Keeping ED patients safe beyond the ED: ED nurse referral to an acute outreach support team

Ms Allana Henery1, Ms Cassandra Rooney1, Ms Emily Cooper1, Ms Dale Mason1, Dr Amy Johnston1,2

1Princess Alexandra Hospital, Department Of Emergency Medicine And Sonmsw University Of Queensland, Brisbane, Australia, 2University of Queensland, School of Nursing Midwifery and Social Work, Brisbane, Australia

Implementation of the National Emergency Access Targets (NEAT) has driven increasing pressure to discharge unwell and potentially unstable patients with complex care needs into busy acute wards. However, Standard 8[1] directs proactive responses to care for patients likely to deteriorate and the need to ameliorate the risks of suboptimal care in ward areas. Research literature suggests that risks to patients in ward areas can include limited supervision, limited capacity to monitor patients or appreciate care for patients with altered vital sign ranges, potential deficits in fundamental assessment skills and knowledge and reduced organizational processes to support seeking advice around patients who appear to deteriorate. This knowledge creates a dilemma for an ED flow nurse; to move or not to move that sick patient?

This presentation describes a unique nurse referral process developed in the ED that capitalizes on available resources such the intensive care unit (ICU) outreach nursing team. The process enables all ED registered nurses who have completed the Coordinator Training Package to make direct contact with the ICU outreach coordinator regarding a transferring patient who meets the inclusion criteria. The ICU Outreach Service confirms if they will accept the patient at the time of the call and this is documented an handed over to the receiving unit. This triggers a subsequent visit by the ICU outreach team to the patient on the ward and ensures expert review and provision of any upskilling of ward nurses required to support the patient. There are a number of possible benefits of this for staff and patients – reducing workload stress and moral distress for nurses. It is an example of a nurse-developed care strategy that empowers ED nurses and helps contribute to more effective use of hospital-wide resources to safely support ED patient flow.



Allana Henery is an experienced and capable ED nurse with a keen interest in providing ED patients with the best possible care processes. She works as part of a dedicated and committed team of CNCs and ED nurses to ensure best possible processes are developed, trialled, implemented and then evaluated in the ED space.