New program to improve patient and staff experience in emergency care

With the Emergency Care Assessment and Treatment (ECAT) protocols now launched, the ACI’s Emergency Care Institute is working with partners to roll out this new program supporting hospitals to provide consistent, best-practice care.

Nurses are usually the first point of clinical contact for more than 3 million patient presentations to emergency departments (EDs) each year in NSW. They perform triage, followed by patient assessment and management.

While nurse-initiated protocols and models of care were well established in NSW EDs, they had not been standardised across the state. This can lead to variation in patient care and nursing practice; and limits the ability for nurses to transfer their skills between hospitals.

A group of passionate emergency nurses originally began work on the Emergency Care Assessment and Treatment (ECAT) project more than five years ago, to address these challenges. In 2021, support was gained from state partners to scale up across NSW, the program was refreshed and taken on by the ACI’s Emergency Care Institute (ECI).

ECAT aims to provide an improved experience for patients and staff through supporting metropolitan and rural hospitals to provide consistent care across NSW. The program will achieve this through:

• standardised ECAT protocols that ensure equity of access to care
• a consistent education pathway for emergency nurses that supports transferrable skills and career progression
• a governance framework that reduces unnecessary duplication of effort and cost across the system.

The first elements of the ECAT program launched in late 2023. These include 41 adult and 32 paediatric protocols, and education resources released via the NSW Health Education and Training Institute (HETI).

Clinical engagement and partnerships key to success

The ECAT program has been a truly collaborative and multidisciplinary project at every level, explains Kylie Smith, ECI Manager at the ACI.

“The first step in the development process was 12 months of engaging with stakeholders, including local health districts (LHDs) and specialty health networks (SHNs), nursing, medical, pharmacists and other allied health professionals working across the system in emergency care, to understand the issues.”

Engaging with, and seeking advice from, NSW Health partner organisations was also crucial. These included HETI, eHealth NSW, the Clinical Excellence Commission and the Nursing and Midwifery office (NAMO) at the Ministry of Health. The team also spent time visiting EDs from across the state to understand the day-to-day scenarios and challenges faced by patients and emergency nurses in services of all sizes.

“Driving on bumpy roads between Inverell and Tamworth hospitals, it really emphasised the fact that if you can remove the need for a patient to travel that same road to receive equity of care at a bigger ED, you’ll improve outcomes,” says Kylie.

To develop the protocols themselves, the ECI harnessed the expertise and contacts of other ACI clinical networks, as well as experts across the system. Each protocol is based on a thorough evaluation of the evidence from existing local guidelines, published research studies, and expert consensus for the management of patients presenting to the ED.

“Our biggest challenge was also the project’s greatest strength. This was the sheer number of people involved across the system,” explains ECAT Project Officer Amy Donehue.

Training to support capability and transfer of skills

The ability to transfer skills is just as important as the ECAT protocols themselves, so nurses can move between different LHDs, services and environments (including disaster situations in the field) using the same protocols and education standards.

“Not only do the new protocols mean a nurse can proactively attend to the needs of a patient – which is great for the patient, their family and the nurse – but it also means an emergency nurse's skills and expertise are recognised across the state,” explains NAMO’s Adjunct Associate Professor Matt Lutze, Principal Advisor Nursing Practice, NSW Health.

HETI has led the development of education and training resources, including:

• an Emergency Nursing Capability Framework, guiding nurses from novice to expert
• an education pathway that begins after a Bachelor of Nursing degree and can be completed according to the nurse’s individual needs
• an Education and Recognition of Prior Learning guide
• My Health Learning modules:
  • Nursing in emergency care settings
  • ECAT - Introduction to protocols

More specific modules will follow as part of the Transition to Specialty Practice Program.

Adjunct Associate Professor Gail Forrest, Director of Leadership Management Development and Educational Design at HETI, says a collaborative approach was used to develop the education resources, with representation from across the state. "Emergency nurses came together to develop the new framework and pathway," she explains, "building on all the excellent work gone before to create a consistent approach that incorporates the latest evidence-based best practice."

The result is a flexible learning pathway that has been designed to suit nurses working in different contexts and with a range of experience.

For the health system, the key benefit is a standardised education pathway that reduces duplication, provides a statewide record of nurses' education and training, and improves workforce agility.

The path to implementation

ECAT will begin to go live across all LHDs and SHNs from May, with each LHD and SHN Executive Steering Committee deciding the appropriate time for their site to transition, as well as establish a governance committee to monitor local implementation.

An ECAT Implementation Plan and Go Live Schedule have been developed to assist LHDs and SHNs with planning and milestones to be achieved before going live with the protocols. Staff involved in implementation can join the ECAT mailing list to stay up to date with the program or join the ECAT Implementation Community of Practice.

Learn more about ECAT.