ETP - What can the ED do?
ETP is a whole system target and the focus should not be on the Emergency Department (ED) alone to achieve and implement this. It is clear, however, that EDs have a crucial role to play and there will always be scope for improvements within the ED environment. Some, but by no means all, of the key areas that facilities have found it helpful to focus on are:
- Match staffing levels to arrival times and peak activity.
- Consider the use of a Navigator Role. An example of a navigator role is here.
- Involve staff in the process from the outset. Staff input is crucial in identifying how and what can be improved. Consider asking staff the top 3 barriers for patients moving through the ED and listen to their suggestions.
- Carefully consider the ordering of diagnostic test to ensure they are always appropriate.
- If a result is not vital to a decision being made, why wait for it?
- Have agreed turnaround times for investigations, tests and pathology to reflect clinical urgency.
- Consider exploring enhanced access to radiology and pathology, including point of care testing with agreement on who can request according to protocols.
- Investigate admitting rights for designated medical staff in the ED.
- Utilize Models of Care that are appropriate for case mix, complexity and activity in your department, such as Fast Track, Early Treatment Zone, Senior Assessment.
- The Emergency Department should focus on the identified delays in the patient journey in the ED and use a patient journey template to assist this:
- Waiting to be seen
- Waiting for diagnostics and procedures
- Waiting for specialist review
- Waiting for senior clinical decision making and a plan of care
- Other delays relating to clerical and domestic roles may also impact on time
- Existing models of care should be reviewed for efficiency
- Are there ways to avoid admission and attendance at the ED
- Issues around workforce skills mix and capacity need also be noted
- Have a balanced scorecard to help monitor progress that includes KPIs for whole hospital e.g. discharges before 11am, length of stay etc.
- Have staged targets within the 4 hours to help with the whole system to respond in a timely manner, such as referring the patient to the inpatient team at X hours.
- Determine how referrals to the admitting team work and the process after acceptance to ensure timely departure from the ED. Audit and feedback on this.
- Maximize the use of all clinicians in the ED looking at skill mix and task allocation so that all providers are working according to the top of their scope of practice.
- Introduce support roles in ED to transfer non-clinical tasks from clinicians as appropriate.
We recognise that this is not a comprehensive list and would love to hear about particular initiatives or ways you have found to improve efficiencies within your ED. Please email us with your thoughts and suggestion so that we can include these.