Optimising patient flow: reducing delay to discharge from acute wards to residential aged care facilities (RACF) to improve access block in the emergency department

Emergency departments (EDs) are overcrowded and unable to meet the ever-increasing demands for healthcare. Access block is the most significant contributor to ED overcrowding. Access block refers to delays in admitted patients leaving the ED due to an unavailability of inpatient beds. The consequences of access block can be catastrophic, including adverse events, higher mortality rates, reduced quality of care, and increased costs.

Large numbers of patients who occupy acute beds are non-acute and considered safe and ready for discharge. These patients are predominantly waiting for residential aged care facility (RACF) placement. In addition to financial and patient flow strain, hospital stays longer than required creates significant risk of functional decline.

As the largest public health service in Queensland, Metro North Health has made significant investments in various successful hospital avoidance, substitution and navigation programs. However, timely access and flow of patients to RAC, which increases availability of inpatient beds for patient admission from ED, remains a significant issue. Therefore, this research investigates: How can we reduce discharge delay from acute wards to RACFs to improve access block?

This research will characterise the cohort of patients who are ready for discharge and waiting for RACF placement, and understand the barriers and solutions to discharge delay. These findings can then be used in future phases of this research program to predict patients who will have a delayed discharge, target strategies and pathways at admission, model the impact of released acute bed capacity on access block, and develop metrics for inpatient stays.

Implementation and Evaluation of a Surgical Rapid Assessment Unit – Improving Emergency Department Flow with Timely Surgical Care

Emergency Departments (EDs) in Queensland hospitals are often overcrowded, leading to long wait times and reduced patient satisfaction. At Logan Hospital, patients with surgical problems currently go through a full ED assessment before seeing a surgical specialist, causing unnecessary delays. To address this, we’re creating a Surgical Rapid Assessment Unit (SRAU). This unit will be open on weekdays from 8 am to 4 pm and will directly assess stable patients with surgical issues, bypassing the usual ED process. This means patients will be seen faster by the right specialist.

Our research aims to evaluate how well the SRAU works. We’ll look at:
1. How it affects patient wait times and overall hospital stay
2. Patient safety
3. Whether it’s cost-effective
4. Challenges in implementation

This project is innovative because it fundamentally changes the patient journey, allowing direct surgical assessment without the usual step of ED evaluation. This approach could improve care quality and use hospital resources more efficiently. If successful, the SRAU model could significantly reduce ED congestion and improve patient flow. This model of care could be applied statewide and nationally to other Australian hospitals facing similar challenges.

We’ll use multiple research methods, including comparing data before and after SRAU implementation, surveying patients and staff, and analysing costs. The results will provide strong evidence on whether this model works and how it could be adopted by other Queensland hospitals, potentially leading to widespread improvements in emergency surgical care across the state.

Reducing delayed admissions from ED to ICU, ICU discharge delay and after-hours discharge through a co-designed multi-component intervention: A stepped wedge feasibility cluster randomised trial (the REDEEM-ED-ICU trial)

Hospitals and in particular, emergency departments (ED) are often overcrowded and unable to meet ever-increasing demand. The leading cause of overcrowding is access, or ‘bed-block’. This is a serious issue as it impacts the ability of staff to provide quality care to their patients.

Hospital patient flow is a nationwide problem that has attracted attention from researchers and policymakers, yet solutions to improve it, have been ineffective. As ED and Intensive Care Units (ICU) treat the most critically ill patients, it is unsurprising that the patient’s journey through these departments is closely connected. ED patient flow can be impacted by ICU bed capacity, delayed admission into ICU, and delayed and after-hours discharge from ICU. Bed-block can have significant consequences for the patient - including increased waiting time, prolonged length of ICU and hospital stay, more hospital-acquired complications, higher mortality and increased financial burdens for the health system. It is estimated that delayed discharges from ICU alone costs Australia $40 million/year.

The proposed study aims to co-design and test a multi-component intervention to address patient flow, building on a foundation of our preliminary collaborative research looking at hospital priorities, current strategies and practice, and barriers and enablers to ICU discharge processes.

We expect the impacts of this work will include,
• Improved patient outcomes
• Improved patient flow through ICUs, including admission from ED to ICU
• Reduced cost to the Australian healthcare system.
• Informing future national competitive grant applications for national implementation of the multi-component intervention

Acceptability, feasibility and efficacy of the Activity Level and Flow Report – Emergency Department (ALFRED) tool. Measurement of capacity, overcrowding and escalation reporting in a tertiary paediatric emergency department

Emergency department (ED) overcrowding and subsequent impacts on patient safety and quality of care is a global public health challenge. Capacity measurement and risk assessment tools play a vital role in capturing and communicating ED overcrowding to trigger escalation strategies, mitigate risk and facilitate patient safety and flow. Currently, there is no universal definition of ED crowding and tools developed to measure crowding and quality of care in paediatric EDs are largely based on research undertaken in the adult setting.

The Queensland Children’s Hospital (QCH) ED currently use the Staffing Acuity Physical Transfer/Disposition Environment (SAPhTE) tool, manually calculated by the Emergency Flow Coordinator (EFC) and designed to assess and escalate ED capacity, access block and departmental risk. Audits and staff surveys have identified challenges in the SAPhTE tool including timely completion especially during peak ED activity, inter-operator variability in interpretation and scoring, limited central visibility and poor shared understanding around escalation. QCH ED have co-designed the Acuity Level and Flow Report - Emergency Department (ALFRED) dashboard which provides near real-time capacity metrics from FirstNet to provide an automated and visual report of ED capacity, patient flow challenges and risk assessment. As a measure of overcrowding, ALFRED incorporates the single-site validated Pediatric Emergency Department Overcrowding Scale (PEDOCS). Further research is required to evaluate the acceptability, feasibility and efficacy of the ALFRED tool in a paediatric ED. This will facilitate potential translation to other pediatric centers and mixed emergency departments to promote a proactive approach to capacity risk assessment and improve patient flow.

Research Capacity Building – Older Persons Emergency Network Metro North

The strategic vision for our research program is to support early and experienced clinical researchers to participate in and contribute to high quality, robust, research activities and develop their research skills and knowledge through enrolment into higher degrees in research and participation in Older Person Emergency Network (OPEN) implementation and evaluation activities.

The proposed Capacity Building Grant will provide the opportunity to build research capacity and capability whilst strengthening OPEN’s research culture and further embedding research into our everyday practice. Funding will support the employment of a suitably qualified research officer (RO) (health practitioner, nursing or academic stream) to be mentored by the OPEN research team. This will include supporting the clinical OPEN team’s novice researchers to develop their research skills, encourage individual pursuit of higher degrees, leading journal clubs, preparing ethics and governance applications, contributing to writing protocols, carry out data collection, assist clinicians with research studies and be responsible for leading the translation of research findings into practice. RO support will also enable OPEN senior researchers time to focus on preparing grant applications to further build capacity through grant funding.

The key measurable outcomes we expect to achieve include support for the currently active five funded and 19 unfunded research projects at various stages of preparation. All of these projects are underpinned by an implementation framework to understand the real-world applications of the proposed research. The RO role will be responsible for obtaining ethical, governance and contractual approvals, to carry out the data collection for key pilot projects to inform large multi-centre trials where competitive grants will be sort.

Our long-term goal is to prove the value of the RO role leading to a permanently funded position well beyond this grant period with sustained research growth within the OPEN team.

Exploring Effective Communication Strategies for Children and their Caregivers in a Paediatric Emergency Department Waiting Room

Optimising communication in the Emergency Department (ED) waiting room is the best means of improving paediatric patient and caregiver satisfaction of their acute hospital experience. There are many different approaches to addressing this matter across Australian EDs, however, there is limited research assessing the effectiveness of individual strategies on improving patient and caregiver experience.

This study will aim to address this gap in literature through the following:
(1) A systematic literature review on effective communication strategies used in emergency department waiting rooms globally, and
(2) A qualitative approach, cross sectional single-centre study in the Queensland Children’s Hospital Paediatric ED waiting room to ascertain paediatric patient and caregiver perspectives and satisfaction regarding different communication strategies implemented.

Automated Clinical Data Extraction to Enhance Toxicology Services and Improve Emergency Medicine Outcomes: Project STREAM (System for Toxicology Research and Emergency Medicine)

Problem: Emergency Medicine research faces significant challenges due to outdated data collection methods, particularly when it comes to the use of clinical data. These issues lead to incomplete datasets and inaccuracies, negatively affecting research quality and patient care. Clinical Toxicology, a sub-specialty of Emergency Medicine, is an excellent example, where currently crucial clinical datasets are compromised by inconsistent practices and manual entry.

Research Question: How can we improve access to emergency care, improve the burden that toxicology patients place upon the emergency care system, and enhance data collection and efficiency in toxicology services by developing automated data extraction methods and standardized practices?

Proposed Solution: We propose the development of the STREAM, an automated clinical data extraction system designed to enhance data collection and analysis in emergency medicine.

Significance: This project addresses the enormous burden that toxicology patients place on emergency care. Toxicology is an area of emergency practice which relies on clinical information contained in databases to support the delivery of quality patient care. By improving data quality and standardizing practices, we aim to enhance research accuracy and optimize resources.

Innovation: The project introduces an innovative, cutting-edge automated tool to overcome current inefficiencies in data collection. This approach will enhance data management and research capabilities, providing a model for other clinical research areas.

Expected Impact: The project will improve the management of poisoning and toxic exposure, benefiting other emergency clinical research areas that rely on detailed data analysis. We anticipate higher-quality data, reduced manual workload, and better patient outcomes.

Retrospect matched-cohort study of the clinical outcomes of emergency department patients streamed to acute overflow

Overcrowding and access block is a common problem across many Australian Emergency Departments (ED) resulting in poor patient outcomes (Morley et al., 2018). Consequently, patients streamed through the acute part of the ED who ideally require an acute bed are instead moved to temporary triage rooms or wait in the waiting room as Acute Overflow (AO). Monitoring for deterioration for the AO patient is therefore restricted due to lack of appropriate monitoring, staff availability, overcrowding in these areas, and bed capacity potentially resulting in poor patient outcomes. However, there is no study that has examined the impact of acute patients streamed to AO. Here, we aim to conduct a retrospective matched-cohort study, across a six-month period, to examine the clinical sequelae including any adverse events of acute ED patients streamed to AO. The findings from this study will provide insight into the potential impact of streaming patients to the AO, and may provide underlying evidence to advocate for improved monitoring and staffing of this potentially vulnerable and yet often forgotten area of the ED.

The impact of horse-related injuries presenting to the Emergency Department and patient-reported outcomes measures: A two-phase cohort study

Children and adults who experience injury from horses-related accidents can be at risk of severe trauma due to injury mechanism, i.e., falling from, being kicked, hit, trampled, or crushed by a horse. Despite a low incident rate of injury in horse-riding and equestrian sports when an accident occurs there is a high-risk of the injury being severe due to the mechanism. Injury risk from horses has been found among experienced horse riders and handlers to increase with frequency of interaction and over time.

There is a lack of current evidence on the impact from all mechanisms of horse-related injuries experienced by children and adults treated in the emergency department. And the examination of health-related recovery of children and adults after discharge from the emergency department and hospital has been rarely researched. The aim of this study is to examine horse-related injury and recovery from injury among children and adults.

This project will be conducted in two phases, a review of health care data from emergency department presentations including all types of horse-related injury from 2018 to 2024. The second phase of the study will be conducted prospectively from July 2025 to June 2026 to examine how children (eight-years-and-above) and adults have recovered from injury. Patients (or parent/guardian) will consent for health care data to be collected and for follow-up by research staff after discharge from the emergency department or hospital at three-and six-months, this will include completion of a health-related quality of life questionnaire.

Drug Overdose with Reduced Consciousness: Patient and Staff Perspectives. A Mixed Methods Study

Drug overdoses are a common reasons for Emergency Department (ED) presentation. Overdoses may be intentional (self-harm), recreational, or accidental and often lead to reduced consciousness. Patients often need extra attention to their airway and breathing. They can be managed conservatively with oxygen, observation and regular nursing assessments. However, some require intubation: insertion of a breathing tube under sedation.

There is practice variation between doctors as to which overdose patients require intubation. Thus, the patient’s perspective becomes paramount, as their experiences influence management. We also need to understand clinician thought processes to ensure that care is standardised where possible.

This qualitative research is innovative in being the first to assess the patient experience around airway and breathing management for drug overdose with reduced consciousness, and assessing clinician attitudes. This will be done through patient and clinician questionnaires and semi-structured interviews.

AIM 1: To investigate the patient experience for an ED presentation with drug overdose and reduced conscious level. To understand the impact that interventions such as intubation can have on patients.

AIM 2: Explore clinician attitudes to the management of airway and breathing for these patients. Barriers to a conservative approach, triggers for intubation, departmental pressures and existing frameworks of care.

The research will provide insight into how this vulnerable patient population experience their care, and how clinicians reach critical decisions. It will inform development of a pathway of care to be used in the ED assessment of airway and breathing management for patients with drug overdose and reduced consciousness.