Two hour evaluation and referral model for shorter turnaround times in the emergency department

Burke, John A., Greenslade, Jaimi, Chabrowska, Jadwiga, Greenslade, Katherine, Jones, Sally, Montana, Jacqueline, Bell, Anthony and O'Connor, Alan (2017) Two hour evaluation and referral model for shorter turnaround times in the emergency department. Emergency Medicine Australasia, 29 3: 315-323. doi:10.1111/1742-6723.12781


Author Burke, John A.
Greenslade, Jaimi
Chabrowska, Jadwiga
Greenslade, Katherine
Jones, Sally
Montana, Jacqueline
Bell, Anthony
O'Connor, Alan
Title Two hour evaluation and referral model for shorter turnaround times in the emergency department
Journal name Emergency Medicine Australasia   Check publisher's open access policy
ISSN 1742-6723
1742-6731
Publication date 2017-06-01
Sub-type Article (original research)
DOI 10.1111/1742-6723.12781
Open Access Status Not yet assessed
Volume 29
Issue 3
Start page 315
End page 323
Total pages 9
Place of publication Richmond, VIC, Australia
Publisher Wiley-Blackwell Publishing Asia
Language eng
Subject 2711 Emergency Medicine
Abstract Objective: The objective of this study was to assess the implementation of a novel ED model of care, which combines clinical streaming, team-based assessment and early senior consultation to reduce length of stay. Methods: A pre–post-intervention study was used to compare ED performance following an extensive clinical redesign programme. Clinical teams and work sequences were reconfigured to promote the role of the staff specialist, with a focus on earlier decisions regarding disposition. Primary outcome measures were ED length of stay and National Emergency Access Target (NEAT) compliance. Secondary outcomes included referral and workup times, wait times by triage category, ambulance offload times, ward discharges and unit transfers within 24 h of admission, representation within 48 h, and Medical Emergency Response Team (MERT) calls within 24 h of admission. Results: Two seasonally matched 26 week intervals were compared with adjustment for demographics, triage category and arrival by ambulance. Overall, there was an 18.4% rise in NEAT performance (95% confidence interval (CI): 17.7–19.1) while ED length of stay decreased by a total of 86.8 min (95% CI: 83.6–90.1). Time series analysis did not suggest any preexisting trends to explain these results. The average time to referral decreased by 74.7 min (95% CI: 69.8–79.6) and waiting times decreased across all triage categories. Rates of MERT activation and unplanned representation were unchanged. Conclusion: A facilitated team leader role for senior doctors can help to reduce length of stay by via early disposition, without significant risks to the patient.
Formatted abstract
Objective: The objective of this study was to assess the implementation of a novel ED model of care, which combines clinical streaming, team-based assessment and early senior consultation to reduce length of stay.

Methods: A pre–post-intervention study was used to compare ED performance following an extensive clinical redesign programme. Clinical teams and work sequences were reconfigured to promote the role of the staff specialist, with a focus on earlier decisions regarding disposition. Primary outcome measures were ED length of stay and National Emergency Access Target (NEAT) compliance. Secondary outcomes included referral and workup times, wait times by triage category, ambulance offload times, ward discharges and unit transfers within 24 h of admission, representation within 48 h, and Medical Emergency Response Team (MERT) calls within 24 h of admission.

Results: Two seasonally matched 26 week intervals were compared with adjustment for demographics, triage category and arrival by ambulance. Overall, there was an 18.4% rise in NEAT performance (95% confidence interval (CI): 17.7–19.1) while ED length of stay decreased by a total of 86.8 min (95% CI: 83.6–90.1). Time series analysis did not suggest any preexisting trends to explain these results. The average time to referral decreased by 74.7 min (95% CI: 69.8–79.6) and waiting times decreased across all triage categories. Rates of MERT activation and unplanned representation were unchanged.

Conclusion: A facilitated team leader role for senior doctors can help to reduce length of stay by via early disposition, without significant risks to the patient.
Keyword Access block
Emergency department
National Emergency Access Target
Overcrowding
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: HERDC Pre-Audit
Faculty of Medicine
 
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