1. ED Stream Workshop TMH ED MOC August 2013 ED Stream Workshop 1

2. TMH ED Models of Care (MOC) Triage Clinical Initiatives Nurse (CIN) Senior Assessment Streaming (SAS) Early Treatment Zone (ETZ) Consults (Fast Track) Paediatrics Resuscitation Acute Care Sub-acute Care 2

3. TMH Consult MOC  TMH ED Consult area has been running for the past 7 years  It was built into the new department in 2010 and is now embedded into our daily processes  Has evolved in hours of operation and processes over this time  Open between 0800-2400hrs 7 Days/week  Staffed by one nurse and one doctor  Situated at “front of house” very separate from the acute/sub-acute area 3

4. MAP 4

5. Physical space Floor space – 10m x 15m (150m2) Staff work station (2 computers) 1 x plaster room 1 x Procedure room (bed) 3 x Chairs Slit lamp Interview room 5

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8. Differences between your Model and the definition in the “Emergency Department Models of Care July 2012” Recent work completed aligning Consults with the ED MOC 2012 Document as part of the SAS Project Consult MOC consistent with ECI definitions and key principles of “Fast Track” Minor Differences are; –No Nurse Practitioner –No dedicated allied health support (physio) 8

9. Clinical operation Guideline Business rules Operational flow chart Nursing expectations In process of building competencies for nursing staff 9

10. The old! Previous inclusion/exclusion criteria 10

11. The New!

13. Resource Required for TMH ED Consults Nursing Registered Nurse 2.94FTE Medical SRMO or Registrar 2.94FTE Training Pre-requisite – experience in Acute / sub acute (knowledge of department and hospital processes) One hour orientation (Data entry and clinical governance/operation) Preferable or working toward competency in; -Mobility aids and assessment -Tissue adhesive application -Soft tissue injury management/ splinting - NIX & NIA - IVC & venepuncture 13

14. Benefits of the Model Allows for the waiting room queue to be separated into complex and single system injury management Easy identification of those who are “sick” in the waiting room Reduces non-acute patients using acute MOC, improving patient safety. Reduces the waiting times to treatment for everyone Providing care that is standardised and targeted to specific conditions and injuries 14

15. Challenges Nursing Staff (broad skill set) Medical staff (not always a senior decision maker) Compliance with guideline Doctor to patient ratio Blockages Bottlenecks – Paediatric Emergency just opened! Not open during the night Reception duties 15

16. Identify how it supports KPIs and NEAT Maitland's only hope! 43 % of our patients are able to be seen in consults increasing likelihood of meeting NEAT by bringing up % of discharged and admitted patients within 4 hours. Category 4 and 5’s streamed to consults are generally seen by a doctor within triage KPI’s. 16

17. Evaluation – Not so good! Recently evaluated against fast track MOC and revised. Waiting time for treatment by triage category Collect data on total time in ED – aim for all consult patients within 2 hours White board will soon reflect patient time in department through colour/codes – monitoring system to track those that are nearing or over the 2 hours Admitted patients from fast track – need to capture data and identify patient group National Emergency Access Target (4-hour target). Patient incidents and complaints Staff feedback 17