Clinical process redesign for unplanned arrivals in hospitals

O'Connell, T. J.; Bassham, Jane E; Bishop, Rod; Clarke, Christopher W; Hullick, Carolyn; King, Diane; Peek, Carmel; Verma, Raj; Ben-Tovim, David I.; McGrath, Katherine

doi:10.5694/j.1326-5377.2008.tb01669.x

Cited by 16 publications

(31 citation statements)

References 7 publications

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“…Although junior medical staff are encouraged to consult with more senior colleagues for clinical advice to ensure a high standard of safe emergency care, the need for consultation can result in significant delays in treatment and/or disposition decisions,6 23 which is contradictory to the rapid throughput aim that underpins fast track systems. The unresolved tension of balancing the need for experience and training in the management of a variety of patient groups and the throughput aims of fast track systems remains a challenge for both emergency medicine and emergency nursing.…”

Section: Discussionmentioning

confidence: 99%

Effect of clinician designation on emergency department fast track performance

Considine

Kropman

Stergiou

2010

Emergency Medicine Journal

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Objective To examine the effect of clinician designation on emergency department (ED) fast track performance. Design and Setting A retrospective audit of patients managed in the fast track area of an ED in metropolitan Melbourne, Australia. Participants Patients triaged to ED fast track from 1 January 2008 to 31 December 2008 (n¼8714). Main Outcome Measures Waiting times in relation to Australasian triage scale (ATS) recommendations and ED length of stay (LOS) for non-admitted patients were examined for each clinician group. Results Compliance with ATS waiting time recommendations was highest (82.5%) for emergency nurse practitioners/candidates and lowest (48.2%) for junior medical officers. Median ED LOS was less than 3 h for non-admitted patients, and 85.8% of non-admitted fast track patients (n¼6278) left the ED within 4 h. Patients managed by emergency nurse practitioners/ candidates had the shortest ED LOS (median 1.7 h) and patients managed by junior medical officers and locum medical officers the longest ED LOS (median 2.7 h) (c 2 ¼498.539, df¼6, p<0.001). Conclusions Clinician designation does impact on waiting times and, to a lesser extent, ED LOS for patients managed in ED fast track systems. Future research should focus on obtaining a better understanding of the relationship between clinician expertise, time-based performance measures and quality of care indicators.Emergency department (ED) fast track systems have evolved to improve the management of patients with non-urgent complaints by decreasing waiting time, ED length of stay (LOS) and overcrowding, and increasing patient and staff satisfaction with ED care.1e6 A statewide survey of fast track services in Victorian ED showed most metropolitan and major rural ED in Victoria had a formal fast track system. 7 The majority of fast track systems in Victorian ED operated during hours that matched periods of peak demand and most ED offered a fast track service for 12e16 h per day. 7In order to optimise the function and capacity of ED fast track systems, a geographically dedicated area staffed by dedicated senior medical and nursing staff is recommended.1 4 8 It is proposed that dedicated senior medical and nursing staff optimise the performance of fast track systems as they have the ability to make timely treatment and disposition decisions with minimal consultation. 1 4 8 9 In addition, dedicated fast track staffing is thought to promote faster patient throughput by reducing handovers and fragmentation of ED care. 4 8Although 83.4% of Victorian ED roster specific staff to their fast track area, there is variation in the staffing profile of fast track systems across Victoria. 7 The majority of ED used a combination of medical and nursing staff; however, 86.7% of ED with dedicated fast track staffing allocated staff using a rotating roster. 7 The level of medical staff rostered to fast tracks systems was variable and ranged from emergency physicians to interns.7 In contrast, the majority of ED used senior nursing staff in their fast track areas a...

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Section: Discussionmentioning

confidence: 99%

Effect of clinician designation on emergency department fast track performance

Considine

Kropman

Stergiou

2010

Emergency Medicine Journal

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“…This developing crisis results in a delay in availability and ambulance diversion, producing additional delays with longer transport times and placing patient safety at risk 3. Such delays are considered unacceptable in a modern National Health Service (NHS) and a zero tolerance has been recommended by the Department of Health (DH) 4 5…”

Section: Introductionmentioning

confidence: 99%

Ambulance handovers: can a dedicated ED nurse solve the delay in ambulance turnaround times?

et al. 2013

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“…The third article focuses on the management of unplanned admissions in our hospitals and the stresses experienced in emergency departments (EDs) in Australia, which are far removed from the glamour and drama of TV shows like House , ER , and All Saints https://doi.org/10.5694/j.1326-5377.2008.tb01669.x 5 …”

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confidence: 99%