Access block

Metropolitan Emergency Department Access Initiative: a report on Ambulance ramping in metropolitan hospitals, Queensland Health, July 2012

Access block and overcrowding: a literature review, University of New South Wales and The Simpson Centre for Health Services Research, September 2008

Communication and cultural awareness

Communicating for Health in Emergency Contexts - University of Melbourne and University of Technology, Sydney

This project has created evidence-based resources for learning and teaching effective communication in health care settings, focusing in particular on complex, high-risk contexts such as emergency departments.

Domestic violence

Domestic Violence Routine Screening Program

NSW Health domestic violence screening and response in NSW Emergency Departments: Feasibility Study

Drug and Alcohol

Final Report of the National Ice Taskforce, Department of The Prime Minister and Cabinet, 2015

Electronic Medical Record (EMR)

NSW Health Independent Review of Cerner FirstNet, Deloitte Touche, 2011

This is the independent review of Cerner FirstNet, which is the IT system selected by the NSW Department of Health to support the operation of emergency departments. This review assesses the suitability of the FirstNet system to meet the clinical, functional and usability requirements of the users, and whether its continued use poses any risk to clinical safety.

Manly Voice Recognition Evaluation Report

End of Life

Advance Planning for Quality Care at End of Life: Action Plan 2013 - 2018

This Action Plan provides the way forward for NSW Health in implementing advance care planning in the NSW public health system over the next 5 years. It identifies strategic partnerships with other government agencies and sectors to improve this aspect of planning for end of life care in primary, acute and aged care settings. This Action Plan seeks to normalise Advance Care Planning and improve end of life care by ensuring patients are provided with care consistent with their wishes, within therapeutic limits. See the final report here.

Literature Review: Care at the End of Life in Emergency Departments, R. Forero et al, 2012

International

UK: What's going on in A&E - the key questions answered, The King's Fund, March 2016

This explores how A&E waiting times have changed over the past few years and explores the impacy of different factors impacting on A&E and why these are so complex and reflect wider pressures on the NHS and social care.

UK: The reconfiguration of clinical services. What is the evidence? The King's Fund, November 2014

This paper provides new insights into the drivers of reconfiguration and the underpinning evidence. It builds on a major analysis, commissioned by the National Institute for Health Research (NIHR), of reviews of service reconfigurations conducted by the National Clinical Advisory Team (NCAT). Here, we set out the main findings of the analysis and discuss their implications for the NHS.

UK: Urgent and emergency care: a prescription for the future, Royal College of Physicians, NHS Confederation, Society for Acute Medicine and The College of Emergency Medicine, July 2013

Hospitals are struggling to cope with increasing pressure on urgent and emergency care services. The challenges faced by emergency departemtns are the most visible sign of pressure across our health system. This statement sets out a 10-point vision for addressing these challenges.

UK: Resolving the emergency crisis: 10 priorities for the A&E crisis, The College of Emergency Medicine, December 2013

The College has published ’10 priorities for resolving the crisis in Emergency Departments’ which clearly sets out what action needs to be taken to address the current crisis in A&E. The College through its Members is playing its part and we are working in 5 key areas. However, this crisis cannot be solved by us alone, we need urgent action by all stakeholders to work with us to provide a stable long term future for A&E services whilst tackling the short term immediate pressures. This is why we have identified 5 priorities for us and 5 for the Government and NHS leadership to grasp to address this crisis. Our proposals are the collective view of practicing Emergency Physicians; they represent cost-effective solutions to ensure we can deliver safe patient care.

USA: The evolving role of Emergency Departments in the United States, Rand Health

Ireland: National Emergency Medicine Programme

The Emergency Medicine Programme or EMP was initiated in July 2010 and its overarching aim is to improve quality, access and value in Irish Emergency Departments (EDs) and to reduce waiting times for patients.

The EMP working group is comprised of nurses, doctors, therapists and other clinicians who work in Irish EDs and Pre-hospital Care. It is supported by advisory groups from the medical training bodies, nursing and the therapy professions.

Internet Access

Survey of Internet use in Emergency Departments, Emergency Care Institute, NSW Agency for Clinical Innovation, January 2014

Access to online resources and the Internet has been identified by emergency care clinicians as a major issue in NSW Emergency Departments (EDs) with consistent feedback through stakeholder surveys and ad hoc comments indicating that lack of access impedes clinicians’ ability to deliver quality care. The Emergency Care Institute (ECI) surveyed NSW EDs to explore the use and availability of Internet services.

Review of Internet Access and Usage in Emergency Department, Literature Review, Emergency Care Institute, NSW Agency for Clinical Innovation, January 2014

This report explores the importance of point of care clinical resources to clinicians in practicing Evidence Based Medicine. In particular, it examines the value of access to Internet resources in overcoming knowledge translation issues and facilitating the practice of EBM in Emergency Departments. The body of evidence presented in the report represents a strong argument for open access to Internet resources to be afforded to all clinicians in an Emergency Department setting.

Internet Use in NSW Emergency Departments, ECI Conference Poster

Presented at ACEM 24 to 28 November 2013 in Adelaide.

Mental Health

External Review of Psychiatric Emergency Care Centres in NSW, NSW Ministry of Health, November 2012 (Revised December 2012)

The Mental Health and Drug Alcohol Office (MHDAO) undertook an external review of the Psychiatric Emergency Care Centres (PECC) to review the operations of each PECC against the PECC Operational Model of Care Guideline and to review the appropriateness of the Operational Model of Care Guideline in the clinical environment. MHDAO is currently in the process of developing its response to the report.

Patient Experience

NSW Emergency Department Patient Survey, Bureau of Health Information, March 2015

Leading Practices in Emergency Department Patient Experience, Prepared for the Ontario Hospital Association by InfoFinders 2010/2011

This report is intended to provide background to assist in advancing the development of a performance improvement strategy for patient satisfaction in Emergency Departments. This work was commissioned by the Ontario Hospital Association (OHA) and the Emergency Room Patient Satisfaction Performance Improvement Advisory Committee (ER PIAC).

Quality and safety

Improving Quality in the English NHS: a strategy for action, The King's Fund, February 2016

This paper argues that the NHS in England cannot meet the health care needs of the population wihtout a sustained and comprehensive commitment to quality improvement as its principal strategy.

Quality Standards for Australian Emergency Departments and other hospital based emergency services, ACEM & CENA, 2015

This aims to provide guidance and set expectations for the provision of equitable, safe and high quality emergency care in Australian emergency departments and other hospital based emergency care facilities.

Improving Diagnosis in Health Care, Institute of Medicine, September 2015

Getting the right diagnosis is a key aspect of health care - it provides an explanation of patient's health problem and informs subsequent health care decisions. Improving Diagnosis in Health Care, a continuation of the landmark Institute of Medicine reports To Err is Human: Building a Safer Health System (2000) and Crossing the Quality Chasm: A New Health System for the 21st Century (2001) finds that diagnosis - and, in particular, the occurrence of diagnostic errors - has been largely unappreciated in efforts to improve the quality and safety of health care. The result of this inattention is significant: the committee concluded that most people will experience at least one diagnostic error in their lifetime, sometimes with devastating consequences.

The Neville Report Update, The Queensland Ombudsman, June 2011

An update on the implementation of recommendations from an investigation into the adequacy of the health complaint mechanisms in Queensland, and other systemic issues identified as a result of the death of Elise Neville, aged 10 years.

A Quality Framework and Suite of Quality Measures for the Emergency Department Phase of Acute Patient Care in New Zealand, Ministry of Health, New Zealand, March 2014

This publication by the Ministry of Health in New Zealand suggests a quality framework including a common suite of measures. District Health Boards in New Zealand will be expected to use these measures to improve the acute patient journey, thereby improving patient experience.

Review of events surrounding Northam Hospital Emergency Department, Professor Gary Geelhoed, Chief Medical Officer for WA, March 2013

The executive summary of the review requested by the Director General of WA Department of Health, Kim Snowball, into events surrounding Northam Hospital ED. The executive summary includes the recommendations.

UK: Commissioning the delivery of high quality care in the Integrated Emergency Department: Guidance for Commissioners, clinicians and managers, The College of Emergency Medicine, November 2013

This position paper by the College of Emergency Medicine provides guidance for commissioners, clinicians and managers on how to deliver high quality care in the integrated Emergency Department. This guide recommends ten key recommendations that the College believes should always be considered when the configuration of local EDs are made.

UK: Integrating safety into the departmental activity, The College of Emergency Medicine

The Safer Care Committee has developed a new checklist for integrating safety into your Emergency Department. This allows you to assess how well you integrate and consider safety in your departmental activities and makes suggestions for which staff need to be involved.

UK: Review into the quality of care and treatment provided by 14 hospital trusts in England: Overview Report, Professor Sir Bruce Keogh KBE

UK: How to achieve safe, sustainable care in our Emergency Departments? System benchmarks and recommendations, The College of Emergency Medicine

UK: Mid Staffordshire Foundation Trust Public Inquiry, National Health Service, UK

Service Quality and Communication in Emergency Department Waiting Rooms Report, December 2012

In 2009/2010, the Clinical Excellence Commission (CEC) funded research into service quality and communication in emergency department waiting rooms. The research team was comprised of staff from Southern Cross University with applied skills and knowledge in organisational communication, culture, history, structures and operations.

Four emergency departments across NSW were involved in the research (sites involved are not identified within the report). Discussion of next steps regarding key recommendations is underway in collaboration with the Agency for Clinical Innovation and the Emergency Care Institute, accompanied by recognition of significant initiatives implemented throughout NSW since the report completion.

The final report and response from the Clinical Excellence Commission are available from the above link.

Windows into safety and quality in healthcare 2011, Australian Commission on Safety and Quality in Healthcare, October 2011

Service planning

NSW Health Telehealth Framework and Implementation Strategy 2016 - 2021, NSW Ministry of Health, March 2016

NSW Rural Health Plan: Towards 2021, NSW Ministry of Health, January 2016

Reducing ambulance turnaround time at hospitals, Ambulance Service of NSW, NSW Ministry of Health, July 2013

The final report of the Audit Office performance audit on Reducing Ambulance turnaround Time at Hospitals. This audit assessed whether there are effective strategies in place to reduce the time spent by ambulance crews at emergency departments. The following questions were answered:

• do NSW Health’s strategies to reduce ambulance delays at emergency departments free up ambulances to respond to other incidents?
• do the Ambulance Service’s demand management strategies limit the number of patients it takes to emergency departments?

Review of NSW Aeromedical (Rotary Wing) Retrieval Service, November 2012

As part of the review, independent consultants Ernst & Young were engaged to undertake the following three key tasks:

1. Prepare a 10 year strategic direction for the provision of aeromedical rotary wing medical retrieval Services for NSW, taking into account the existing fixed wing service contract.
2. Determine the optimum rotary wing service configurations to support the medical retrieval system for NSW for the next 10 years.
3. Advise on the contractual amendments required to the rotary wing contracts or current service arrangements to support the above, and recommend a preferred procurement strategy and implementation plan to establish the recommended configuration.

Fixed wing and road retrieval services and contracts do not form part of the project scope.

Reducing ambulance turnaround time at hospitals, Ambulance Service of NSW, NSW Ministry of Health, July 2013

This audit assessed whether there are effective strategies in place to reduce the time spent by ambulance crews at emergency departments. We answered the following questions:

do NSW Health’s strategies to reduce ambulance delays at emergency departments free up ambulances to respond to other incidents?

do the Ambulance Service’s demand management strategies limit the number of patients it takes to emergency departments?

Strategic Review: Ambulance Service of NSW, December 2012

The Plan sets out five strategic directions for improving the operations of NSW Ambulance:

1. Integrating NSW Ambulance within the broader health system

2. Separating non-emergency patient transport from urgent medical retrieval patient services. This means that NSW Ambulance can better focus on its core role – attending to emergencies

3. Developing new models of care and investing in new providers to effectively manage demand; have a positive impact on response time; reduce paramedic fatigue, and improve the operating costs of NSW Ambulance

4. Ensuring that NSW Ambulance has effective infrastructure with a funding model that ensures financial sustainability into the future

5. Strengthening the leadership, workforce and governance structure of NSW Ambulance and embracing the NSW Health CORE values of Collaboration, Openness, Respect and Empowerment.

Role Delineation Levels of Emergency Medicine: Consistent with the Guide to the Role Delineation of Health Services 2016, NSW Health, November 2017

Guide to the Role Delineation of Clinical Services, NSW Health, February 2016

This document contains the current Role Delineation Levels of Emergency Medicine in NSW Public Hospitals. Role delineation is a planning tool used in service and capital developments. It describes the mimimum support services, workforce and other requirements for the safe delivery of clinical services. The aim of the NSW Health Guide to the Role Delineation of Clinical Services is to provide a consistent language for describing clinical services.

Principles for emergency care models in NSW small rural hospitals, NSW Health Statewide Services Development Branch, August 2010

Urgent Care Centres

Comparing Utilization and Costs of Care in Freestanding Emergency Departments, Hospital Emergency Departments, and Urgent Care Centres

• Ho, V et al. (2017) Annals of Emergency Medicine, e-pub ahead of print, 15 February 2017.

Evaluation of Urgent Care Centres Pilot: Final Report, Agency for Clinical Innovation, April 2014

An independent evaluation was commissioned by the NSW Agency for Clinical Innovation (ACI) to assess the perceived appropriateness, efficiency and effectiveness of the UCC Service Delivery Model for public hospitals in NSW. Five pilot sites were evaluated, including one tertiary referral hospital, two children’s hospitals, and two major metropolitan health facilities. This is the final evaluation report.

Workforce and staffing

Review of medical internal training: final report, Australian Health Ministers' Advisory Council, September 2015

The potential role of Physician Assistants in the Australian context - Final Report, Health Workforce Australia, 2012

Phase II of the Physician Assistant Demonstrations Evaluation Report, New Zealand Ministry of Health, 2015

Medical Portfolio Programs Review, HETI, 2014

The Medical Portfolio Programs Review was commissioned by the Chief Executive of the Health Education and Training Institute (HETI) in 2012. The review aimed to:

• investigate the purpose, goals governance and structure of all HETI medical programs

• ensure that HETI Medical Portfolio programs are ‘fit for purpose’, pursuing excellence in health education and training and workforce capability to improve the health of patients and the working lives of NSW Health staff.

NSW Health and HETI Response to Review Recommendations, April 2015

Why is there a workforce shortage in NSW Emergency Departments? Challenges and Options for Action, University of Sydney, May 2014

HWA Expanded Scopes of Practice Program: Evaluation Progress Report 1, Centre for Health Service Development, University of Wollongong, March 2013

Discussion paper: Allied Health Profession Staffing in Queensland Health Emergency Departments, Allied Health Workforce Advice and Coordination Unit, Queensland Health, March 2011

The objectives of this discussion paper are to:

• Describe current staffing levels for allied health professionals in EDs across the state;

• Provide a rationale for allied health Models of Care in EDs based on Australian and international evidence / literature

• List the principles of provision of an allied health service in Queensland Health EDs

• Make recommendations for minimum allied health staffing levels for EDs in Queensland

Emergency Department Workforce Research Project (EDWRP), NSW Health

The publication is the final report on the EDWRP and details the project background, methodology and outcomes including the development of Principles and Guidelins for emergency department skill mix that can be adapted to the individual circumstances of emergency departments.

Emergency Department Workforce Analysis Tool (ED-WAT), NSW Health, 1 August 2011

The ED-WAT is a workforce planning tool designed to support workforce and skill mix planning in Emergency Departments in NSW. The ED-WAT is the result of the EDWRP and is currently being implemented acrsoss NSW. The output of the ED-WAT is a prioritised list of strategies required to address skill mix issues.