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Clinical support

  • Activity Based Funding
  • Patient Flow
  • Data collection and reporting
  • Privacy
  • ED Design
  • Professional development
  • Incident management
  • Quality
  • Non-Clinical Tools
  • Reports
  • NSW Police Force Crash Investigation
  • Communicating in a crisis
  • Debriefing
  • Over-census strategies
  • Activity Based Funding

    A key feature of the health reforms is the national introduction of Activity Based Funding (ABF). A variety of resources on this have been collated that provide more information, detail out the specifics as well as focus on the implications for Emergency Departments.

    ABF in Emergency Departments

    Click the link above to view the presentation delivered by Ms Susan Dunn at the 9 August 2013 ECI Leadership Forum.

    Funding reform

    NSW Health, 2012

    The NSW Health Website linking to comprehensive information about funding reform overall including presenations, videos, recent Symposium information and factsheets.

    Data collection and reporting

    Transfer of Care & Transfer of Care Reporting System

    Transfer of Care is defined as the transfer of accountability and responsibility for patient care from an Ambulance Paramedic to a hospital clinician. Contact your local transfer of care reporting system representative for further information.

    Emergency Department Data Dictionary, PD2009_071, NSW Health, 6 November 2009

    The Emergency Department Data Dictionary (Version 4) outlines the data standards for the Emergency Department Data Collection.

    NSW Emergency Department Data Collection (EDDC) Reporting and Submission Requirements

    Specifies the data which specified hospital Emergency Departments are required to report re presentations

    ED Design

    Presentations:

    ACEM Emergency Department Design Guidelines, 3rd Edition, October 2014

    NSW Police Crash Investigation

    Timely attendance of Police Crash Investigators to serious motor vehicle collisions is vital to police investigation of these incidents and the efficient clearing of major on road incidents. To assist in the proper assessment of these incidents and to asses the level of police resources deployed to investigate these collisions the assistance of Admitting Officers in Hospital Emergency Departments is vital. The below sets out the procedures that will be followed by Police Crash Investigators in obtaining information regarding injuries received by victims involved. These protocols are consistent with current government policy and legislation for the sharing of information between government agencies for law enforcement purposes.

    Patient Flow

    The following tools and resources have been developed to assist with improving patient flow:

    Understanding Patient Flow in Hospitals

    • Nuffield Trust, Briefing prepared by Sasha Karakusevic, October 2016

    Overcensus strategies

    This is a page developed by the ECI (October 2013) which presents information on overcensus strategies along with evidence and papers which may help you engage your hospital in the problems of overcrowding in the ED.

    Patient Flow Program

    This is a NSW Health program that provides staff with the knowledge and tools to minimise delays in patients moving through care. Within this program are three core elements:

    The Patient Flow Systems Framework was developed to identify elements that contribute to good patient flo

    Models of Care

    This 2012 document details Models of Care (MoC) in operation across NSW and features MoC

    • within the ED
    • outside the ED
    • within the community setting

    Self assessment checklists have also been produced to assist EDs and hospitals to have a clearer picture of where the MoC works well as well as identifying priority areas to improve the operation of the MoC to assist with improving patient flow.

    Presentations:

    Emergency Department Short Stay Units, NSW Health PD2014_040

    This policy outlines the mandatory requirements for the use of Emergency Department Short Stay Units (EDSSUs) in NSW hospitals. EDSSUs are Inpatient Units, managed by Emergency Department staff, designated and designed for the short term (generally up to 24 hours) treatment, observation, assessment and reassessment of patients initially triaged and assessed in the Emergency Department.

    At the ECI Leadership Forum on 27 June 2014 there was a series of presentations delivered on ED Short Stay Units. These are listed below:

    Privacy

    Privacy Manual for Health Information, NSW Health

    The NSW Health Privacy Manual for Health Information provides operational guidance to the legislative obligations imposed by the Health Records and Information Privacy Act 2002. The manual outlines procedures to support compliance with the Act in any activity that involves personal health information.

    Professional development

    How to ace a consultant interviewArticle by Dr Clare Skinner, Director of Emergency Medicine at Hornsby Ku-ring-gai Hospital and Chair of the Emergency Medicine Network for NSLHD

    ED General Clinical Progression Pathway

    ED Paediatric Clinical Progression Pathway

    Originally developed by the Sydney Children's Hospital, Randwick this form has been developed to:

    • meet the clinical skill requirements in an emergency department setting
    • provide an example of a possible career pathway for ED nurses
    • support managers efforts to enhance and manage performance

    It is recommended that the use of this tool should be accompanied by a recognition of prior learning document.

    Quality

    Quality Standards for Australian Emergency Departments and other hospital based emergency services, 2015

    ACEM and CENA

    This aims to provide guidance and set expectations for the provision of equitable, safe and high quality emergency care in Australian emergency departments and other hospital based emergency care facilities.

    National Antimicrobial Resistance Strategy 2015 - 2019

    Department of Health, Australia

    The Australian Government has released the first National Antimicrobial Resistance Strategy to guide the response tothe threat of antibiotic misue and resistance. The strategy was developed in partnership with industry and government, and will guide action by governments, health professionals, veterinarians, farmers and communities to reduce the emergency of resistance bacteria.

    ED Quality Framework Project

    The Australasian College for Emergency Medicine (ACEM) Policy on a quality framework for emergency departments was developed due to the belief that ‘a quality culture is fundamental to the provision of the highest standard of care in Australasian emergency departments’.

    This policy was developed by the ECI into standards (with supporting tools and resources) to allow assessment and implementation in Emergency Departments (EDs) across NSW. Quality Support Officer (QSO) posts were funded by the MoH in 23 EDs throughout NSW to help support ED teams to establish a quality team, implement and evaluate the ED Quality Framework and undertake a range of quality projects.

    Presentations:

    A guide to using data for health care quality improvement

    Victorian Quality Council, Rural and Regional Health and Aged Care Services Division, Victorian Government Department of Human Services, Melbourne, Victoria, June 2008

    The purpose of this guide is to assist all members of the health care team to understand the role of data in quality improvement and how to apply some basic techniques for using data to support their quality improvement efforts.

    Policy on a quality framework for emergency departments

    Australasian College for Emergency Medicine, April 2012

    These guidelines provides ACEM's recommended quality framework for Emergency Departments based on the following profiles:

    • Clinical
    • Education and Training
    • Research
    • Administrative
    • Professional

    Communicating in a Crisis

    “To Err is Human...”[i]

    We all know that one of the major sources of error and conflict in our work is communication failure. Whether this break-down is with our colleagues, other medical teams, patients or families the potential for error is huge, and the resulting consequences of this mis-communication can be disastrous.

    In recent years, there has been a greater focus on firstly recognising that communication is hugely complex and fraught with difficulty, and secondly on actively implementing strategies which can help us to reduce the risk of communication failure.

    We would actively encourage each of you to read at least one of these excellent resources, and reflect upon your own practice.

    Debriefing

    Running a successful debrief is a huge skill in itself. In the midst of a crisis or busy emergency department there never seems to be ‘enough time’ or ‘the right time’ to do this. But as increasingly recognised, a good debrief can be an important part of the quality improvement process, as well as providing emotional support for staff. A timely debrief can give structure to your reflections on the case and provide clarity about sequence of events, including explaining the rationale for the decisions made, to all the staff involved with the case. Importantly, it can identify areas for improvement in a non-judgemental way – focusing on team performance rather than portioning individual blame, or highlight gaps in resources (human or equipment) which may be addressed for future patients.

    One could spend months learning the skills required to run a successful debrief, but the following resources can give you a good introduction to some of the key component:

    [i] To Err is Human. Institute of Medicine (US) Committee on Quality of Health Care in America; Editors: Linda T. Kohn, Janet M Corrigan, and Molla S. Donaldson. National Academies Press (US) 2000

    Overcensus Strategies

    In the Emergency Department (ED) "overcensus" is part of business as usual. Patients are delayed unloading from ambulance stretcher to ED bed, ambulances suffer extended turn around times and are "ramped" in ED corridors or holding bays. Unable to access a clinical space on arrival, patients are "parked" in every nook and cranny and have delayed transfer of care.

    Because patients, for whom the ED phase of care is finished, continue to wait for a hospital bed in the ED, there is simply not enough room in the ED for new arrivals. For over a decade Emergency Physicians have been calling for better access for patients from the ED to the hospital, and overcensus within the hospital has been proposed on many occasions. The argument for this is apparent, in that sick, undifferentiated patients wait on ambulance stretchers because all the beds in the ED are full with admitted and stable patients.

    So why don't we send the stable and differentiated patients to the ward even if they are not quite ready to receive them, thus freeing up space in the ED to assess and treat new arrivals? Surely in the balance of risk, being overcensus by many in an acute area with undifferentiated patients (the ED) is much more dangerous for patients than just one or two extra stable fully assessed and treated patients in a ward which has, for the most part, stable patients waiting for discharge.

    With NEAT has come another set of targets but also recognition (maybe) that the problem of sick patients on ambulance stretchers in the ED is a whole of hospital problem. This has been known to the ED and demonstrated serially over the last decade or so, and has been recently reinforced by the NSW Auditor General's 2013 report Reducing ambulance turnaround time at hospitals.

    We present information, evidence and papers here which may help you engage your hospital in the problems of the ED.

    International perspectives

    It's pretty clear the problems are the same the world over. In the UK the NHS have worked it out and they still call EDs A&E. Click here for a paper.

    In Canada, the whole province of Alberta implemented an over capacity protocol (OCP) in 2010 which you can see here in the following presentations

    Most importantly, what about in Australia? Why haven't we tried it here? Not through lack of effort and evidence this paper Full Capacity Guide produced for the ED Taskforce in 2008, following on from work in 2002-3 by Sally McCarthy and the other emergency physicians at Liverpool ED, succinctly puts the case.

    And just in case better outcomes, decreased risk and common sense doesn't sway us the patients like it as well as shown in the Patient Preferences paper published in the EMA. See the related presentation by Daniel Fatovich at the 2008 ACEM Access Block Solutions Summit which can be accessed by clicking here.

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