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
Grant ID: EMPF-031R02-2024-TRENOWETH
Project Summary
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.
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