The CATCH-23 Project

CATCH-23 aims to ensure that acutely unwell children attending Sydney Children's Hospitals Network (SCHN) emergency departments (EDs) receive high-quality treatment as early as possible.

SCHN EDs have found it challenging to consistently meet the NSW Heath key performance indicators (KPIs) for providing timely care to children in triage categories 2 and 3. Data from 2022-24 showed that on average, 31 children a day experienced a delay in receiving care.

Delays can result in worse outcomes for children, frustration for families, stress for staff and increased hospital costs. The CATCH-23 project aims to enable SCHN EDs to meet these KPIs and improve the ED experience for children triaged as category 2 and 3, as well as their families and carers.

The value of fast-tracking category 2 and 3 patients

Delays in care and prolonged waits impact clinical outcomes¹ and increase patients’ length of stay in hospital.² They also lead to staff burnout,³ higher healthcare costs and decreased patient satisfaction.⁴ Studies link timely treatment to reduced intensive care admissions for conditions like sepsis, asthma and febrile neutropenia.^{5, 6, 7} It also improves workflows, hospital discharges and patient outcomes. This all benefits patients, families, staff, hospitals and the health system.

EDs are high-stakes environments at the core of the health system. They need to run effective, efficient and timely systems that enable the prioritisation of patients and the care they need. The Australian Triage Scale is a clinical tool used nationally to determine how quickly patients should be seen and forms part of the performance profile for EDs.^8,9 The scale helps ensure patients with urgent (category 2) and potentially urgent (category 3) issues receive timely and appropriate care within expected timeframes, which is 10 minutes for category 2 patients and 30 minutes for category 3 patients.

In undertaking the CATCH-23 project, the SCHN is seeking to improve the systems that enable the delivery of sustainable, high quality and culturally safe care to ensure that these timeframes are consistently met.

Finding solutions that will make an impact

This project was initiated as part of the Agency for Clinical Innovation Graduate Certificate of Healthcare Redesign program. The project team collected current performance data, held process mapping workshops with staff, conducted tagalongs with staff and families and distributed staff and patient surveys. The team used this information to identify bottlenecks and factors that might be contributing to treatment delays.

The diagnostic stage involved extensive stakeholder consultation with nurses, medical staff, parents and executive teams. This helped to generate approximately 40 potential solutions and ensured that all perspectives and cultural needs were considered when the project team developed solutions.

The project team presented the top 10 to the project’s steering committee, where they identified high priority solutions. The following solutions are designed to be sustainable and are built around a shared, multidisciplinary approach:

• An 'ED physician' exam – senior ED medical staff can start treatment with a rapid assessment approach.
• Use of Emergency Care and Assessment (ECAT) protocols – nursing staff who have completed ECAT training can use these protocols for initial rapid assessment and to begin treatment sooner.
• Accurate timestamping – enhance the education process on accurate ‘time seen’ documentation for medical and nursing staff.
• Allocation of beds – a flowsheet is to be developed for the triage team to allocate treatment space, to reduce delays and reduce the number of phone calls to allocate bed/treatment space.
• Establishment of a respiratory bay – a standard assessment space to be identified for category 2 and category 3 patients.
• Education triage time – reinforce training to facilitate early/appropriate category 2 allocation.
• Providing parent/carer information – written and/or electronic will aid in the timely provision of information and reassurance.

CATCH-23 is now moving into the implementation phase where the solutions will be piloted and monitoring put in place to measure their impact on the category 2 and 3 KPIs.

View this project's poster from the Centre for Healthcare Redesign graduation December 2025.

References

1. Australian College of Emergency Medicine. Policy on the Australasian Triage Scale. Melbourne: ACEM; 2023 Nov [cited 27 Oct 2025]. Available from: https://acem.org.au
2. Liew D, Liew D, Kennedy MP. Emergency Department Length of Stay Independently Predicts Excess Inpatient Length of Stay. Med J Aust. 2003;179(10):524-526.
3. Xu H, Kynoch K, Tuckett A, et al. Effectiveness of Interventions to Reduce Emergency Department Staff Occupational Stress and/or Burnout: A Systematic Review. JBI Evid Synth. 2020;18(6):1156-1188.
4. Nyce A, Gandhi S, Freeze B, et al. Association of Emergency Department Waiting Times With Patient Experience in Admitted and Discharged Patients. J Patient Exp. 2021;8(8). doi:10.1177/23743735211011404
5. Weiss SL, Peters MJ, Alhazzani W, et al. Executive Summary: Surviving Sepsis Campaign. Pediatr Crit Care Med. 2020;21(2):186-195.
6. Rowe BH, Spooner C, Ducharme FM, et al. Early Emergency Department Treatment of Acute Asthma With Systemic Corticosteroids. Cochrane Database Syst Rev. 2001;(1):CD002178.
7. Salstrom JL, Coughlin RL, Pool K, et al. Pediatric Patients Who Receive Antibiotics for Fever and Neutropenia in Less Than 60 Min Have Decreased Intensive Care Needs. Pediatr Blood Cancer. 2015;62:807. doi:10.1002/pbc.25435
8. Australian College of Emergency Medicine. Guidelines on the Implementation of the Australasian Triage Scale in Emergency Departments V6 G24. Melbourne: ACEM; 2023 Nov [cited 27 Oct 2025]. Available from: https://acem.org.au
9. Australian College of Emergency Medicine. Position Statement: Access Block. Melbourne: ACEM; 2022 Oct [cited 27 Oct 2025]. Available from: https://acem.org.au