1. 15: The ‘Admin’ Question Patient flow Dr Tony Kambourakis

2. Summary Marked out of 10 2 + 5 + 3 for each section Pass mark 5 Average mark = 3/10 Median = 4/10 Pass mark 11%

3. Issues Read the question Factors impacting Measure their impact I am not looking for strategies or solutions Do not repeat the same factor Be specific The following is not acceptable: Factor = access block Measure = audit or measure access block. Write what you will measure – eg % to ward < 4hrs from arrival

4. Pre –hospital factors Patient demand / demographics annual attendance growth Change in presentations by age % arriving by ambulance (but not ambulance ramping) Alternatives to ED % direct admissions (waiting times) % referred by GP Outpatient clinic waiting times Patients transferred from residential care % presenting for outpatient referral Scheduled reviews in ED

5. ED factors Cubicle and treatment access Waiting times by triage (arrival to clinician) Arrival to cubicle time (including ambulance offloads) % Left without treatment Processes Time to analgesia - % < 30 mins Time to antibiotics % < 1 hr for neutropenia Time to cath lab / thrombolysis % home < 4hrs for non-admitted patients Unplanned re-attendances < 48 hrs

6. ED factors Diagnostics Pathology turnaround time – collection to result % < 90 minutes Radiology turnaround time Plain xray Request to test % < 30 minutes CT, ultrasound Request to test Test to report (% < 2hrs for non-critical tests)

7. ED factors Senior decision making Arrival to Doctor Doctor to clinical decision to admit (eg bed request, SSU) Unplanned re-attendances < 48 hrs Referrals ED doctor to specialty unit time Mental health referral to seen time

8. Flow out of ED Discharges & transfers Decision to discharge Ambulance transport request to departure Time to allied health referral Time to pharmacy referral Short Stay model of care % admitted to SSU % patients in SSU requiring inpatient admission (< 20%) Appropriateness of conditions (eg abdo pain > 65) Transfers

9. Flow out of ED Admissions Specialty referral timeframes Number ED physician delegated admissions Time from bed available to depart (% < 30 mins) Access to inpatient beds : % admitted < 4hrs; average ED length of stay (LOS) Inpatient LOS Access to subacute - time from referral to bed available Inpatients > 30 days Discharges < 10AM Number of patients going to discharge lounge

10. Thank you