - this should be discussed at staff meetings."]
[null,"B - The ED has a documented process in place that is followed some of the time.  ","Determine when processes are not being followed and carry out a review to determine why - processes may not be relevant or out of date, or it could be a result of resource constraints. \nReview performance data to determine if processes are efficient to run the model. If performance data is below the recommended target, review the documented processes of the model, review the models of care document and implementation toolkit information (if relevant) and document new processes to run the model effectively. \nPut in place measures to enable ongoing feedback on current processes and their effectiveness - this should be discussed at staff meetings."]
[null,"C - The ED does not have well documented or well defined processes. The processes are in place but are not always followed.   ","Determine when processes are not being followed and carry out a review to determine why - processes may not be relevant or out of date, or it could be a result of resource constraints. \nIf no defined processes are in place, convene a team of senior clinicians to review the needs of the ED and to develop, agree and document the processes for the model. The group should refer to the MOC and implementation tool kit (if relevant) when establishing the processes. The processes should consider operational, staffing and flow of patients through the model. \nPut in place measures to enable ongoing feedback on current/new processes and their effectiveness - this should be discussed at staff meetings."]
[null,"D - The ED has no standardised or well defined processes in place. ","A team of senior clinicians need to be convened to review the needs of the ED, and develop, agree and document the processes for the model. The group should refer to the MOC and implementation tool kit when establishing the models. The processes should consider operational, staffing and flow of patients through the model. \nPut in place measures to enable ongoing feedback on new processes and their effectiveness - this should be discussed at staff meetings.."]
[]
[null,"Monitoring Measures - in place - ED","Monitoring Measures - in place - ED"]
[null,"A - The ED has well established monitoring processes in place which are reviewed at meetings monthly/as required/as scheduled.","Continue to collect, monitor and report/review monthly data about performance and patient outcomes.  Review the monitoring measures that are being collected for relevance and ability to provide adequate information about the effectiveness of the model and ED operations.   \nContinue with the feedback loops to all staff to disseminate data and review these periodically for effectiveness in communication.\nEstablish regular evaluation periods (eg biannually) to examine the effectiveness of the models and to determine if the models business rules are being adhered to by staff. "]
[null,"B - The ED has monitoring processes in place which are reviewed some of the time.  ","Continue to collect, monitor and report/review monthly data about performance and patient outcomes.  Review the monitoring measures that are being collected for relevance and ability to provide adequate information about the effectiveness of the model and ED operations.   \nContinue with the feedback loops to all staff to disseminate data and review these periodically for effectiveness in communication.\nReview the periods or when monitoring measures were not reviewed to understand why.  \nEstablish regular evaluation periods (eg biannually) to examine the effectiveness of the models and to determine if the models business rules are being adhered to by staff. \nEstablish feedback loops with all staff to disseminate performance data and build a culture of performance improvement amongst staff by showing staff where the model is  performing well or the areas in which it is underperforming. "]
[null,"C - The monitoring processes are in place but are not always completed or reviewed.   ","Review the monitoring processes and measures in place to determine why they are not being completed or reviewed as planned.  Review the monitoring measures that are being collected for relevance and ability to provide adequate information about the effectiveness of the model and ED operations.   \nEstablish regular evaluation periods (eg biannually) to examine the effectiveness of the models and to determine if the models business rules are being adhered to by staff. \nEstablish feedback loops with all staff to disseminate performance data and build a culture of performance improvement amongst staff by showing staff where the model is  performing well or the areas in which it is underperforming. \nEstablish feedback loops with all staff to disseminate performance data and continue to improve the effectiveness of the model.\n"]
[null,"D - The ED does not have standardised monitoring processes in place. ","Consider the monitoring measures you will need to effectively monitor the model.\n Refer to the model of care document to guide your decision making and to understand the data requirements. \nEstablish monitoring measures to determine the effectiveness of the model. Monitoring measures should be purposeful, clearly defined and easy to interpret. Examples include; \n• Operational indicators: eg patient wait times, LOS, off-stretcher times, NEAT and patient turnaround times.\n• Clinical indicators: relates to patient safety more specifically and measures the ‘clinical management or outcome of care’ of patients, such as time to analgesia, time to antibiotics, morbidity, mortality rates, adverse events, patient satisfaction and complaints.\nOnce data requirements been determined, establish the monitoring measures and nominate staff(s) who will have responsibility for collecting data for review. \nAgree on a timeline for the implementation of monitoring measures.  \nThe monitoring measures should be discussed at meetings on a regular (predetermined) basis. "]
[]
[null,"Feedback Processes "]
[null,"A - The ED has well established feedback processes in place with monitoring measures reviewed and discussed at meetings monthly/as required/as scheduled.","Continue to monitor and feedback model of care performance and activity and any identified issues with all key staff/stakeholders.\nReview the feedback processes every few months for effectiveness, loop closure and follow up actions to enable a continued and effective process for monitoring and improvement. \nDiscuss and agree any changes to the feedback processes with all ED staff. \n\nReview the feedback processes every few months for effectiveness, loop closure and follow up actions to enable a continued and effective process for monitoring and improvement. \nDiscuss and agree any changes to the feedback processes with all ED staff. "]
[null,"B - The ED has feedback processes in place which are reviewed some of the time.","Continue to monitor and feedback model of care performance and activity and any identified issues with all key staff/stakeholders.\nReview and analyse the feedback processes in consultation with ED staff to understand why the monitoring measures and feedback are not being reviewed as intended. \nAmend the feedback processes as required to improve staff acceptance and adherence to the processes.\nCommunicate any changes to staff prior to commencement of new feedback processes. \nAssign the responsibility/accountability of these processes to a key staff member in ED. \nReview the feedback processes every few months for effectiveness, loop closure and follow up actions to enable a continued and effective process for monitoring and improvement. \nDiscuss and agree any changes to the feedback processes with all ED staff. \n"]
[null,"C - The ED does not have feedback processes in place. The feedback processes are in place but are not always completed or reviewed","Review the monitoring requirements of the ED to determine the feedback processes to be commenced in the ED and to hospital staff external to ED.\nIn consultation with staff develop and agree feedback processes to be implemented, this should include the who, what where and how of providing feedback and the timing of feedback with escalation processes as necessary.\nAgree a timeline for implementation with staff and collaborate to develop an implementation plan and begin the processes of feedback. \nAssign the responsibility/accountability of these processes to a key staff member in ED. \nCommunicate any changes to staff prior to commencement of new feedback processes.  \nFor all feedback processes that include staff external to ED ensure consultation with this group and agreement of processes.\nReview the feedback processes every few months for effectiveness, loop closure and follow up actions to enable a continued and effective process for monitoring and improvement.\n"]
[null,"D - The ED does not have standardised monitoring and feedback processes in place. ","Review the monitoring requirements of the ED to determine the feedback processes to be commenced in the ED and to hospital staff external to ED. \nIn consultation with staff develop and agree feedback processes to be implemented, this should include the:\n- who\n- what \n- where, and \n- how of providing feedback and the timing of feedback with escalation processes as necessary.\nAgree a timeline for implementation with staff and collaborate to develop an implementation plan and begin the process of feedback. \nAssign the responsibility/accountability of these processes to a key staff member in ED. \nCommunicate any changes to staff prior to commencement of new feedback processes.  \nFor all feedback processes that include staff external to ED ensure consultation with this group and agreement of processes.\nReview the feedback processes every few months for effectiveness, loop closure and follow up actions to enable a continued and effective process for monitoring and improvement.\n"]
[]
[null,"Model Implementation - Physical/dedicated  Spaces"]
[null,"A - The ED has dedicated spaces/resources as included in the guidelines and principles to allow the model to operate at all times.","Continue to evaluate demand pressures on the ED and model of care by determining the volume of patients that are seen in the model and evaluate if the physical space and resources are sufficient.\nEvaluate the performance of the model to determine efficiency. This should be undertaken by assessing performance data and conducting satisfaction surveys of staff and patients. Use this data to inform/identify any requisite changes to improve the physical layout of the model or include additional resources to improve the efficiency of the model.\n"]
[null,"B - The ED has dedicated spaces/resources to allow the model to operate some of the time.  ","Evaluate the performance data of the model to determine if the physical space and resources are adequate to run the model efficiently. This should be undertaken by assessing performance data and conducting satisfaction surveys of staff and patients. This has the potential to improve the physical layout of the model or include additional resources to improve the efficiency of the model.\n\nNeed to determine why the model is not operating continuously, is there a lack of:\na) Physical space to operate the model continuously - Undertake a staffing survey to determine if the current physical space has any impact on the function of the model. Questions should investigate: ease of access to the model, is the area large enough to cater for volume of patients, is the physical space adequate to assess the current volume of patients. \nb) Demand for the model to operate the model continuously -  you will need to evaluate the demand requirements for the model. This involves correlating the volume of patients and the time of day to determine peak periods of demand. If the demand does not support the model to run continuously, align the models operating times with peak demand periods.\nc) Staffing resources to operate the model continuously -  is there a sufficient amount of staff to run the model continuously, if yes, determine if a) or b) is the cause of the model not running continuously. If there is not enough staff, evaluate rostering schedules to reorganise staff to make them available to work in the model continuously. If there is an insufficient skill mix of staff to run the model consider retraining or up skilling staff to work in the model. You can refer to the ED-WAT to understand alternative staffing options.      "]
[null,"C - The ED does not have dedicated spaces/resources to allow the model to operate. The ED has dedicated spaces/resources but the model does not always operate . ","Analyse data (volume of patients that would use the model) to determine the amount of space/resources required to run the model effectively. \nIdeally you will be able to reconfigure your existing ED space and resources to operate the model. If not there may be a need for capital works. If this is required, determine what sign-off or approval is required before proceeding. Generally a  business case will be required to justify the need for capital works.    \nOnce you have determined the amount of space/ resources that are required, remember the model should promote flow through the ED. Therefore the physical space should allow for easy access in and out of the model. In addition, consider the support services the model will require eg radiology, pathology etc and determine how the physical space will best support access to these services. Refer to the model of care document and implementation toolkit. \nIf the physical space/resources are available, determine why the model is not operating continuously, is there a lack of:\na) Physical space to operate the model continuously - Undertake a staffing survey to determine if the current physical space has any impact on the function of the model. Questions should investigate: ease of access to the model, is the area large enough to cater for volume of patients, is the physical space adequate to assess the current volume of patients. \nb) Demand for the model to operate the model continuously -  you will need to evaluate the demand requirements for the model. This involves correlating the volume of patients and the time of day to determine peak periods of demand. If the demand does not support the model to run continuously, align the models operating times with peak demand periods.\nc) Staffing resources to operate the model continuously -  is there a sufficient amount of staff to run the model continuously, if yes, determine if a) or b) is the cause of the model not running continuously. If there is not enough staff, evaluate rostering schedules to reorganise staff to make them available to work in the model continuously. If there is an insufficient skill mix of staff to run the model consider retraining or up skilling staff to work in the model. You can refer to the ED-WAT to understand alternative staffing options.  \n"]
[null,"D - The ED does not have dedicated spaces/resources to allow the model to operate. ","Analyse activity data according to triage category and time of day to determine the volume of patients that could potentially use the model and use this information to determine the number of treatment spaces/resources required to run the model effectively. \nIdeally you will be able to reconfigure your existing ED space and resources to operate the model. \nIf not, there may be a need for capital works, if this is required, determine the approval processes required before proceeding. Generally a  business case will be required to justify the need for capital works.   \nOnce you have determined the treatment spaces/resources required assess the access in and out of the model to promote patient flow. \nConsider the support services the model will require eg radiology and pathology services and determine how the physical space will best support access to these services. Refer to the model of care document for additional information about the model requirements. \n"]
[]
[null,"Model Implementation - Data to support the model"]
[null,"A - The ED carries out ongoing reviews of activity data/patient cohorts/available resources to support the implementation of the model.","Continue to carry out regular reviews of activity data/patient cohorts/available resource. \nThe reviews should be used to assess the models performance and potential need to change - expand and refine the model. \nFacilitate an ongoing review process of activity data/patient cohorts/available resources:\n- regular (biannually or as changes in performance are seen).\n- revealed to staff to foster a culture of transparency and to promote inclusion of all the staff in the management of the model.\n- used to improve how the model functions.\n- used to compare KPI data and available resources.\n- used to influence clinical pathway development.\nEstablish guidelines to use the reviews to improve the model by linking in with the above activities.    "]
[null,"B - The ED has reviewed the activity data/patient cohorts/available resources to support the implementation of the model.  ","Establish regular data review periods and compare activity data against KPIs and available resources - Compare patient cohorts against current clinical pathways and determine if there is a need to expand or update clinical pathways.\nThe reviews should be used to assess the models performance and potential need to change - expand and refine the model. \nFacilitate an ongoing review process of activity data/patient cohorts/available resources:\n- regular (biannually or as changes in performance are seen).\n- revealed to staff to foster a culture of transparency and to promote inclusion of all the staff in the management of the model.\n- used to improve how the model functions.\n- used to compare KPI data and available resources.\n- used to influence clinical pathway development.\nEstablish guidelines to use the reviews to improve the model by linking in with the above activities.    "]
[null,"C - The ED has reviewed some activity data/patient cohorts/available resources to support the implementation of the model. ","Determine what activity data/patient cohorts/available resources have not been reviewed and determine why the data has not been reviewed. Nominate staff member(s) that will take responsibility of reviewing the data.  \nEstablish regular data review periods and compare activity data against KPIs and available resources - Compare patient cohorts against current clinical pathways and determine if there is a need to expand or update clinical pathways.\nThe reviews should be used to assess the models performance and potential need to change - expand and refine the model. \nFacilitate an ongoing review process of activity data/patient cohorts/available resources:\n- regular (biannually or as changes in performance are seen).\n- revealed to staff to foster a culture of transparency and to promote inclusion of all the staff in the management of the model.\n- used to improve how the model functions.\n- used to compare KPI data and available resources.\n- used to influence clinical pathway development.\nEstablish guidelines to use the reviews to improve the model by linking in with the above activities.    \n   "]
[null,"D - The ED has not has reviewed any activity data/patient cohorts/available resources to support the implementation of the model. ","Determine the activity data (patient volumes per triage category) /patient cohorts (specific conditions according to DRG) /available resources (staff and physical space) the model requires to run efficiently. \nReview the data required to understand the appropriateness of the model for your ED. Such data includes:\n• Waiting time for treatment by triage category.\n• Total time in ED. (The aim is discharge within 2 hours of presentation.)\n• Did not wait rates.\n• National Emergency Access Target (4 hour target).\n• Patient incidents and complaints.\n• Staff feedback. \nNominate staff member(s) that will take responsibility for reviewing/analysing the data.  \nEstablish regular data review periods and compare activity data against KPIs and available resources - Compare patient cohorts against current clinical pathways and determine if there is a need to expand or update clinical pathways.\nThe reviews should be used to assess the models performance and potential need to change - expand and refine the model. \nFacilitate an ongoing review process of activity data/patient cohorts/available resources:\n- regular (biannually or as changes in performance are seen).\n- revealed to staff to foster a culture of transparency and to promote inclusion of all the staff in the management of the model.\n- used to improve how the model functions.\n- used to compare KPI data and available resources.\n- used to influence clinical pathway development.\nEstablish guidelines to use the reviews to improve the model by linking in with the above activities.    "]
[]
[null,"Monitoring Measures - meeting targets"]
[null,"A - The ED has well established monitoring processes in place and is meeting all targets.","Continue to monitor the processes and performance of the model using the measures included. \nUndertake an evaluation of the monitoring process to determine:\n- how often the monitoring processes are reviewed, it should be at least every quarter.\n- if results of the monitoring process are fed back to staff to disseminate performance data. Regular feedback loops should be established to disseminate this information. \n- if current process of the model need to be changed to improve the functioning of the model. The efficiency of the model should be continuously reviewed so improvements can be implemented before performance begins to fall"]
[null,"B - The ED has monitoring processes in place and is meeting targets more than 75% of the time.  ","Continue to monitor the processes and performance of the model using the measures included. \nAnalyse performance targets and determine why targets are not being met. Undertaken an evaluation of the models operational arrangements and business rules. Staff surveys should be included. This evaluation should reveal key areas that need improving which can be linked to the under performing data. \nEstablish a team that is accountable for driving changes.    \nEstablish feedback loops with all staff to disseminate performance data and build a culture of performance improvement amongst staff by showing staff where the model or the ED is underperforming and what areas are performing well. \nRegularly monitor the staff who have been trained in this area and put in place feedback processes that allow for continuous improvement of training programs and their frequency.\n"]
[null,"C - The monitoring processes are in place but are not always being met.   ","Assess if the model has been implemented correctly. Select a team of staff to undertake a review of the model to determine if the business rules, operational arrangements and processes of the Model have been implemented effectively (as per the implementation toolkit) and if staff are adhering to them. \nThis evaluation should reveal key areas that need improving which can be linked to the under performance data. \nEstablish a team that is accountable for driving changes.\nEstablish feedback loops with all staff to disseminate performance data and build a culture of performance improvement by demonstrating what areas are performing well and where the model or the ED is underperforming. \nRegularly monitor the staff who have been trained in this area and put in place feedback processes that allow for continuous improvement of training programs and their frequency.\n\n\n"]
[null,"D - The ED is not monitoring data/targets/effectiveness of models. ","Undertake an evaluation of the model to determine what monitoring data needs to collected. Examples of monitoring measures in the Models of Care document include:\n• Time from start to end of triage\n• Regular triage audits to determine appropriateness of triage category allocation, and time taken for triage process\n• Number of occasions when flexible plans were activated to support peak periods of demand and analysis to understand underlying causes (for example, growth in ED presentations, downstream system delays)\n• Time to treatment by a clinician by triage category. \n• Patient complaints and adverse events.\n• Staff feedback\n\nEstablish monitoring measures to effectively monitor how the model is performing, refer to the implementation toolkit or ED MOC document.\nMonitoring measures should be purposeful, clearly defined and easy to interpret. Measures have been provided in the Models of Care document. Examples are:\n• Operational indicators: eg patient wait times, LOS, off-stretcher times, NEAT and patient turnaround times.\n• Clinical indicators: relates to patient safety more specifically and measures the ‘clinical management or outcome of care’ of patients, such as time to analgesia, time to antibiotics, morbidity, mortality rates, adverse events, patient satisfaction and complaints.\nNominate  staff member(s) who will be responsible for capturing the monitoring data/targets for review. These monitoring measures should be discussed with staff in the ED at team meetings.\nAgree on a timeline for the implementation of monitoring measures."]
[]
[null,"Model Implementation - Operation due to resources and activity"]
[null,"A - The model of care is well set up and operates continuously in our ED regardless of activity and resource challenges. ","Continue to monitor the model for operation and effectiveness. Establish monitoring measures to determine if the model is effective in improvement ED performance (KPIs), and determine levels of satisfaction from staff and patients (via surveys). \n"]
[null,"B - The model of care is well set up and operates the majority of the time regardless of activity and resource challenges. ","Analyse the monitoring measures and data to determine why the model is not running continuously and if the model was to run continuously would it impact on the performance data (KPIs). Undertake an evaluation to determine if the model has the demand and available staff to run the model continuously. "]
[null,"C - The model of care is set up but will be limited in its operation depending on activity and available resource - in busy periods the model does not operate as per the guidelines. ","Analyse the data to determine peak periods of demand that would support the model of care. The model should operate in this period. \nSelect a team of staff to undertake a review of the model to determine if the business rules, operational arrangements and processes of the Model have been implemented as per the implementation tool kit or ED Models of care document and if staff are adhering to them. \nThis evaluation should reveal key areas that need improving which can be linked to operation of the model and requisite changes.  \nEstablish a team that is accountable for driving changes. This should include education programs for staff to implement business rules, operational arrangements and process as per the implementation toolkit. This team should be bound to established time frames to achieve these goals. "]
[null,"D - The model of care operates infrequently depending on activity and available resource.","Analyse activity data compared to time of day to determine peak periods of demand that would support the model of care. The model should operate in this period. \nSelect a team of staff to undertake a review of the model to determine if the business rules, operational arrangements and processes of the Model have been implemented as per the implementation tool kit or ED Models of care document and if staff are adhering to them. \nThis evaluation should reveal key areas that need improving which can be linked to operation of the model and requisite changes.  \nEstablish a team that is accountable for driving changes. This should include education programs for staff to implement business rules, operational arrangements and process as per the implementation toolkit. This team should be bound to established time frames to achieve these goal"]
[]
[null,"Policies ","Policies "]
[null,"A - The ED and inpatient units are aware of and actively applying NSW Health policies to support the model of care. ","The policies are in place and followed. \nPut in place review processes to facilitate the inclusion/implementation of updated and new policies in your ED. \nEstablish feedback loops with all staff to enable timely and appropriate feedback of all policies for effectiveness and relevance.\n"]
[null,"B - The ED and inpatient units are aware of and sometimes applying NSW Health policies to support the model of care. ","Carry out a review of the current policies with feedback from staff to understand why they are not followed.\nBased on feedback revise and develop policies that can facilitate standardised practice to reduce variation and improve the communication and other processes for providing a health care service. \nPut in place feedback processes to enable staff to feedback about policies in a timely manner and include the revision and monitoring in ED meetings regularly to allow transparency of the process. \nInclude processes for feedback from clinical staff outside the ED to enable a review of effectiveness for them in providing a service for emergency care patients\nPut in place a process to feedback any challenges or issues with the creator of the policy, for example NSW Health, the hospital units.\nContinue the monitoring policies and adherence to check for effectiveness and allow for continuous quality improvement and education of staff as required. \nGain support from the ED and hospital Executive for implementation and use of the policies.\n"]
[null,"C - The ED is aware of NSW Health policies to support the model of care but their use is limited and not supported by inpatient units. ","Carry out a review/analysis of the current policies and relevant processes with feedback from staff to understand why they are not followed consistently.\nIdentify the gaps/issues with the policies and education about their importance, to understand what must change to improve their use.\nBased on feedback revise the policy/process of implementation to facilitate standardised practice to reduce variation and improve the communication and other processes for providing a health care service. \nProvide education and appropriate guidance in the use of the policy for all staff.  \nPut in place feedback processes to enable staff to feedback in a timely manner and include the revision and monitoring, and policy information updates in ED meetings regularly to allow transparency of the process. \nPut in place a process to feedback any challenges or issues with the creator of the policy, for example NSW Health, the hospital units.\nContinue the monitoring process to check for effectiveness and allow for continuous quality improvement and education of staff as required. \nGain support from the ED and hospital Executive for implementation and use of the policies.\n"]
[null,"D - The ED is not aware of NSW Health policies available to support the operation of models of care. ","Analyse the current practices in the ED/hospital to understand what processes/policies staff are currently following.\nBased on this understanding work with a key group of ED/hospital stakeholders to develop policies/processes for communication and implementation that are acceptable to all groups of staff.\nSet out the key objectives for and outcomes from the use of the policies and clearly articulate these to staff through education sessions and meetings to facilities a transparent approach.\nAgree a timeline for implementation with staff and collaborate to develop an implementation plan. \nPut in place monitoring measures and a feedback process to facilitate timely feedback and continuous improvement and further education of staff as required. \nPut in place a regular review and monitoring process, including results in all staff meetings to enable transparency.\nPut in place a process to feedback any challenges or issues with the creator of the policy, for example NSW Health, the hospital units.\nGain support from the ED and hospital Executive for implementation and use of the policies.\n"]
[]
[null,"Diagnostics"]
[null,"A - The ED has timely access to all diagnostics (pathology, radiology and ultrasound) and turn around times have been agreed with each Diagnostics Department to support the model of care. ","\nContinue to monitor the performance of diagnostic services to determine if timely access and turnaround time are being met. These results should be discussed at regular intervals (quarterly or biannually) with diagnostic  services.  \nReview the monitoring measures and processes regularly with diagnostic services to facilitate ongoing improvements and changes as required.  "]
[null,"B - The ED in most cases has timely access to all diagnostics (pathology, radiology and ultrasound) and turn around times have been agreed with some of the Diagnostic Departments to support the model of care. ","Undertake a review with diagnostics departments to understand why the agreed targets are not being met. \nFor those diagnostic services where the targets have not been agreed, convene a meeting to discuss what the model of care is aiming to achieve and how you can work together with the diagnostic services to meet the targets. Agree turn around times that are feasible, achievable and communicate the processes to all staff working in ED and in the diagnostic service.\nEstablish a monitoring system for the turn around time performance to determine if timely access and turnaround time targets are met. These results should be discussed at regular intervals (quarterly or biannually) with diagnostic  services.\nReview the monitoring measures and processes regularly with diagnostic services to facilitate ongoing improvements and changes as required. \n"]
[null,"C - The ED has diagnostics services available most of the time to support the model of care but turnaround times have not been agreed and ED diagnostics are not prioritised. ","For those diagnostic services where the targets have not been agreed, convene a meeting to discuss what the model of care is aiming to achieve and how you can work together with the diagnostic services to meet the targets. Agree turn around times that are feasible, achievable and communicate the processes to all staff working in ED and in the diagnostic service. \nEstablish agreed timeframes for access and turnaround times for results with diagnostic services.  Undertake meetings with diagnostics departments to get agreement on the timeframes and for prioritisation of ED patients. \nEstablish a monitoring system for the turn around time performance to determine if timely access and turnaround time targets are met. These results should be discussed at regular intervals (quarterly or biannually) with diagnostic  services.\nReview the monitoring measures and processes regularly with diagnostic services to facilitate ongoing improvements and changes as required. \n"]
[null,"D - The ED has limited access to diagnostic services some of which are located off site and there is no shared agreement about turnaround times. ","Establish meetings with diagnostic service providers and agree on delivery of services and discuss performance arrangement of access to services and turnaround times for results. \nEstablish a monitoring system for the turn around time performance to determine if timely access and turnaround time targets are met. Turnaround times should be monitored with regular meetings set up with diagnostics services to discuss the performance to enable transparency and to determine ways to achieve improved results. These results should be discussed at regular intervals (quarterly or biannually) with diagnostic  services.\nReview the monitoring measures and processes regularly with diagnostic services to facilitate ongoing improvements and changes as required. "]
[]
[null,"Communication/handover"]
[null,"A - The ED has standardised and established communication processes and tools in place to support the model of care, and these are used by all ED and inpatient teams. ","Continue to use the established communication processes. Carry out a periodic review of processes to determine if staff are using the communication process and tools such as the NSW MoH Clinical Handover – Standard Key Principles Policy Directive to promote handover from ED.  \nEducation programs should be conducted periodically to promote the use of standardised communication processes and tools by all staff members, and to introduced new processes as they are adopted. Continue with formal education sessions for new staff and staff on rotation in ED.\nEstablish regular review periods to monitor the use of established communication processes for effectiveness.\nConsult with inpatient and other patient care teams to assess the effectiveness of communication and identify any issues with current processes.  "]
[null,"B - The ED has standardised and established communication processes and tools in place to support the model of care, and these are sometimes used by ED and inpatient teams. ","Continue to use the established communication processes. Undertake a review to determine how many staff are using the communication process and tools such as the NSW MoH Clinical Handover – Standard Key Principles Policy Directive to promote handover from ED.  Consult with staff determine why they are not using communication process and tools on all occasions. Consult with inpatient and other patient care teams to assess the effectiveness of communication and identify any issues with current processes.  \nDevelop a standardised approach to educating staff on the  use of communication processes and tools using the learning's from the evaluation above. This education is particularly important for new staff and staff on rotation in ED.\nEstablish regular review periods to monitor the use of established communication processes for effectiveness.  Communicate with the inpatient teams any changes to communication processes.   "]
[null,"C - The ED has communication processes and tools in place to support the model of care, and these are used infrequently by ED and inpatient teams. ","Undertake a review to determine how many staff are using the communication process and tools such as the NSW MoH Clinical Handover – Standard Key Principles Policy Directive to promote handover from ED.  Consult with staff determine why they are not using communication process and tools. Consult with inpatient and other patient care teams to assess the effectiveness of communication and identify any issues with current processes.  \nDevelop a standardised approach to educating staff on the  use of communication processes and tools using the learning's from the evaluation above. This education is particularly important for new staff and staff on rotation in ED.\nEstablish regular review periods to monitor the use of established communication processes for effectiveness. Develop feedback loops to enable timely feedback of any communication issues. Communicate with the inpatient teams any changes to communication processes."]
[null,"D - The ED has no standardised communication processes and tools in place to support the model of care. ","Determine the communication needs of the ED for all relevant care providers, the target audience and the type of information, delivery format to support the model of care. Use established tools such as the NSW MoH Clinical Handover – Standard Key Principles Policy Directive to promote standardised communication process from the ED. \nConsult with all relevant stakeholders when developing and introducing communication processes to enable an agreed, transparent and standardised approach to all patient communications. Establish standardised communication processes and tools that are tailored to these audiences that will support the model of care. \nDevelop a standardised approach to educating staff about the communication processes and tools using the learning's from the evaluation above. This education is particularly important for new staff and staff on rotation. \nEstablish an implementation timeline to establish the communication processes and tools. \nEstablish regular review periods to monitor the use of established communication processes for effectiveness. Develop feedback loops to enable timely feedback of any communication issues. Communicate with the inpatient teams any changes to communication processes."]
[]
[null,"Staff Competencies - available"]
[null,"A - All staff identified in the model are accredited and available at all times and dedicated to work in the model of care.","Continue to accredit and allocate staff to the model as currently. Evaluate patient flow and activity, and patient presentation types through the model to determine if staffing skill mix and allocated numbers are adequate for the model to functional effectively. Establish an ongoing review process of model operation, and rostering practices and patterns to staff the model and feed this back at regular ED staff meetings.  \nRegularly monitor staff satisfaction by surveys to allow for continuous improvement of the model and the education programs for the model. "]
[null,"B - All staff identified in the model are available most times and when available are dedicated to work in the model of care.","Continue to accredit and allocate staff to the model. \nEvaluate patient flow and activity, and patient presentation types to determine the  staffing resources (skill mix and numbers) required to run the model effectively. Review the periods when the model was not able to operate due to staffing challenges to understand the reasons behind resourcing challenges. Use this information to address any resource issues through for example, changes to rosters to facilitate adequate staffing numbers, up skilling staff to address any skill mix deficiencies and reviewing alternative workforce models. Establish an education program to educate staff about the model and facilitate an appropriate skill mix of staff for the model.       \nImplement rostering schedules that support the skill mix required to run the model effectively. Establish an ongoing review process of model operation, and rostering practices and patterns to staff the model and feed this back at regular ED staff meetings.  \nRegularly monitor the staff satisfaction by surveys to allow for continuous improvement of the model and of education programs for the model. "]
[null,"C - Staff identified for the model are not always available and may work across several areas of ED.","Evaluate patient flow and activity, and patient presentation types to determine the  staffing resources (skill mix and numbers) required to run the model effectively. \nReview the periods when the model was not able to operate due to staffing challenges to understand the reasons behind resourcing challenges. Use this information to address any resource issues through for example, changes to rosters to facilitate adequate staffing numbers, up skilling staff to address any skill mix deficiencies and reviewing alternative workforce models. Determine whether staff resources can be reconfigured to run the model effectively without affecting other areas in the ED.  \nImplement rostering schedules that support the skill mix required to run the model effectively. Establish an education program to educate staff about the model and facilitate an appropriate skill mix of staff for the model.\nEstablish an ongoing review process of model operation, and rostering practices and patterns to staff the model and feed this back at regular ED staff meetings.  \nRegularly monitor the staff satisfaction by surveys to allow for continuous improvement of the model and of education programs for the model. \n\n"]
[null,"D - No staff are dedicated to work solely in the model and this lack of staff means the model does not operate.","Evaluate the staffing resources required to run the model effectively - use activity data according to triage category and time of day to determine staffing needs. Review this against the current staff skill mix and numbers in the ED to identify resourcing gaps. \nEstablish an education program to educate staff about the model and facilitate an appropriate skill mix of staff for the model. \nReconfigure existing staff allocations to roster staff to the model. \nEstablish an ongoing review process of model operation, and rostering practices and patterns to staff the model and feed this back at regular ED staff meetings.  \nRegularly monitor the staff satisfaction by surveys to allow for continuous improvement of the model and of education programs for the model"]
[]
[null,"Clinical Pathways","Clinical Pathways "]
[null,"A - The ED has documented clinical pathway in place and followed.","Continue to utilise appropriate clinical pathways as appropriate to deliver safe and timely emergency care.\nEstablish a formal monitoring and review processes to determine the effectiveness of using the clinical pathways whether they are being adhered to.\nEstablish a feedback loop for outcomes of the monitoring review to be feed back to staff.\nContinue the monitoring process to check for effectiveness and allow for continuous quality improvement and ongoing education of staff as required."]
[null,"B - The ED has a documented clinical pathway/standing order in place that is followed some of the time.  ","Carry out a review of the clinical pathways, processes, staffing and outcomes to understand why they are not being utilised as intended. \nBased on the review, if required revise the clinical pathways in consultation with relevant ED staff to facilitate standardised practice, currency of pathways to best practice and improve compliance with their use.\nCommunicate with staff about the use of pathways, the objectives for their use and who they are intended to be used by.\nEstablish formal monitoring processes to determine if clinical pathways are being adhered to and establish a feedback loop for outcomes of the monitoring review to be feed back to staff.\nEstablish a review to determine if staff are using the clinical pathways/standings. \nContinue the monitoring process to check for effectiveness and allow for continuous quality improvement and ongoing education of staff as required.\nImplement appropriate governance and measures to ensure staff are supported when using the clinical pathways /standing orders.\nGain support from the ED and Hospital Executive for their implementation and use.\n"]
[null,"C - The ED does not have well documented or well defined clinical pathways/standing orders in our ED. \nThe clinical pathways/standing orders are in place but are not always followed.   \n","Carry out a review of the clinical pathways, processes, staffing and outcomes to understand why they are not being utilised as intended. \nBased on the review, if required revise the clinical pathways in consultation with relevant ED staff to facilitate standardised practice, currency of pathways to best practice and improve compliance with their use.\nCommunicate with staff about the use of pathways, the objectives for their use and who they are intended to be used by.\nIf no clinical pathways are in place, analyse the data to determine which clinical pathways/standing orders are best suited for your ED. \nEstablish clear documentation of the clinical pathways/standing orders that staff must adhere to and establish a formal monitoring processes to determine if clinical pathways are being adhered to and establish a feedback loop for outcomes of the monitoring review to be feed back to staff\nEstablish an education program for staff to inform them of the need of the clinical pathways/standing orders and how to use them. \nContinue the monitoring process to check for effectiveness and allow for continuous quality improvement and ongoing education of staff as required.\nImplement appropriate governance and measures to ensure staff are supported when using the clinical pathways /standing orders.\nGain support from the ED and Hospital Executive for their implementation and use\n"]
[null,"D - The ED does not have standardised clinical pathways/standing orders in place. ","Analyse the data (eg patient cohorts of conditions)  to determine what clinical pathways are required by the ED. \nEstablish clear documentation of the clinical pathways/standing orders that staff must adhere to and establish a formal monitoring processes to determine if clinical pathways are being adhered to.\nEstablish a feedback loop for outcomes of the monitoring review to be feed back to staff\nEstablish an education program for staff to inform them of the need of the clinical pathways/standing orders and how to use them. \nContinue the monitoring process to check for effectiveness and allow for continuous quality improvement and ongoing education of staff as required.\nImplement appropriate governance and measures to ensure staff are supported when using the clinical pathways /standing orders.\nGain support from the ED and Hospital Executive for their implementation and use."]
[]
[null,"Model Implementation - Agreed processes","Model Implementation - Agreed processes "]
[null,"A - The model principles and processes, including timelines have been agreed and are adhered to by the whole of hospital to allow the model to operate effectively.  ","Continue to apply and utilise the agreed model principles and processes to enable a whole of hospital delivery of safe and timely emergency care.\nEstablish a formal monitoring and review processes with the rest of the hospital to determine the effectiveness of using the emergency care models and whether the principles, processes and timelines are being adhered to.\nEstablish a feedback loop for outcomes of the monitoring review to be feed back to all relevant hospital staff.\nContinue the monitoring process to check for effectiveness and allow for continuous quality improvement and ongoing education of all hospital staff as required.\n"]
[null,"B - The model principles and processes, including timelines have been agreed and are adhered to by some services/units in the hospital to allow the model to operate effectively most of the time.  ","Carry out a review of the model, processes, timelines for assessment and review, staffing and outcomes to understand why they are not being utilised as intended. \nBased on the review, if required consult with relevant ED and hospital staff to agree model use and facilitate standardised practice and improve compliance with model use and operation.\nCommunicate with all relevant hospital staff about the models, the objectives for their use and who they are intended to be used by, and what the role of each care provider is in the effective operation of the model.\nEstablish formal monitoring processes to determine if models are being utilised as intended and to identify any issues with their use. \nEstablish a feedback loop for outcomes of the monitoring review to be feed back to hospital staff.\nContinue the monitoring process to check for effectiveness and allow for continuous quality improvement and ongoing education of staff as required.\nImplement appropriate governance and measures to ensure staff are supported in use of all the emergency care models.\nGain support from the ED and Hospital Executive for the model implementation and use.\n"]
[null,"C - The model principles and processes, including timelines have not been agreed by all hospital staff and the model does not operate effectively to assist the hospital with patient flow. The model principles and processes, including timelines have been agreed but the model is adhered to only on occasion. ","Carry out a review of the model, processes, timelines for assessment and review, staffing and outcomes to understand why they are not being utilised as intended. \nBased on the review, if required consult with relevant ED and hospital staff to agree model use and facilitate standardised practice and improve compliance with model use and operation.\nCommunicate with all relevant hospital staff about the models, the objectives for their use and who they are intended to be used by, and what the role of each care provider is in the effective operation of the model.\nIf no models are in place, analyse the data to determine which emergency care models are best suited for your ED. \nConsult with other ED colleagues to understand the appropriateness and benefits of the emergency care models that are relevant to your ED. \nIn collaboration with ED staff and relevant staff external to ED, use the NSW Model of Care document (2012) to develop the emergency care models for your ED/Hospital.\nEstablish clear documentation of the model, with principles, processes and timelines for staff to adhere to.\nEstablish an education program for all relevant ED/Hospital staff to inform them of the model, and their role in its effective operation. \nEstablish a formal monitoring process to determine adherence and effectiveness, with a feedback loop for outcomes of the monitoring review to be feed back to staff\nContinue the monitoring process to check for effectiveness and allow for continuous quality improvement and ongoing education of staff as required.\nImplement appropriate governance and measures to ensure staff are supported when using the emergency care model.\nGain support from the ED and Hospital Executive for their implementation and use\n"]
[null,"D - The principles and processes associated with this model are not in place for our hospital. ","Analyse the data to determine which emergency care models, principles and processes are best suited for your ED. Examples of the data that should be assessed are:\n• Length of stay in ED.\n• Emergency Access Performance Target (4 hour target).\n• Waiting time for treatment by triage category.\n• Patient incidents and complaints.\n• Staff feedback.\n\nConsult with other ED colleagues to understand the appropriateness and benefits of the emergency care models principles, processes and timelines that are relevant to your ED. \nIn collaboration with ED staff and relevant staff external to ED, use the NSW Model of Care document (2012) to develop the emergency care models principles, processes and timelines for your ED/Hospital.\nEstablish clear documentation of the model, with principles, processes and timelines for staff to adhere to.\nEstablish an education program for all relevant ED/Hospital staff to inform them of the model, and their role in its effective operation. \nEstablish a formal monitoring process to determine adherence and effectiveness, with a feedback loop for outcomes of the monitoring review to be feed back to staff\nContinue the monitoring process to check for effectiveness and allow for continuous quality improvement and ongoing education of staff as required.\nImplement appropriate governance and measures to ensure staff are supported when using the emergency care model.\nGain support from the ED and Hospital Executive for their implementation and use.\n"]
[]
[null,"Monitoring Measures - in place - Whole of hospital"]
[null,"A - The hospital executive/support services/inpatient units has well established monitoring processes in place which are reviewed at meetings monthly.","Continue to work with the Hospital Executive/support services/inpatient units to monitor the effectiveness of the model and feedback processes at regular meetings. \nEstablish a process to regularly review the monitoring measures for appropriateness and to agree alternative measures as required. \nEstablish feedback loops with all ED staff to disseminate information from hospital executive/support services/inpatient units."]
[null,"B - The hospital executive/support services/inpatient units has monitoring processes in place which are reviewed some of the time.  ","Continue to work with the Hospital Executive/support services/inpatient units to monitor the effectiveness of the model and feedback processes at regular meetings. In consultation with the other units, assess the periods in which the review process was not carried out as planned to understand why. Use this information to agree an approach to improving the review process for the hospital.   \nEstablish regular review periods that are adhered to and discussed at meetings on a regular (predetermined) basis. \nEstablish a process to regularly review the monitoring measures for appropriateness and to agree alternative measures as required. \nEstablish feedback loops with all ED staff to disseminate information from hospital executive/support services/inpatient units."]
[null,"C - The monitoring processes are in place but are not always completed or reviewed by the hospital executive/support services/inpatient units.   ","Continue to work with the Hospital Executive/support services/inpatient units to monitor the effectiveness of the model and feedback processes at regular meetings. In consultation with the other units, assess the periods in which the review process was not carried out as planned to understand why - determine where the gaps in the process are and what is causing information to not be completed or reviewed. Use this information to agree an approach to improving the review process for the hospital.   \nEstablish regular review periods that are adhered to and discussed at meetings on a regular (predetermined) basis. \nEstablish a process to regularly review the monitoring measures for appropriateness and to agree alternative measures as required. \nEstablish feedback loops with all ED staff to disseminate information from hospital executive/support services/inpatient units.\nAppoint an ED staff member(s) to be responsible for collecting data to be presented to hospital executive/support services/inpatient units meetings.    "]
[null,"D - The hospital executive/support services/inpatient units does not have standardised monitoring processes in place. ","Consult with the Hospital Executive/support services/inpatient units to set out key objectives for the model and monitoring processes and what the monitoring measures are seeking to capture. Examples of the monitoring measures are:\n• National Emergency Access Target (4 hour target).\n• Waiting time for treatment by triage category.\n• Did not wait rates.\n• Patient incidents and complaints.\n• Diagnostic turnaround times\n• Admission rates from ED\n• Length of Stay for admitted patients\n• Time to inpatient team review\nDevelop and agree monitoring measures to be collected, how and from what data source, and nominate staff(s) responsible to collect monitoring measures for review by hospital executive/support services/inpatient units.\nThe monitoring measures should be discussed and reviewed at meetings on a regular (predetermined) basis. \nAgree on a timeline for the implementation of monitoring measures. \nEstablish a process to regularly review the monitoring measures for appropriateness and to agree alternative measures as required. \nEstablish feedback loops with all ED staff to disseminate information from hospital executive/support services/inpatient units."]
[]
[null,"Feedback Processes","Feedback Processes "]
[null,"A - The hospital executive/support services/inpatient units has well established feedback processes in place with monitoring measures reviewed and discussed at meetings monthly/as required.","Continue to monitor the feedback process to check effectiveness of the model/referral/communication/admission processes.\nIf not in place, establish feedback loops to disseminate information from c to staff.\nReview the feedback processes every few months for effectiveness, loop closure and follow up actions to enable a continued and effective process for monitoring and improvement. \nDiscuss and agree any changes to the feedback processes with all ED staff and other hospital executive/support services/inpatient units. "]
[null,"B - The hospital executive/support services/inpatient units has feedback processes in place which  are reviewed some of the time.  ","In consultation with the hospital executive/support services/inpatient units, review the current feedback processes to determine why they are not being followed/utilised. \nIn collaboration with other hospital staff amend the feedback processes as required to improve staff acceptance and adherence to the processes - this should include the processes of feedback, the what when and how, accountability for follow up and any necessary escalation processes.\nCommunicate any changes to staff prior to commencement of new feedback processes. \nContinue to monitor the feedback process to check effectiveness of the /referral/communication/admission processes.\nEstablish regular review periods to ensure the business rules of the model are being adhered to and discussed at meetings on a regular (predetermined) basis.\nReview the feedback processes for effectiveness, loop closure and follow up actions to enable a continued and effective process for monitoring and improvement.   \nIf not in place, establish feedback loops to disseminate information from hospital executive/support services/inpatient units to staff.\nReview the feedback processes every few months for effectiveness, loop closure and follow up actions to enable a continued and effective process for monitoring and improvement. \nDiscuss and agree any changes to the feedback processes with all ED staff and other hospital executive/support services/inpatient units.  "]
[null,"C - The hospital executive/support services/inpatient units does not have feedback processes in place. The feedback processes are in place but are not always completed or reviewed.   ","In consultation with the hospital executive/support services/inpatient units, review the current feedback processes to determine why they are not being followed/utilised. \nIn collaboration with other hospital staff amend the feedback processes as required to improve staff acceptance and adherence to the processes - this should include the processes of feedback, the what when and how, accountability for follow up and any necessary escalation processes.\nCommunicate any changes to staff prior to commencement of new feedback processes. \nContinue to monitor the feedback process to check effectiveness of the /referral/communication/admission processes.\nEstablish regular review periods to ensure the business rules of the model are being adhered to and discussed at meetings on a regular (predetermined) basis.\nReview the feedback processes for effectiveness, loop closure and follow up actions to enable a continued and effective process for monitoring and improvement.   \nIf not in place, establish feedback loops to disseminate information from hospital executive/support services/inpatient units to staff.\nAgree timelines for implementation with all staff and implement the processes. \nReview the feedback processes every few months for effectiveness, loop closure and follow up actions to enable a continued and effective process for monitoring and improvement. \nDiscuss and agree any changes to the feedback processes with all ED staff and other hospital executive/support services/inpatient units.  "]
[null,"D - The hospital executive/support services/inpatient units does not have standardised monitoring and feedback processes in place. ","Review the monitoring requirements of the ED to determine the feedback processes to be commenced in the ED and with the hospital executive/support services/inpatient units. \nIn consultation with all relevant staff develop and agree feedback processes to be implemented, this should include the who, what where and how of providing feedback and the timing of feedback with escalation processes as necessary.\nAgree a timeline for implementation with staff and collaborate to develop an implementation plan and begin the processes of feedback. \nCommunicate any changes to staff prior to commencement of new feedback processes.  \nReview the feedback processes every few months for effectiveness, loop closure and follow up actions to enable a continued and effective process for monitoring and improvement.\nDiscuss and agree any changes to the feedback processes with all ED staff and other hospital executive/support services/inpatient units.  "]
[]
[null,"Signage"]
[null,"A - The triage area is immediately accessible and clear signage is posted - this includes appropriate signage that directs patients and carers to triage on arrival in ED and guides processes for patients who leave the ED without waiting for treatment ","Continue to monitor the effectiveness of signage for triage and prevent the posting of distracting or misleading signage in the waiting room. \nInclude satisfaction surveys of staff and patients, and any adverse events/complaints  to assess the effectiveness of signage. \nSignage that clearly directs patients and carers to triage area, reception and the waiting area must be displayed (GL2009_010 Technical Series 2 - Wayfinding for Health Facilities) alongside signage that guides the process for who choose not to be wait to be treated.  "]
[null,"B - The triage area is immediately accessible and with signage posted. The signage does not always clearly direct the patients and carers to triage on arrival in ED. ","Continue to monitor the effectiveness of signage for triage.  Review the  location and visibility of signage to assess effectiveness, refer to the  NSW Health PD2010_075 Emergency Department Patients Awaiting Care and GL2009_010 Technical Series 2 - Wayfinding for Health Facilities. Use this information to modify the location and visibility of signage as required. \nPrevent the posting of distracting or misleading signage in the waiting room. \nPut in place measures to monitor the effectiveness of signage for triage. Include data from satisfaction surveys of staff and patients, and any adverse events/complaints  to assess the effectiveness of signage. \nReview recommended signage using the Practical steps to improving Emergency Department signage guide.\nhttp://internal.health.nsw.gov.au/pubs/2008/ed_signage.html. "]
[null,"C - The triage area is immediately accessible and with signage posted. The signage is not according to NSW Health and ACEM recommendations and patients and carers frequently experience difficulty locating triage on arrival in ED. ","Refer to the  NSW Health PD2010_075 Emergency Department Patients Awaiting Care and GL2009_010 Technical Series 2 - Wayfinding for Health Facilities for guidance on appropriate signage for your ED. Review the gaps in signage recommended and modify as required.  \nPut in place measures to monitor the effectiveness of signage for triage. Include data from satisfaction surveys of staff and patients, and any adverse events/complaints  to assess the effectiveness of signage. \nPrevent the posting of distracting or misleading signage in the waiting room. \nReview recommended signage using the Practical steps to improving Emergency Department signage guide.\nhttp://internal.health.nsw.gov.au/pubs/2008/ed_signage.html. "]
[null,"D - The triage area is immediately accessible, however no signage is posted to direct patients and carers to triage. ","Refer to the  NSW Health PD2010_075 Emergency Department Patients Awaiting Care and GL2009_010 Technical Series 2 - Wayfinding for Health Facilities for guidance on appropriate signage for your ED. Review the gaps in signage recommended and modify as required.  \nConsult with ED staff and patients as required when planning and preparing signage for implementing. \nDevelop a plan, timeline and communication for the implementation of signage as this may require a change in work practices as patients are directed to an area of ED. \nPut in place measures to monitor the effectiveness of signage for triage. Include data from satisfaction surveys of staff and patients, and any adverse events/complaints  to assess the effectiveness of signage. Modify signage and placement as required based on initial monitoring results. Feedback to staff and allow a process for staff to comment on effectiveness of the signage. \nPrevent the posting of distracting or misleading signage in the waiting room. \nReview recommended signage using the Practical steps to improving Emergency Department signage guide.\nhttp://internal.health.nsw.gov.au/pubs/2008/ed_signage.html. "]