Emergency department models of care in Queensland: a multisite cross-sectional study
Anthony Bell A B C I , Ghasem-Sam Toloo A , Julia Crilly D E , John Burke A B C , Ged Williams F H , Bridie McCann G and Gerry FitzGerald AA Queensland University of Technology, School of Public Health and Social Work, Kelvin Grove, Qld 4059, Australia. Email: sam.toloo@qut.edu.au; john.burke@health.qld.gov.au; gj.fitzgerald@qut.edu.au
B University of Queensland, School of Medicine, Herston, Qld 4006, Australia.
C Department of Emergency Medicine, Royal Brisbane and Women’s Hospital, Herston, Qld 4006, Australia.
D Department of Emergency Medicine, Gold Coast Hospital, Southport, Qld 4215, Australia. Email: julia.crilly@health.qld.gov.au
E School of Nursing and Midwifery, Menzies Health Institute Queensland, Griffith Health Centre, Gold Coast Campus, Griffith University, Qld 4222, Australia.
F Griffith University, Gold Coast Campus, Qld 4222, Australia. Email: ged_williams@hotmail.com
G Metro North Hospital Health Service, Herston campus, Qld 4006, Australia. Email: Bridie.McCann@health.qld.gov.au
H Present address: SEHA (Abu Dhabi Health Service), Khalidia, PO Box 109090, Abu Dhabi, UAE.
I Corresponding author. Email: Anthony.Bell@health.qld.gov.au
Australian Health Review 43(4) 363-370 https://doi.org/10.1071/AH17233
Submitted: 17 October 2017 Accepted: 26 March 2018 Published: 7 September 2018
Journal Compilation © AHHA 2019 Open Access CC BY-NC-ND
Abstract
Objective The acuity and number of presentations being made to emergency departments (EDs) is increasing. In an effort to safely and efficiently manage this increase and optimise patient outcomes, innovative models of care (MOC) have been implemented. What is not clear is how these MOC reflect the needs of patients or relate to each other or to ED performance. The aim of this study was to describe ED MOC in Queensland, Australia.
Methods Situated within a larger mixed-methods study, the present study was a cross-sectional study. In early 2015, leaders (medical directors and nurse managers) from public hospital EDs in Queensland were invited to complete a survey detailing ED activity, staffing profiles, treatment space, MOC and National Emergency Access Target (NEAT) performance. Routinely collected ED information system data was also used.
Results Twenty of the 27 EDs invited participated in the study (response rate 74%). 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.
Conclusion There is considerable variability in the MOC used throughout EDs in Queensland. A more complete analysis of the relative effectiveness of different MOC either in isolation or as part of a comprehensive approach would help inform more consistent MOC in Queensland EDs.
What is known about the topic? MOC in any given ED are implemented in response to factors such as the geographical location of the hospital, hospital-specific characteristics and service profile, staffing profile and patient demographic profile. In the era of time-based targets, they may also serve to address a particular aspect of flow in the face of rising ED demand. Although many of the MOC attempt to deal with flow in a linear fashion, target specific phases of the ED journey or address particular patient cohorts, what is clear is that not all EDs are shaped and formed the same.
What does this paper add? The study provides a comprehensive description of the varied models of care operating within Queensland public hospital EDs and how they relate to ED performance. A basic taxonomy of contemporary ED MOC is necessary to allow comparison between departments and inform decisions regarding safety, efficiency and cost-effectiveness.
What are the implications to practitioners? A contemporary understanding of the presence and profile of ED MOC that currently exist within a network of hospitals and health services is important for managers, clinicians and patients to inform decision-making regarding the safety, clinical effectiveness and cost-effectiveness of these models. This understanding can also inform where and how further improvements in care delivery can progress.
Additional keywords: medical workforce, nursing workforce.
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