optimiSed PAtient Flow using prEhoSpital Triage (safest)

There have been significant increases in system pressure for unscheduled public healthcare in Australia. Likewise, ambulance services have seen an unprecedented increase in demand for services along with a change in ambulance utilization. These pressures affect all aspects of patient flow, from triple zero call through to hospital admission and discharge. Improvements in the integration of prehospital services into the healthcare system can reduce time delays at their interface. Triage and clinical deterioration tools guide clinicians' decisions when directing patients to clinical streams within the emergency department whilst balancing patient safety. Paramedics are highly trained clinicians, that are well placed to assess and determine a patient’s clinical priority and potential for deterioration. If paramedics can demonstrate their application of validated triage and clinical deterioration tools to efficiently and safely direct patients to the most appropriate facility and/or clinical stream within a facility, then there would be potential time savings across the system. Furthermore, this would provide a validated tool to identify patients that are safe to be referred to the virtual emergency department. This study proposes to assess paramedics' ability to apply triage and clinical deterioration tools to identify the clinical stream either within an emergency department or via the virtual emergency department. If successful, this process could improve patient safety while reducing delays at the ambulance and emergency department interface.

SAFE STEPS – SAFE and Seamless Transition through Enhanced Proactive Support

The physical health equivalent of a relapse in a mental health patient would be a repeat stroke or heart attack. Episodes may be fatal and the chances of full recovery decreases with each episode. Every effort must be made to detect and prevent emerging crisis in the community. Currently, patients present to Emergency Department (ED) despite being open to community case management, using precious ED resources. There is limited evidence regarding reducing unplanned ED presentations, with some needing psychiatric inpatient care. Princess Alexandra Hospital employed a Transition Coordinator to support the care of people who are deteriorating in the community. The Transition Coordinator has been collating a unique dataset, names of patients who have been flagged as deteriorating and have received support successfully, as well as those who have had unplanned presentations to ED or have needed admission. Our proposed study will analyse this dataset and identify key defining characteristics of planned and unplanned admissions. We will also survey patients, families and staff regarding what helps in a crisis and why they presented to the ED rather than to the community clinic. A clinical audit of the notes will also provide information on what happened in the lead up to an unplanned admission. In-depth interviews with patients and supporting family and staff will provide further insights. The findings will inform service changes. They will be pulled into a replicable package to free up ED resources and inpatients beds through provision of early detection and treatment in the community.

Criteria Led Discharge from Emergency Department Short Stay Unit

The Emergency Department Short stay unit (EDSSU) is used to facilitate flow through the Emergency department (ED) for patients requiring further investigations, treatment or period of observations, with the likely disposition of home. Current access block issues and increasing patient presentations means the SSU is consistently full, with multiple patients waiting to be transferred to this unit. Furthermore, limited medical staffing with only one junior doctor to follow up on these patients creates an exit block during periods of increased activity. Criteria Led discharge (CLD) is a proposed strategy that allows for safe and timely discharge of patients by nursing staff from the EDSSU once diagnosis-specific criteria have been met without the need for final medical review. Post initial assessment and investigations, medical staff can identify specific patient cohorts for the CLD pathway. Nursing staff can then discharge patients once criteria is met. CLD is not a new concept; being used among wards and paediatric centres statewide, however it has not been utilised within the adult emergency space in Queensland to the best of our knowledge. This process will decrease length of stay (LOS) within the ED and EDSSU, increasing patient satisfaction with the healthcare service, redirecting medical resources allowing medical staff to prioritise acute patient presentations or perform critical emergency procedures, and alleviate pressures created by medical sick leave when no residents can be allocated to SSU as nursing staff can manage and discharge this cohort of patients using the CLD pathway.

Paeds with a wheeze – Improving patient flow with Nurse Led Stretching of Inhaled Salbutamol (NLSIS)

Wheeze is one of the most common emergency department presentations for pre-school aged children. The typical treatment regime involves early review by a medical officer or nurse practitioner and an intensive “burst” of inhaled salbutamol therapy, followed by an admission to a short stay unit to wean inhaled salbutamol therapy to 3-hourly. The medical officer or nurse practitioner will review the child hourly to establish the need for further treatment or the capacity to increase the interval between salbutamol therapy. As they manage a concurrent case load in both the emergency department and short stay unit, there are often delays in bedside assessment and administration of salbutamol. During the COVID-19 pandemic, the substantial increase in wheezing presentations caused significant bed pressure, waiting room overcrowding and poor patient flow. Nurse Led Stretching of Inhaled Salbutamol (NLSIS) is a pathway that optimises registered nurse’s skills and scope of practice to perform a detailed respiratory assessment on a child presenting with a wheezing illness and determines when the next dose of salbutamol should be administered. The aim of the project is to evaluate whether NLSIS reduces short stay unit length of stay optimising patient care and patient flow in a children’s emergency department and short stay unit.

Study to Analyse Patient Flow in Queensland Public Hospitals

This study will adopt a system-wide view to capture relationships and interactions between flow metrics to identify access issues and inform the design of interventions/solutions to improve patient flow at a system level. A system-wide approach covering prehospital and ED services offers the potential for improving patient flow at the ambulance/hospital interface. By integrating ambulance, ED and inpatient data, it is possible to identify blockages along the entire patient journey that have a flow-on effect on ED access. It is also possible to identify critical hospital and ambulance service levels when performance starts to degrade, suggesting where the system would benefit from revised strategies.

The project ‘Study on Patient Flow in Queensland’s public hospitals’ is conducted by a research team comprising experts from CSIRO, Queensland Health, UQ and QAS.