ED Stream Workshop Acute MOC August 2013 ED Stream Workshop 1

List All MOC used in your Facility 3.1Triage and Registration as per NSW Health Emergency Department Models of Care July Fast Track 2

Describe your Fast Track Model Key principles – Expedite the journey for less-urgent/non-complex patients Operating hours reflect high demand periods Patients with a single system problem that can be discharged <2 hours Rapid access to appropriate imaging and pathology Uses dedicated staff – Nurse Practitioner (NP) 0.8FTE, other senior MO as identified by NUM/IC Nurse and supported by NUM/IC Nurse as required. Benefits of the Model Fast track zones provide an alternative option to treat non-complex patients in a timely manner, reducing long waiting times for minor problems and enabling NEAT to be met. Challenges Needs to be instigated at the discretion of the IC Nurse IC Nurse needs to delegate a suitable Senior MO in the absence of NP Not suitable night duty as Belmont Hospital does not have non urgent imaging after MN and pathology needs to be couriered to JHH Clinician run model (attach model guideline ) 3

Differences between your Model and the definition in the “Emergency Department Models of Care July 2012” Fast track is run from Belmont Hospitals cubicles – Beds They are not quarantined as Fast Track beds and if needed are utilised by patients requiring an ED bed for assessment. Fast Track is instigated and ceased on a needs basis throughout the day by the NUM/IC Nurse No dedicated staffing other than NP when on duty 4

Identify the Resource Required for your Fast Track Model What do you need to run the model – To run the model the way we do needs our NP on duty or an MO identified by NUM/IC Nurse. If run by MO, the IC Nurse will usually need to commit some time to support the fast track whilst it is being utilised. Staffing - We do not have dedicated staffing or a dedicated FTE. The staff are utilised from the routine ED staffing and amount to a NP or a MO and RN for the period of time designated to the need for Fast Track to be implemented. The MO and RN are always senior members of staff in the ED. Training - There is no formal training for the Fast Track role. Senior staff are required when implemented. Guidelines - Guidelines have been modified from the JHH Safe Flow Project Guide (page 13) Physical space - The physical space required is usually 1-2 cubicles to alternate a patient being prepped by RN and the NP/MO physically treating a patient in the other room. 5

Monitoring and Evaluation Identify how it supports KPIs and NEAT Fast Track Model allows all triage category KPIs to be better met. Fast track patients would usually be Category 4 and 5 with some Category 3s. The timely treatment of fast track identified patients allow those KPIs to be met as well as freeing other ED medical staff to attend to the remaining patients in a more timely fashion. The nature of fast track being that patients selected would be anticipated to have been treated in under 2 hours supports the principles of NEAT. Fast track moves patients throughout their journey in a timely fashion with minimal resource of space thereby allowing beds to be freed throughout the ED to assist with ambulance offload KPIs 6 Triage CategoryActual YTD % Cat 1100% Cat 289% Cat 385% Cat 496% Cat 587% Off stretcher within 30mins89% NP no. patients seen% patients met NEAT 586 (Feb 2013 – July 2013)100%

Evidence of Success Improvement in KPIs since implementation – 7 Belmont ED KPI Comparisons Category 1 % Category 2 % Category 3 % Category 4 % Category 5 % EAP NEAT

Impact on overall service – the previous graphs show the impact on overall service at Belmont ED has improved since the inception of NEAT principles including Fast Track MOC Sustainability – maintained for last 6 months Transferability – this MOC works for the number of patients seen in Belmont ED and the criteria of patient presentations at this facility ie limited specialties. Attach supporting evidence – after hours ASET, - anecdotal evidence to support less ASET reviews waiting until the morning. As a modification to the Fast Track MOC Belmont ED has implemented a Short Stay Low Risk Chest Pain pathway and guidelines. Attachments – After Hours ASET, Fast Track pathway, Low Risk Chest Pain Short Stay Pathway 8

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