Keeping an eagle eye on movement: a nurse driven strategy for flow in the emergency department.

Mrs Tracey Millichamp1, Mrs Chris Ozols1, Mrs  Nicola Rugg1, Mr Gary Forshaw1
1Emergency Department, Redland Hospital, Cleveland, Australia

Emergency Department (ED) overcrowding is an international public health issue that has become increasingly significant in the last 15 years.  Evidence demonstrates strong links between ED overcrowding and prolonged length of stay, a rise in medical errors, increased morbidity and mortality and overall inferior health care delivery. In response to these alarming facts the United Kingdom introduced the 4hr rule in 2004, stating that 98% of ED patients should be seen, admitted or discharged within 4 hours of presentation.  Variations of this strategy were adopted by several healthcare agencies worldwide with differing levels of success and, although at times controversial, from 2008 to the current day Australia has implemented, trialled and revised iterations of this 4hr rule, referred to as the National Emergency Access Target (NEAT) and known operationally as the Emergency Length of Stay (ELOS). In October 2017 Queensland’s Metro South Hospital and Health Service (MSHHS) released its ED Patient Flow Improvement Plan which outlined specific key performance indicators (KPI’s) for admitted ELOS, Short Stay Unit ELOS and discharged ELOS and tasked its health service facilities with achieving these internal flow targets. One response to this was the development of a new nursing role, Clinical Nurse Consultant: Emergency Access, Guidance and Logistics (CNC EAGLE).  The aim of this role is to support the ED and hospital in the delivery of safe, high quality care by facilitating delay reduction and streamlining patient flow, ultimately assisting the achievement of these KPI’s and reducing ED overcrowding. Redland Hospital (MSHHS) implemented this CNC EAGLE role 7 days a week, 0700-2300, in November 2017. Initial results indicate a satisfactory improvement in KPI’s. The authors will present preliminary data collection and analysis and will focus on the innovative approach

Tracey and Chris are both Clinical Nurse Consultants at Redland Hospital Emergency Department in Qld.