Front Door Task Force

Ms Nicole Hoskins1
1SCGH Perth WA, Nedlands, Australia

The Emergency Department at Sir Charles Gairdner Hospital (SCGH), hereafter referred to as ED, reported experiencing significant patient flow issues that affected the patient experience, staff satisfaction and service delivery.
Staff of the ED broadly described two main issues that contribute to the ability of the service to assess, treat, admit and discharge patients in a timely way:

  • The volume of presentations at peak ED arrival times (between 10:00hrs and 12:00 hrs) and
  • Not having somewhere to move their patient to once stable (access block)

These two key issues cause the ED to become overcrowded thereby restricting patient flow through the department.
ED staff felt that although they had no control over patient arrival times and inpatient bed block, a review of their internal process might help to reduce the impact of these phenomena on the patient experience, staff satisfaction and service delivery

Following project approval, a project-working group and a governance and reporting structure was established. The Clinical Service Redesign (CSR) methodology – Lean-Six Sigma (DMAIC) was applied.

ED observation ward

  1. Criteria Led Discharge
  2. Priority Ward Round Process


  1. Pre arrival clerking for ambulance patients
  2. Simultaneous triage and clerking process
  3. Allocation of assessment cubicles from triage
  4. Patient transport into ED Assessment for Ambulance Arrivals

Assessment Area

  1. Restructuring ACO and A2 roles into two Assessment Team Leader (ATL) roles

Rapid Assessment Team
A team structure and guidelines were introduced to ensure:
The Rapid Assessment Team worked as a team

  • The Rapid Assessment Team add value to the Patient journey
  • There was a consistent method to communicate between the RAT and other medical teams within the department

In addition, the RAT was allocated a dedicated space to assess, treat and discharge patients at triage.

An emergency nurse for 15 years I have seen many changes in nursing practice. This change however streamlined what we do and made significant changes that made the ED Teams job satisfaction improve immensely. Now I am the nurse manager of a tertiary ED, where human resources and budget constraints mean we need to work smarter not just harder, this project gave us the ability to make changes that would be hopefully sustainable. 18 months of process mapping and engaging staff and working on processes that would see improvements to the patient journey and staff satisfaction were the objectives for this project. w3e implemented and are now evaluating so as to secure the investment needed to make the changes.