SWAMPED: Linking best practice workforce models to Emergency Department funding

State-wide Workforce and Activity-Based Funding (ABF) Modelling for Queensland Emergency Departments

Grant ID: EMPJ-12-185-BELL-SWAMPED

Lay Summary

The aims of this research are to link best practice ED workforce models to available ED funding under an activity-based funding (ABF), while contributing to the development of an improved national activity and outcome-based ED funding model. This research will identify the current status of funding of EDs, identify and critically appraise models for funding of EDs and identify the workforce implications of those funding models and propose a State-wide ED clinical workforce framework.


Outcomes

In early 2015, leaders (medical directors and nurse managers) from 27 public hospital EDs in Queensland were invited to complete a survey detailing ED activity, staffing profiles, treatment space, models of care (MOC) and National Emergency Access Target (NEAT) performance. Routinely collected ED information system data was also used. Twenty of the 27 EDs invited participated in the study (response rate 74%).

1) Models of Care
An extensive array of MOC were identified that were categorised into those that facilitate input, throughput and output from the ED. There was no consistent evidence as to the relative effectiveness of these MOC in achieving ED performance benchmarks, such as NEAT performance--further research is needed for each MOC.

2) Staffing
Weighted activity units (WAUs) and nursing staff varied based on hospital type and size. Larger hospital EDs had on average 9076 WAUs and 13 full time equivalent (FTE) nursing staff per 1000 WAUs; smaller EDs had on average 4587 WAUs and 10.3 FTE nursing staff per 1000 WAUs. Medical staff was relatively consistent (8.1-8.7 FTE per 1000 WAUs). The proportion of patients admitted, discharged, or transferred within 4 hours ranged from 73% to 79%. The ED medical and nursing staffing numbers did not correlate with the 4-hour performance.

Conclusions
There is considerable variability in the MOCs used throughout EDs in Qld. There would be value derived from a more consistent and comprehensive approach but this depends on a more complete analysis of the relative effectiveness of different MOCs either in isolation or as part of a comprehensive approach. There are MOCs that show real promise but as yet have not been taken up more broadly.


IMPACT

The key authors were able to use the information gained in the Statewide survey to influence changes in MOC at QE II, RBWH and Cairns hospitals. The information was important in developing and arguing for resource allocation at a hospital level. Information was also presented to the Queensland Statewide ED Network (QEDSAP),

Leveraged Funds

- In-kind: $179,110


Dissemination

Publications:
- Bell A., Toloo G.S., Crilly J, Burke J., Williams G., McCann B., FitzGerald G., “ Emergency department models of care in Queensland: a multisite cross-sectional study”, Australian Health Review, 2019; 43: 363-370. doi: 10.1071/AH17233
-Toloo G-S., Burke J., Crilly J., Williams G., McCann B., FitzGerald G., Bell A., “Understanding ED performance after the implementation of activity-based funding”, The International Journal of Health Planning and Management, 2018 Apr;33(2):405-413. doi: 10.1002/hpm.2475. [Epub 2017 Nov 29]
- Wylie K, Crilly J, Toloo GS, FitzGerald G, Burke J, Williams G, Bell A., "Emergency department models of care in the context of care quality and cost: A systematic review.", 'Emergency Medicine Australasia', 2015; 27(2), 95–101.
- Bell A, Crilly J, Williams G, Wylie K, Toloo GS, Burke J, FitzGerald G., "Funding emergency care: Australian style", 'Emergency Medicine Australasia', 2014; 26(4), 408–410.
- Wylie K, Bell A, FitzGerald G, Crilly J, Toloo GS, Burke J, Williams G., "The Implications of Activity Based Funding for Emergency Departments: A Comprehensive Literature Review", Queensland University of Technology, Brisbane, Australia, 2014; Published Monograph.


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