Staff perception of a patient flow strategy for patients presenting to the ED with mental illness: A qualitative study

Nerolie Bost1,2, Amy N.B. Johnston1,2,3, Julia Crilly1,2,3

1 Gold Coast University Hospital Emergency Care, 1 Hospital Blvd, QLD 4215 Australia.
2 Menzies Health Institute Queensland, Griffith University Gold Coast campus QLD 4222 Australia
3 School of Nursing and Midwifery, Griffith University, Gold Coast Campus, QLD 4222 Australia

Background: Over recent years Emergency Department (ED) overcrowding and access block have been problematic in Australian hospitals. To reduce time to discharge and transfer from ED and admission to hospital, the National Emergency Access Target was introduced across all States. In one Queensland hospital ED, a targeted patient flow strategy was implemented in 2012 to improve time to assessment and treatment in ED and streamline the discharge process for patients who present to ED and are diagnosed with a mental illness. An outcomes evaluation of this strategy indicated that for this cohort, access block improved and overall ED length of stay for mental health patients decreased by 41 minutes over a 6 month timeframe1.

Objective: The aim of this study was to explore ED and mental health clinical staff perceptions of mental health care delivery in relation to the mental health patient flow strategy.

Methods:  This qualitative study used semi-structured interviews with four ED and four mental health clinicians. Interviews were digitally recorded and transcribed verbatim. Meaning was developed through inductive and deductive thematic analysis undertaken independently2 by three experienced researchers.

Findings: Three key themes emerged including: i) ‘Them and us: the gap’, ii) ‘patient ownership of and responsibility for patients’, and iii) ‘discordance in expectations around quality of care and time’.


  1. Bost, N., J. Crilly, and K. Wallen, The impact of a flow strategy for patients who presented to an Australian emergency department with a Mental Health illness. Int Emerg Nurs, 2015. 23(4): p. 265-73.
  2. Bogdan, R.C. and S.K. Biklin, Qualitative research for education: An introduction to theory and methods. 5th ed. 2007, Boston: Pearson Education Inc & Alleyn Bacon. 304.


Amy Johnston is a joint appointment research fellow, working between Griffith University and Gold Coast Hospital and Health Service (GCHHS), Emergency care, seconded from a senior lecturer position at Griffith University.  She has a background in tertiary nurse education, particularly in the biosciences. Her developing research strength in ED research is in collaboration with A/Prof Julia Crilly and the ED research office at GCHHS. Her love of clinical research is heartfelt and (hopefully) infectious. She is involved in HDR student supervision and onsite development of ED staff research skills.