Care of the older person in Emergency – a module of learning for Emergency Nurses

Erin Cranitch1,2, Ellen Burkett1,2, Tamara Ward1, Laura Hines1

1Clinical Excellence Queensland, 2Metro South Health

Background:

Australian Emergency Departments (EDs) are experiencing significant growth in older person presentations.  Older persons, defined as people sixty-five years and older, are more likely to present with complex histories, co-morbidities and pharmacological considerations.  Older people present with symptoms and deceptively different vital signs from their younger counterparts, that may correlate with serious pathology.  Often referred to as ‘atypical or non-specific’ these symptoms also confound diagnosis and timely treatment in ED.  There is an opportunity to educate ED Nurses about these differences.  A survey of national health department sites and a grey literature search, was unable to identify any other departments with a specific older person  module within current training packages for ED nurses.

Objectives:

The project aim was to develop a statewide education module on the unique care needs of older persons in the ED with content able to be utilised across the spectrum of novice to highly experienced senior nurses. This education will be a catalyst for improvement of clinical outcomes for this growing cohort.

Methods:

A working group of Emergency and Gerontologic nursing, medical and allied health experts was formed to inform the development of content and learning activities with geriatric specific domains.  The domains encompass care of the older person in Emergency, common older person presentations and pharmacologic and psychosocial considerations of the older person.  The content also addressed important adult medico-legal issues relevant to the older person cohort in ED.

Results:

The module is being rolled out across Queensland EDs to coincide with a statewide Frail Older Persons program. Quality indicators will be measured via self-report of clinician knowledge and satisfaction of care provided to this vulnerable cohort.  The module will be incorporated into the statewide Emergency Transition Support Program during its next review and is available for nation-wide health departments via the Queensland Frail Older Persons website.  The content is suitable to be leveraged for other groups including medical officers and allied health clinicians.


Biography:

Erin is an Emergency (ED) Nurse Practitioner (NP) and a Clinical Lead at the Healthcare Improvement Unit, Clinical Excellence Queensland.  With more than eleven years in ED including adult and paediatric tertiary centres and a founding member of two ED outreach teams for Residential Care Facility patients Erin has a special interest in vulnerable groups across the age continuum.  Erin has completed the Masters of Nursing Science, NP, Masters of Emergency Nursing and the International Paediatric Postgraduate Certificate.  Erin has the International Diploma of Humanitarian Assistance (IDHA) and is member of the IDHA 37 Alumni, New York. Erin is a health delegate on the Australian Medical Assistance Team and a sessional academic at Queensland University of Technology.

Nurse initiated sedation in the Emergency Department: Diazepam and Droperidol

Mr Benjamin Learmont1, Mr Benjamin Horan2

1Princess Alexandra Hospital, Brisbane, Australia, 2Princess Alexandra Hospital, Brisbane, Australia

Emergency Departments (EDs) are often sites of impactful occupational violence; impactful on processes, care delivery and staff and patient wellbeing. Evidence suggests that often acutely disturbed patients can be well-managed using pharmacological means [1], but medical interventions can be delayed by patient load and acuity. This presentation will outline the processes one metropolitan tertiary ED used to upskill experienced nurses such that they are able to intervene pharmacologically (as well as behaviourally) in instances of significantly unstable patient behaviour. The capacity of nurses to effectively (autonomously) designate and administer Diazepam and Droperidol in the ED is unusual and under current evaluation – but the lessons learned from gaining such approvals can inform practice change in other EDs. Steps include:

  1. Identified need – Increased aggression and acutely behavioural disturbed patients. Indication to provide an effective and timely approach to violence and aggression within the ED.
  2. Support of a Toxicology Consultant for standing orders including Diazepam and Droperidol
  3. Discussion at departmental medication safety meeting including multidisciplinary inputs from ED Pharmacy, CNC team, medical staff and ED Director.
  4. Development of a proposed standing order and procedure.
  5. Approval from the hospital Drugs and Therapeutic Committee.
  6. Identification of appropriate nursing staff
  7. Development of competency and safety training and education for dissemination to and engagement by authorised staff.
  8. Standing order reviewed yearly.
  9. Ongoing audit and careful research evaluation as part of the trial

These will be discussed and barriers and enablers highlighted, with a view to enhancing capacity and autonomy for senior ED nurses.

  1. Johnston, A.N.B. et al., Interventions for people presenting to emergency departments with a mental health problem: a scoping review. EMA Dec 2018 EMA-2018-475. In press 2019

Biography:

Emergency Nursing for 10 years and has a interest in managing and decreasing occupational violence within the hospital setting. Currently has been working as a ROVE (Response to Occupational Violence Emergency) nurse in the Princess Alexandra Hospital.

Everyone’s a Winner: A design better than we’ve ever done before

Mrs Nerys Brackman1,2

1Queensland Health, Caboolture, Australia, 2The University of Queensland, School of Nursing, Midwifery and Social Work , St Lucia, Australia

Background

The current project has used best practice guidelines, data analysis and site visits to develop planning for an interim extension and a complete new build of a Metropolitan Emergency Department.

Aim

To create an Emergency Department design that focused on improving time to treatment by optimising design and supporting flow whilst continuing to foster the unique staff culture and team dynamics.

Methods

Presentation data was collected from 2015-2017, American analytic firm – Huddy Health Care Solutions was hired by MNHHS as an ED design Consultant to deliver operational and design insights to the hospital design, project and infrastructure team.  Following the collection of analytics and prior to a joint workshop at Caboolture Hospital with Queensland Health architects, three members of the ED Management Team visited five US Emergency facilities recommended by Huddy for their unique design and/or flow. To evaluate each facility and capture design ideas we developed an evaluation tool and used real time video reflective ethnography.

Results

In collaboration with Huddy, architects engaged by Qld Health, ED clinicians, Caboolture project team and Metro North Infrastructure a unique design and patient flow model was delivered.  The design and model of care incorporates a Pivot/Intake model to quickly stream patients to their correct area, decrease frustrating waits and safely manage the largest cohort of ATS 3 patients who have historically waited in an undifferentiated state with the greatest risk of deterioration outside of a clinical space.  Our design has standardised all clinical spaces to allow for greater flexibility based on departmental demand.

Conclusion

Caboolture Hospital Emergency Department is the first ED in Australia to have used the innovation and experience of Jon Huddy. This has allowed us to develop a design which meets our brief of maintaining staff culture, improving flow; and outcomes for our community.


Biography:

My nursing career spans over 25 years within the public sector and I have worked in a variety of clinical settings. I have over 17 years’ front-line experience as an Emergency Department nurse at all clinical levels, often in very challenging clinical and social surroundings, and I fully understand the Emergency Department environment and the pressures that staff face.  My current role is as the Nursing Director of Caboolture Emergency Department, Woodford Correctional Facility and Kilcoy Hospital.   My passions lie in clinical innovation in the developing workplace, team work, integrity and improving patient outcomes.

Decentralising the nurses Station, The mobile nurses Station

Mrs Jane Congdon1,2

1Qld Health, Caboolture, Australia, 2University of the Sunshine Coast, School of Nursing, Midwifery and Paramedicine, Caboolture, AUSTRALIA

Background

The current project examines the mobile nurses’ station impact on workloads for nurses in a metropolitan hospital.  The premise is that if nurses have access to tools to perform their job within proximity to patients they are providing care for, they will spend less time away from patients.

Aim

The broad aim is to evaluate the effectiveness of a mobile nurses’ station in improving patient direct care time and patient flow through the ED.

Methods

Data collection includes a Nurses’ activity follow / time in motion study.  There were three data sets collected from the activity follow pre and post implementation and include the activity follow, step count, and interruption count. The survey was adapted from the productive ward toolkit, containing both quantitative and qualitative data, pre- and post-implementation ANOVA will be used to compare the means of the pre and post paired survey quantitative responses, a P value of greater than 0.005 will indicate statistical significance.

Results

A total of 62 nurses returned completed pre-implementation surveys, and 43 nurses completed the post-implementation survey.

During the activity follows, nurses were tracked for 32 hours in the ED, there was no statistically significant increase in direct care time.  The steps by nursing staff reduced from an average of 864.72 per hour to 548.6 per hour.

Conclusion

The response survey responses data indicated that there was a positive response from staff to the implementation of the mobile nurses’ station.  There was no statistical increase in patient direct care time, however there was a significant reduction in nurses’ superfluous motion activities.  Furthermore, an analysis of the available literature has clearly identified a gap in the research and practice knowledge, there is insufficient data available on the benefits of decentralising the nurses’ station.


Biography:

I completed my Bachelor of Nursing in 2007 at the University of South Australia, I am enrolled in a Master of Health Research at Sunshine Coast University, having submitted a recent application to articulate to a PHD.  I am currently employed as the BPIO at Caboolture Emergency Department and have worked here for the past eleven years.  Diversity in practice is reflected by my employment history, and participation in a variety of projects within the University and Hospital.  My nursing history is patient focused; improving data and performance is centred around improving the situation for the benefit of the patient.

Emergency Nurses’ experience of adult basic and advanced life support workstations as a support strategy for clinical practice in the Emergency Department

Dr Sharyn Ireland1,2, Mr Marc Marquez1, Ms Claire Hatherley1, Ms Nicole Farmer1,2, Ms Bella Luu1,2, Ms Charlotte Stevens1, Dr Eldho Paul3, Professor Biswadev Mitra1,3

1Alfred Hospital, Emergency & Trauma Centre, Melbourne, Australia, 2La Trobe University, School of Nursing & Midwifery, Melbourne, Australia, 3Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University , Melbourne, Australia

BACKGROUND: Basic Life Support (BLS) and/or Advanced Life Support (ALS) knowledge and skills are essential for health professionals working in Emergency Departments (EDs) and across healthcare facilities.

AIMS: To determine the proportion of Registered Nurses (RNs) in the ED who completed a competency assessment in Adult ALS within 6 months of attending a programme to rehearse essential skills for adult BLS and ALS in a safe learning environment; whether RNs who attended found the programme beneficial to increase their knowledge and skills in BLS and/or adult ALS; and whether RNs felt more confident to use the skills and knowledge clinically after attending the programme.

METHODS: Consented participants were invited to complete an on-line evaluation survey of their experience immediately after the programme and at 6-months following the programme.

RESULTS: A total of 143 RNs working in the ED consented to participate in this study. Post-programme surveys were received from 103 RNs; a response rate of 72%. Of these, 62 (60.2%; 95% CI: 50.5-69.1) RNs had completed their annual competency in ALS since completing the programme. The majority of RNs (97.1%) found the programme to be beneficial and 82 (80.4%) reported using the knowledge and skills gained from the programme in their clinical practice.

Immediately after conclusion of the programme, 128 participants returned surveys on their perception of the programme; a response rate of 89.5%. In general, the majority of nurses reported increased knowledge and skills (93.7%), opportunity to practice skills (91.9%) and increased confidence (91.9%) following workstation attendance.

CONCLUSION: Majority of participants successfully completed their annual ALS competency within 6 months of attendance of the workstations. Participants found this programme beneficial and attendance increased ED RN’s knowledge and skills in adult BLS and ALS. RNs report improved confidence to use their knowledge and skills since attending this programme.


Biography:

Marc Marquez is an Associate Nurse Manager at The Alfred Hospital’s Emergency & Trauma Centre, with a background of ten years clinical experience. Marc graduated from Victoria University with a Bachelor of Nursing in 2008. He holds a Master of Nursing (Emergency Care) from La Trobe University and was awarded the 2018 Australasian Emergency Nurse of the Year by the College of Emergency Nursing Australasia (CENA). Marc has recently been involved in a publication entitled “The World Health Organization trauma checklist versus Trauma Team Time-out: A perspective”, which has been published with the Emergency Medicine Australasia in May 2019.  He also serves as a Nursing Officer for the Royal Australian Army Nursing Corps, and has been an active serving member of the Army Reserve for thirteen years. With a strong passion for the development of international healthcare standards, Marc is heavily involved with the Alfred Hospital’s international programs.

Dr Sharyn Ireland is currently a Clinical Nurse Educator at the Emergency and Trauma Centre, Alfred Health. In her role as senior adjunct lecturer for La Trobe University, Sharyn contributes to the education of Emergency Nurses studying at postgraduate level. For the past 20 years, Sharyn has developed and instructed on many programmes involving various levels of simulation. After completing the Harvard Simulation Instructors programme in Boston, United States of America, Sharyn developed an interdisciplinary fully immersive simulation programme to support health professionals locally progress to working in the Resuscitation area of the Emergency and Trauma Centre. In addition, she co-ordinates and co-facilitates a one-day fully immersive programme with a focus on Trauma, delivered multiple times annually.  Her doctorate research investigated hypothermia in trauma. Sharyn has won many awards for her publications in this area and is held in high esteem internationally as she supports researchers in this topic, both nationally and internationally. She is a peer reviewer for multiple journals and is a current instructor at the Centre of Health Innovation teaching 5th year medical students where she has worked for many years.  As part of her Master’s in Education (Monash University), Sharyn’s thesis explored registered nurses’ experience of their annual Advanced Life Support competency. Outside of her professional life, Sharyn enjoys celebrating the lives of her five adult children and particularly loves participating in and contributing to the achievements of her seven grandchildren, often spending time with them on school holidays whilst their parents work.  Sharyn is an avid traveler enjoying snorkeling where ever that may take her. Swimming with whale sharks on the West coast to Manta rays in Bali and recently meeting a moray eel in New Caledonia are just some of her memorable encounters.  Sharyn is looking forward to attending Wagner’s opera Tristan and Isolde in Bayreuth Germany later in 2019.  Sharyn was the recipient of the prestigious Philippa Moore publication prize awarded by the College of Emergency Nurses Australasia in 2011 and more recently in 2018.

Extended Practice Nursing: Advancing nurses scope of practice to meet evolving emergency department demands

Mr Terry Carroll1,3, Ms  Anna  Carison1, Mrs  Trish  Holiday1, Mrs Joanne  Pleban1, Ms  Jayne  Hughan1,, Dr Dianne Crellin1,2,3

1The Royal Children’s Hospital, Parkville , Australia, 2Murdoch Children’s Research Institute, Parkville, Australia, 3The University of Melbourne , Parkville, Australia

Background

Meeting increasing demand for care in the Emergency Department (ED) has required constant innovation and workforce reform. Extending the scope of experienced emergency nurses could provide another opportunity to improve access and quality of care. Experienced emergency nurses have the potential to meet departmental demands providing autonomous care to certain patient presentations without undertaking a nurse practitioner candidacy.

Aim

To develop a pathway for experienced nurses to extend their scope of practice to manage patients with defined presenting complaints.

Innovation Plan

A scope of practice was produced, and core learning objectives identified to guide the development of a 6-month program to support participants obtaining the required knowledge and skills. Education, mentorship and clinical supervision were the foundation of the program. The program and the achievements of the participants were evaluated using several methods. The final objective was ensuring participants achieved proficiency in performing advanced health assessment, procedural skills, diagnostic interpretation and patient disposition decisions.

Data about Innovation

Two senior nurses completed the first six-month program. They achieved proficiency in advanced assessment and procedural skills assisting in managing specific patient presentations . Post-completion these skills are visibly applied in their substantive ED roles. Participants reported the program was extremely challenging, physically taxing but overall rewarding. Both expressed a keen interest to pursue advanced clinical practice roles in the future and would recommend participation in this program to other nurses. Nurse Practitioners who supervised participants reported improved role satisfaction through educating and seeing participant growth. They acknowledged a significant cognitive fatigue associated with providing supervision however valued the mentor relationships they formed.

Conclusion

The participants extended their scope of practice and achieved advanced clinical decision-making skills. It is anticipated that these skills will support them to contribute to improved efficiency and quality of care meeting the increasing demands on the department.


Biography:

Terry is a recently endorsed Nurse Practitioner working at the Royal Children’s Emergency Department. He has a keen interest in advancing the scope of nursing practice to meet service needs and also meet the professional development needs of nurses aspiring to progress in their careers.

Introducing a new model of care for patients presenting to the Emergency Department requiring medical and forensic responses following sexual assault

Ms Keryn Jones, Ms Erica Rootham, Ms Patsy Jang, Karen Lambert, Leannie Tjong

1St George Hospital, Kogarah, Australia

In 2017, the Southern Sydney Sexual Assault Service (SSSAS) was challenged by an inconsistency in access to a suitably qualified medical clinicians to provide a timely and consistent medical and forensic management of adults who are victims of sexual assault.

Historically, adults presenting after sexual assault to the SSSAS were managed by Obstetrics and Gynaecology (O&G) Registrars. Increasingly competing demands for O&G services within the hospital resulted these clients waiting extended periods in the emergency department to be examined and provided care.

Furthermore, in the instance where a client had concurrent injuries such as soft tissue or musculoskeletal injuries, the injury management would be provided by an emergency clinician and the forensic examination/gynaecological management by the O&G team, resulting in fragmented care.

Consequently, an innovative strategy was trialled with the aim of providing a timely, high-quality, consistent and cost-effective service to sexual assault victims presenting within the SESLHD.

The SSSAS in conjunction the St George Hospital Emergency Nurse Practitioners, (EDNP’s) introduced a Sexual Assault Nurse Examiner/Nurse Practitioner (SANE/NP) model of care in November 2018.  The EDNP’s undertook Graduate Certificate training and upon successful completion, began managing these clients in collaboration with SSSAS.

This model differs from the traditional Registered Nurse/SANE model and provides a more comprehensive care episode than that of the previous model.The EDNP’s manage both the forensic examination and medical treatment needs of the clients within their current NP scope of practice.

As a result, the SANE/NP and SSSAS counsellor complete the total care episode and ongoing follow up. They provide holistic and trauma informed care, promoting a seamless approach to the client’s immediate and ongoing medical and psychological needs, reducing client anxiety and increasing emotional safety.

Building the SANE role into the EDNP Scope enables the service to work within the ED model of crisis work.  It is highly innovative and is the first of its kind nationally.

Anecdotal reports by clients of their experiences has been is overwhelmingly positive.  A formal review of the model is planned to commence in November 2019, 12 months after implementation.


Biography:

As an Emergency Nurse for over 20 years, Keryn found her niche as an Emergency Nurse Practitioner in 2006 and hasn’t looked back.  Over her 20 + years in emergency nursing, her roles have included Nurse Educator for Division of Medicine, Nurse Practitioner Masters’ Program Coordinator and Facilitator, Nurse Practitioner Project Officer for the Local Health District and she has collaborated on numerous research publications, local and statewide policies and emergency/trauma care text book chapters.  Despite this, Keryn tries not to be totally consumed by work. She also a lover of good wine and in her spare time can be found hanging upside down not so gracefully on aerial tissu/trapeze, all the while hoping that she does not end up as a patient at her own workplace!

Erica Rootham has worked in emergency departments for the past 17 years both in Australia and overseas. She began her journey to becoming a Nurse Practitioner in 2013, spending time developing her expertise as a TNP with the Geriatric Flying Squad and in the Emergency Department.  Just when she thought her formal study was completed, she found herself in 2018 completing a Graduate Certificate in the medical and forensic management of adult sexual assault.  In her spare time Erica does not enjoy cooking, nor long walks on the beach. She prefers investigating and researching her next travel destinations or watching documentaries.

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.

[1]. https://www.nationalstandards.safetyandquality.gov.au/8.-recognising-and-responding-acute-deterioration


Biography:

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.

Effectiveness of nurse-initiated x-ray for emergency department patients with distal limb injuries: A systematic review

Prof. Julie Considine1, Prof Ramon Shaban2, Prof Kate Curtis3, Prof Margaret Fry4

1School of Nursing and Midwifery and Centre for Quality and Patient Safety Research, Deakin University – Centre for Quality and Patient Safety Research – Eastern Health Partnership, Melbourne, Australia, 2Sydney Nursing School and Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney – Western Sydney Local Health District, Sydney, Australia, 3Sydney Nursing School, The University of Sydney – Illawarra Shoalhaven Local Health District, Sydney, Australia, 4Faculty of Health, University of Technology Sydney – Northern Sydney Local Health District, Sydney, Australia

Background

Emergency nurses are key partners in the delivery of emergency care and the largest emergency care workforce. Emergency nurses have, over many years, expanded their role and scope of practice to meet the needs of patients and respond to rising demands for emergency care. The aim of this study was to systematically review the literature on the effectiveness of nurse-initiated X-ray (NIXR) for emergency department (ED) patients with distal limb injuries. The primary outcomes were X-ray request practices and accuracy. Secondary outcomes were time to X-ray, waiting time, ED length of stay, patient satisfaction and unplanned ED reattendance.

Methods

The review protocol was registered with PROSPERO and CINHAL, MEDLINE, and EMBASE were searched for studies comparing nurse versus physician initiated X-Ray. Due to heterogeneity of patients, providers and outcomes, a meta-analysis was not performed.

Results

The 16 included studies were conducted between 1971 and 2018 and involved 8881 participants. There were 4 randomised trials and 12 observational studies that focused on X-ray request accuracy (n=14), ED processes (n=6) and patient outcomes (n=2). The quality of evidence for each outcome ranged from very low to moderate. Compared to physician initiated X-ray, NIXR uses no more resources, is safe and acceptable to patients. NIXR did not reduce time to X-ray or waiting time but in some studies, reduced ED length of stay and unplanned follow-up.

Conclusion

The evidence related to NIXR is of very low to moderate quality highlighting the need for well-designed randomised controlled trials, in preference to observational studies.


Biography:

Professor Julie Considine is Deakin University’s Professor of Nursing at Eastern Heath, one of Victoria’s largest health care services. Julie has held clinical, education and research roles in emergency nursing over the last two decades and internationally recognised as a leader in research and education in emergency care. Julie has over 180 publications and has attracted over $5.2M in research and project funding. Julie is a Founding Fellow of the College of Emergency Nursing Australasia (CENA), and in 2013 was awarded the Julie Finucane OAM Medal for leadership in emergency nursing and commitment to CENA. She is a Deputy Editor of the Australasian Emergency Care, represents the College of Emergency Nursing Australasia on the Australian Resuscitation Council, and is a member of the International Liaison Committee of Resuscitation Basic Life Support TaskForce.

An observational and simulation study comparing a pivot nurse with traditional triage model for increasing patient flow through the emergency department

Mrs Janine O’keefe1, Mrs Jane  Congdon, Mr Luke Wainwright

1Emergency Department Caboolture Hospital, Caboolture, Australia

Background

Triage is the first point of contact for patients presenting to the Emergency Department (ED), and is one of several processes that can negatively impact patient flow through the department contributing to increased patient length of stay.  ED waiting rooms have been identified as high risk, high liability areas for patients, minimising the time to be seen by a physician correlates with increased patient satisfaction and reduction of risk.

The pivot nurse model involves a quick assessment by an experienced nurse at the point of entry, producing minimal documentation but including chief complaint and Australasian Triage Scale category.  Compared with traditional triage, the primary difference for the pivot process lies in the omission of additional tasks and extensive documentation.

Aim

This submissions aim is to describe the planning and implementation of the pivot nurse model in a regional emergency department and the supportive flow models.

Objective

The pivot nurse at triage has the potential to enhance patient flow in the Emergency Department.

Methods

This observational study measured the time taken for patient triage in an Australian public ED and compared it to a simulated pivot nurse triage model.  We will report on an observational study comparing data from four sources: 1) Retrospective data for ED triage times over one year, 2) Real time observation of the time taken for patients to reach triage from time of entry to ED, 3) Simulation data for triage time using a pivot nurse model and, 4) Real time observation from the implementation of the pivot model.

Results

The pivot nurse simulation saw six times more patients in the same timeframe as the traditional model.

Conclusions

The pivot nurse model may significantly reduce the time that all patients including the critically ill spend waiting to be seen in a busy ED.


Biography:

My current role is the Clinical Nurse Consultant at Caboolture Hospital, Emergency department.  I have been an employee of Caboolture hospital for the past 25 years, 22 of these years have been in the emergency department.  I have witnessed many changes and challenges in the Emergency department over my career.  I have a passion for change management and improving processes to deliver a high standard of patient care whilst promoting a positive work culture for the staff. My qualifications include Bachelor of Nursing, Cert IV in Training and Assessment and more recently successfully completing Advanced Diploma in Leadership.  I recently travelled to the USA with our leadership group to look at models of emergency care; this has assisted in the development of the models of care that we will be introducing at Caboolture.

12