Fixing the dating game: Building better relationships between ED and inpatient units while improving patient safety.

Miss Allana Henery1, Miss Cassandra Rooney1, Mrs Kylie Gillard1
1Princess Alexandra Hospital Emergency Departmetn, Woolloongabba, Australia

ED patient loads continue to increase nationally(1) and internationally(2). This drives clinical and policy mangers to seek interventions that will support effective patient flow, limit bed block and improve patient safety. This presentation will outline numerous processes to enhance patient flow and patient safety currently trialling at the PAH-ED which capitalise on the introduction of the digital hospital and resultant hospital-wide access to each patient’s electronic medical record (EMR). It is well documented that admitted emergency patient’s mortality is approximately sixfold higher (risk of death) in hospital than those undertaking elective admission. Furthermore evidence indicates significant delays in transfer to inpatient wards is associated with 20-30% increase in inpatient mortality(3). To counteract this an ED based protocol has been developed in conjunction with ICU outreach to identify these patients who are most at risk, initiate a review on arrival to the ward and implement interventions to prevent further deterioration and to expedite transit through ED. Government-imposed NEAT targets can also create difficulties for both ED and the inpatient teams(3). The Rapid Emergency Admission Destination initiative (READi) was developed, in partnership with hospital ward staff, by identifying elements of patient care that contribute to patient safety upon admission to the inpatient unit and building these into an electronically triggered checklist in the patient’s EMR. Patients being admitted to hospital via ED can have contact with 17-28 health professionals(4) highlighting the critical need for accurate and timely transfer of clinical information. Our experience with EMR has highlighted the need for a standardised approach to documentation including an initial assessment document, secondary survey as well as mandatory notification documentation. These initiatives aim to improve ED and inpatient unit staff satisfaction with enhanced capacity to provide timely optimal care and value-add to patient safety.

  1. Lowthian etal., Demand at the emergency department front door: 10-year trends. MedJAust. 2012;196(2):128-32.
  2. Pines etal., International perspectives on ED crowding. AcadEmergMed. 2011;18(12):1358-70.
  3. Staib etal., Uniting emergency and inpatient clinicans across the ED-inpatient interface: The last frontier? EmergMedAustral. 2017;28:740-745
  4. Whitt etal., How many health professionals does a patient see during an average hospital stay? NZMed. 2007;120

Allana Henery- Graduating from QUT in 2011 Allana began her nursing career in Orthopaedics at the Princess Alexandra Hospital before transitioning to the dark side (ED) in 2013 where she is currently an Acting Clinical Nurse. Allana recently completed her Graduate Certificate in Emergency nursing and has a strong passion for patient safety developing new methods of working with the integrated electronic medical record for best practice, as well as working with the ICU outreach team at the PAH developing a protocol to identify unwell patients and assist with improving the patient journey for these patients as well as patient outcomes.

Cassandra Rooney- Cassandra Rooney graduated from Griffith University with a Bachelor of Nursing in 2005. Cassandra began her career in the Princess Alexandra Hospital in a surgical ward, but has spent the last 11 years in the Emergency Department. Cassandra is currently in the position of Clinical Nurse Consultant and through this role has been able to help implement the department’s transition to the first large scale public digital hospital in Australia. Cassandra has also completed a Graduate Certificate Emergency Nursing.