Know the flow: A mixed-method analysis of patient flow through a regional ED

Alex Pryce1,2, Maria Unwin1,2, Leigh Kinsman1,2, Damhnat McCann2

1Tasmanian Health Service, 2University of Tasmania


The equivalent of one in three Australians present to an Emergency Department (ED) in a single 12-month period. The increasing demand for ED care and ED crowding has heightened focus on the movement of patients through the ED (ED patient flow). We set out to map the patient flow through a regional ED in a 300-bed hospital with the aim of recording the movement of patients through the input, throughput, and output phases, and identifying factors contributing to extended ED length of stay.


We undertook a mixed methods study based on retrospective presentation data, prospective observational data and a subsequent focus group with the observers based in a regional Tasmanian hospital ED.


Key findings identified from the retrospective analysis of 89,013 ED presentations and observational data from 382 patient journeys included: arrival numbers were not a predictor of ED crowding; waiting times at triage and in the waiting room created significant risks to patient safety; ED crowding triggers the use of ‘makeshift’ space to assess and treat patients; and access block is the major contributor to crowding. Analysis from the focus group identified four key themes: coping under pressure, compromising care and safety, makeshift spaces, and makeshift roles.


Our mixed methods observational study revealed an environment of crowding and chaos that impacted patient flow and compromised patient and staff safety. Despite this, ED staff maintained outstanding standards of care.

This presentation will highlight key findings and stimulate discussion regarding the need for strategies to address ED crowding that address contributing factors external to ED.


Alex Pryce is a Associate Nurse Unit Manager (ANUM) at the LGH ED. Alex lives in Launceston and enjoys camping with her young family, lego building, mountain biking and running. In her spare time she dabbles in tutoring for the University of Tasmania School of Nursing and assisting in the high fidelity simulation lab for the Launceston Clinical School.

Future Emergency Nursing workforce, what is the evidence telling us?

Mrs Vanessa Gorman1

1The Royal Women’s Hospital, Melbourne, Australia

OBJECTIVE: High nursing turn-over, and low retention rates amongst the field of emergency nursing according to current evidence is a global phenomenon. How is the current evidence influencing managers and organisations to identify key factors that may improve not only retention, but recruitment, into the speciality of emergency nursing?

This study utilised a bibliographic search as well as the authors own experience when performing the integrative review.

26 articles were identified as meeting the criteria of the integrative review. Both national and international articles that met inclusion criteria were included.
4 key themes were identified that may impact on the recruitment and retention of emergency nurses: workplace environment, demands on emergency nurses, resilience, and education and training.
The key themes identified all impact on emergency nurse recruitment and retention, but the evidence is conclusive that a multi-level approach needs to be adopted internationally.

Emergency nursing recruitment and retention is a multi-faceted issue that requires urgent attention to develop tools and strategies to support organizations to build a sustainable workforce. This study has highlighted the need for further studies to understand why emergency nurses lack the knowledge or capability for a long-term career in emergency nursing.


Vanessa commenced her emergency nursing career in 1996 and across her career in emergency nursing she has held positions such as Nurse Unit Manager, Senior Policy Advisor – Department of Health, and State Trauma Manager. Vanessa is the appointed Emergency Services manager at the Royal Women’s Hospital, Melbourne. Vanessa is an appointed member of the International Advisory Council for the Emergency Nursing Association (USA), and is appointed to the CENA membership committee. In 2017, Vanessa was awarded the Australasian Emergency Nurse of the year as she strives to improve emergency care for both patients, and the nursing workforce, through various quality projects.

Exploring interventions used in emergency departments to reduce occupational stressors and or improve staff coping: A scoping review of the literature

Ms Elizabeth Elder1, Dr.  Amy N. B. Johnston2,5,6, Prof. Marianne Wallis2,4, Prof. Julia Crilly2,3

1School of Nursing & Midwifery, Griffith University, Southport, Australia, 2Menzies Health Institute Queensland Griffith University , Southport, Australia, 3Department of Emergency Medicine  Gold Coast Hospital and Health Service , Southport, Australia, 4School of Nursing Midwifery and Paramedicine, University of the Sunshine Coast, Sunshine Coast, Australia, 5School of Nursing Midwifery and Social Work, University of Queensland , Brisbane, Australia, 6Department of Emergency Medicine Princess Alexandra Hospital Metro South, Brisbane, Australia

Introduction: Emergency departments (EDs) are stressful places to work (1). Staff are exposed to many occupational stressors and rely on varying coping strategies (2). Exposure of ED staff to occupational stressors has been linked to increased absenteeism and burnout, higher staff turnover and low staff morale (3). The aim of this review was to examine and synthesize existing evidence relating to interventions designed to reduce the impacts of occupational stressors and/or improve ED staff coping.

Methods: The review involved searching five databases using terms related to stress/or, coping, and emergency department for papers published in English from 2007-2017. Study quality of quantitative studies was assessed using National Health and Medical Research Council Level of Evidence Guidelines (5).

Findings: A total of 45 studies met criteria for review inclusion. The level of evidence of included studies varied from level I (n = 1) to IV (n = 11). Interventions discussed in the literature that targeted occupational stressors included organizational/environmental redesign, policy/protocol change and staff education. Interventions targeted towards improving coping strategies of staff included mindfulness, debriefing and relaxation techniques. Most studies reported some degree of positive effect/s on either reducing exposure to occupational stressors and/or improving staff coping.

Conclusion: This review highlights the limited existing literature relating to interventions designed to ameliorate a wide range of occupational stressors experienced by ED clinicians. The findings of this review support the need for additional research to underpin and guide interventions designed to address occupational stressors and or improving coping strategies used by ED clinicians.


  1. Basu S., et al. Occupational stress in the ED: a systematic literature review. EMJ. 2017;34(7):441-7.
  2. Abraham LJ., et al. Morale, stress and coping strategies of staff working in the emergency department: A comparison of two different-sized departments. EMA. 2018.
  3. Ahwal S. & Arora S. Workplace Stress for Nurses in Emergency Department.
  4. Arksey H. & O’Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol. 2005;8.
  5. National Health & Medical Research Council. NHMRC Levels of evidence and grades. Canberra 2009.


Elizabeth is a credentialed emergency nurse with a passion for education, research and clinical practice.  Believing research is the juncture of clinical practice and academe Elizabeth enrolled in her PhD in 2016.

Staff wellbeing program

Mrs Elizabeth Bradbury1
Clinical Nurse Manager, Melbourne Health, North Warrandyte

The Royal Melbourne Hospital (RMH) is a state-wide trauma service seeing around 78,000 presentations annually. The ED management team recognises staff as our greatest asset and chose to invest in `Caring for the Carers’ by developing a wellbeing program which aligned strongly with our organisational vision to be `First In Care’ and to be an employer of choice.
The ED Leadership team worked in consultation with our the RMH Health & Wellbeing Coordinator to promote Compassion Fatigue workshops in 2017. The aim of these workshops was to increase staff education regarding psychological first aid, identify individual triggers and promote self-care strategies for staff. To compliment our wellbeing program we encouraged our nursing staff to join the MH peer support program, equipping and training this core group with skills to provide `real time’ support and care for clinical staff.
January 2018 marked the introduction of the Wellbeing Dog program which was trialled for 4 months at two days per week in our non-clinical space. The overwhelming response to this trial has now marked a Monday – Friday implementation with feedback from staff stating an increase in morale, reduction in stress and improved staff relationships.
Our ED Leadership Team is committed to the vision of being “First in Care” and an employer of choice. The introduction of our Wellbeing Program aims to promote mental health awareness, minimise the impact of OVA and trauma and implement staff support strategies. At RMH ED we fully acknowledge that these programs do not eliminate the volume, acuity and stress related to Emergency nursing, but we are very clear that we cannot achieve our vision without addressing the needs of the people that provide that care. We believe that we are getting a significant return on our most valuable assets through our innovative investments in wellbeing.

Liz Bradbury has over 30 years of emergency nursing experience. After completing her Post Graduate Emergency Nursing Certificate and a Diploma in Business, has progressed through CNS and ANUM roles and is currently the Clinical Nurse Manager in the Emergency Department at the Royal Melbourne Hospital.
Liz has dedicated years building teams and supportive environments to enhance the professional growth and development of her staff.
Liz has long advocated for a greater focus on wellbeing for Emergency Department nursing staff to support mental health, address the impact of occupational violence and aggression (OVA) and identify enablers for longevity in the emergency nursing role.
Liz has been involved in promoting and supporting departmental wellbeing tools to minimize impact of emergency trauma, Occupational Violence and Aggression (OVA) and aims for RMH ED to be recognised as an Employer of Choice

Breaking nursing silos: A collaborative approach to improving transitional care

Emma Staines1

1Clinical Nurse, Emergency and Trauma Center, Royal Brisbane and Women’s Hospital, QLD

The transfer of patients from emergency to the ward environment is a critical point in the patient’s journey, with wide ranging impacts on patient safety, patient flow, and staff relationships. Poor interdepartmental transitional care and nursing handover are associated with increased adverse events, errors, and poorer patient outcomes. Communication between emergency and inpatient departments must be clear, collaborative, and consistent, in order to ensure patient safety during this transitional point in their care. The Collaborative Care Enterprise (CCE) is a project developed at the Royal Brisbane and Women’s Hospital (RBWH) in 2017, specifically to address the relationship between emergency and inpatient nursing staff.

The CCE has been a collaboration between emergency and inpatient staff, bringing front-line nurses together to discuss issues and concerns related to transitional care, and forge actionable strategies for improved teamwork and patient care. Initiatives of the CCE include conducting education sessions regarding patient flow and scope of emergency care, inviting ward staff for structured walk-throughs of the department to increase understanding of departmental processes, and providing case studies of occasions when the transfer of a patient was concerning to ward staff.

The CCE has provided nurses in emergency and inpatient departments a platform for open dialogue regarding concerns, constructively discuss options for process and policy change, and develop a better understanding of their colleagues work environment. This has resulted in improved relationships and communication between departments, and process changes that have optimised transitional care for patients, such as facilitating ward staff to collect patients from emergency and collect data from the Emergency Department Information System.

Building on the success of the past six month, there are plans for the CCE to expand and incorporate other wards within RBWH, in order to further improve the safety of patients as they are transferred out of the emergency department.


Emma Staines is a Clinical Nurse in the Emergency and Trauma Center at the Royal Brisbane and Women’s Hospital. Emma holds post-graduate qualifications in Acute Care, Immunisation and Emergency Nursing and is currently undertaking her Master’s in Public Health, majoring in Disaster Health and Humanitarian Assistance. For the past year, Emma’s focus has been designing and implementing a quality improvement project targeted toward improving interdepartmental nursing team work, relationships and transitional care. Leading a multi-specialty nursing team, Emma is working toward breaking down departmental silos, turning clinical incidents in transitional care into practical change and thereby developing forward-thinking, professional, evidence-based clinicians.

How to successfully implement transitional research findings into practice in a busy emergency department

Adrienne Ling1
1Royal North Shore Hospital

Back ground:
Approximately 17,000 Australians sustain a fractured neck of femur every year, A 2010 study in Australian Emergency Departments1:
• Only 7% of hip fracture patients received a nerve block in the ED
• Morphine was administered to nearly 60% of patients
• Median time to analgesia of any form was 75 minutes
• Less than 50% of patients had documented pain scores

Other studies have demonstrated that:
• Regional nerve block techniques (RNBs) are more effective than IVI analgesia for managing #NOF pain.
• A Fascia Iliaca Block (FIB) is a type of RNB and patients who have FIBs require significantly less opiate analgesia, potentially reducing risk of delirium.
• FIBs can be safely and effectively performed by registered nurses
• Nurse-initiated FIB early in the patient journey

The focus of this Translational Research project was to implement this proven approach to pain management as a routine procedure. This meant identifying and overcoming various barriers and obstacles

Secondary gains:
Ready-to-use FIB equipment packs were designed. A pre and post FIB checklist on the EMR (FirstNet) system was designed to make documentation streamlined. Charting pain, using the tools Visual Analogue Scale (VAS) and Pain Assessment in Advanced Dementia (PAINAD) for non-verbal and cognitively-impaired patients facilitated the recording of pain scores. Falls patients without #NOF have benefited from the knowledge of PAINAD as an alternative pain scoring tool

Further learning’s:
The eight hour original mixed theory workshops taught by medical staff, is now taught by nurses. Negotiated with anaesthetics re degree of sterility from full sterile gowns to a pair of sterile gloves. Anaesthetising the skin pre insertion of FIB needle abolished. Ropivacaine was low dose 0.2% now changed to full dosage 0.75%.

The FIB assessors have credentialed 32 nurses across two hospitals, no adverse events recorded. The FIB program was deemed successful as a research implementation project.

Adrienne is currently working at Royal North Shore Hospital (RNSH) Emergency Department (ED) as the Clinical Nurse Educator and Clinical Nurse Specialist with 8 years’ emergency nursing experience. Adrienne commenced her nursing carer 16 years ago as an Enrolled Nurse (EN) at St Vincent’s Hospital Sydney while completing her Bachelor of Nursing. Academically she has obtained at her Graduate Certificate in Critical Care and this year has commenced a Masters of Advanced Nursing – majoring in education at the University of Technology Sydney. She is commitment to staff education, development and promotion of evidenced base practice.

Triage of obstetric presentations to the ED. Who are they and how are they triaged? Analysis of an obstetric triage decision aid.

Ms Mary McCarthy1, Dr Wendy Pollock1,2,3, Professor Susan  McDonald1,2
1Mercy Hosptial For Women, Heidelberg, Australia, 2La Trobe University, Bundoora, Australia, 3Melbourne University, Parkville, Australia

Background: Emergency nurses are typically not well-versed in the triage of pregnant and postpartum women. The obstetric triage decision aid (OTDA) was developed to provide structured and standardised triage of pregnant and postpartum women with obstetric and non-obstetric complaints. The validated OTDA consists of 10 common pregnancy complaints with key signs and symptoms, generating an Australasian Triage Scale category based on the targeted questioning responses. The aim of this analysis was to examine the characteristics of obstetric presentation and explore how they were triaged using the OTDA.
Method: In February 2017, the OTDA was introduced to the ED of a metropolitan hospital in Melbourne. New procedures on obstetric triage and support processes were provided to underpin the introduction, and the OTDA was embedded into the ED triage software. Data were extracted for September2017 and underwent non-parametric analysis using SPSS v24. Ethics approval was obtained.
Results: Of the 228 obstetric presentations, ED nurses conducted triage without using the OTDA for 68 (29.8%) women. The majority of presentations were for bleeding and pain in the first trimester (n=29; 43%), of these 21 (72%) were given the equivalent triage score to the OTDA, two (7%) were under triaged and six (21%) had insufficient details to provide a score using the OTDA. Of the presentations for problems over 20 weeks’ gestation (n=24; 35%) only 42% (n= 10) received the same triage score. Seven (29%) were under triaged and 25% (n=6) had insufficient details to give a score in the OTDA. Whilst only six (9%) presentations were in the postnatal period, four (67%) were under triaged and two (33%) received the same score as the OTDA.
Conclusion: The most common pregnancy related problem was early pregnancy bleeding and pain and had the highest concordance with the OTDA score, however under-triage with women over 20 weeks and postnatal problems remained a concern. Under-triage is a known clinical risk and  the OTDA was useful in assisting in the application of a triage score in the ED.

Project lead for the BCV Obstetric triage decision Aid. Is a Registered Nurse/ Midwife, Bachelor of Health Science Nursing, Masters Midwifery. As Manager of the Mercy Women’s Emergency Department has worked extensively to improve the consistency of obstetric triage, customised the Australasian Triage Scale to emergency maternity care and published :“Triage of pregnant women in the emergency department: evaluation of a triage decision aid. EMJ”. Further refinement has produced an Obstetric Triage Decision Aid which has been successfully implemented in both the general emergency setting and maternity unit. In addition has an interest on improving communication in the ED for women who experience early pregnancy loss and developed an evidence base education package for staff who work in the ED.

Fundus Photography in the Emergency Department: Saving lives, sight and time

Dr Hamish Dunn1,2,Ms Julia Costello1,2, Ms Megan Greig1, Mr Jason Montgomery1, Clin A/ Professor  Andrew White1, Dr Matthew Vukasovic1, Ms Alison Pryke1, Ms  Lakni Weerasinghe2, Dr Kai Zong Teo2, A/Prof Clare Fraser2
1Westmead Hospital, Westmead, Australia, 2University of Sydney, Camperdown, 2006

Around the world, Emergency Department’s (ED) are missing up to 13% of patients with clinical signs of blinding and life-threatening pathologies. These missed neuro-ophthalmic and ophthalmic emergencies are avoidable because they are detectable using fundoscopy.

Fundoscopy, looking at the back of the eye, gives a live picture of the brain and blood vessels, revealing critical information including detecting vascular changes, and raised pressure around the brain. However fundoscopy in ED with the direct ophthalmoscope is awkward to use and hard to interpret. A groundbreaking study in Atlanta found ED doctors were only examining 14% of patients who needed fundoscopy and were missing 100% of the pathology which would change their emergency management.

Westmead ED and Ophthalmology Departments collaborated on a research project which implemented the use of a portable non-mydriatic fundus camera (NMC) to take fundus photographs without the need for pupil dilation drops in the ED.

The project recruited a core group of Nurse Practitioners (NP) and doctors to highlight patients needing fundoscopy early in their ED journey, and conduct NMC photography. The photos taken were uploaded to the eMR and reviewed by the Ophthalmology team within 24 hours. The detection of neuro-ophthalmic emergencies by ED improved from 0.06% to 11.9% within two months. The fundoscopy rate improved from 6.4% during the same period the previous year to 89.5% during the trial.

This was the first portable NMC fundus photography program in Australia and demonstrates the value of collaborative fundus imaging for the safety of patients presenting to ED. It lead to rapid translation of evidence-based best practice at Westmead ED.

I am a Nurse Practitioner (transitional) at Westmead Hospital in the Emergency Department (ED). Westmead is an adult tertiary referral hospital in Western Sydney providing expertise in many diverse fields of medical care. One of the largest hospital complex’s in Australia serving a population of over 1.5 million people with one of the busiest ED’s seeing upwards of 65, 000 adult patients each year. My role operates within a multidisciplinary environment working as an advanced clinician primarily from the Urgent Care Centre (UCC) where the majority of the ophthalmic presentations are seen. Eyes are a not-so-secret passion of mine and I have done post-graduate qualifications in Ophthalmology and have previously worked in The Westmead Eye Clinic as well doing formal and opportunistic teaching on the subject of Emergency Eye presentations for both nursing and medical staff. I was the ED clinical lead on the FOTO-ED study.

Making our EDs ‘sharps safe’; Understanding staff attitudes and current use of sharp safety devices

Ms Chantelle  Judge1, Dr Amy N.B. Johnston1,2, Dr Michael  Sinnott1,2, Dr Andy Wong1,3, Dr Rob Eley1,2
1Department of Emergency Medicine Princess Alexandra Hospital  , Brisbane Woollongabba, Australia, 2University of Queensland, Brisbane St Lucia, Australia, 3Queensland University of Technology,, Brisbane , Australia

Introduction: Despite the introduction of a range of safety policies and safer sharps equipment, designed to protect healthcare workers, the rates of percutaneous injuries from occupational exposure to sharps and associated risks of exposure to infectious diseases remains relatively constant(1,2). This has social, professional and economic implications(2). This study focused on a single busy emergency department (ED) and examined types and availability of sharps devices and incidences of inappropriate or unintended uses of sharps to help identify reasons why a clinician might choose a non-safety device over a safety device or an unsafe process over a safer process.
Methods: This mixed methods study used both stock availability audit and thematic analysis of interview data to explore factors that might impact on the risks of sharps injury.
Results: Semi-structured interviews with 30 participants;7 medical and 23 nursing staff, coupled with observational examination of available equipment, identified 3 classes of sharps device in operation; conventional devices (not safe), active (manual) safety devices (relatively safe) and passive (automatic) safety devices (very safe). When focusing on the use of these devices in venipuncture and cannulation, data suggested that most staff did not change, or only changed once, the equipment they used despite provision of newer, safer equipment. Staff identified a range of sharps risks, barriers and enablers to use of safety devices, but these did not appear to influence the procedures they used.
Conclusions: Understanding what ‘sharp’ equipment ED staff use, when they use it and the factors that motivate such usage, can inform development of policies to help reduce the risk and incidence of sharps injury. Culture change and ongoing skills development and practice might help to overcome entrenched procedures and increase voluntary engagement with safer sharps devices as well as to use clinical processes that limit risks of sharps injuries.

  1. Australian Council on Healthcare Standards (ACHS). Australasian Clinical Indicator Report: 2009–2016: 18th Edition. Sydney, Australia; ACHS; 2017.
  2. Pruss-Ustun A, Rapiti E, Hutin Y. Sharp’s injuries: Global burden of disease from sharps injuries to health-care workers. Geneva. World Health Organization. 2003

Dr Amy Johnston currently holds a conjoint senior research fellow/senior lecturer position between Metro South Hospital & Health Service, Department of Emergency Medicine (based at Princess Alexandra hospital) and School of Nursing, Midwifery and Social Work. She works across the academic and healthcare environments to conduct her own research as well as supporting clinicians to develop the skills and confidence to participate in, and conduct research projects relevant to their clinical work. Amy is a neurobiologist and nurse with extensive teaching and research experience and a particular interest in Emergency Department service delivery and patient flow. She also has an enduring interest in the scholarship of clinical learning and teaching, particularly focused on the biosciences. She has been contributing to nursing bioscience teaching for more than 25 years (since the inception of nursing degree programs in Australia).

Stressors and coping strategies of emergency department nurses and doctors: A cross-sectional study.

Mrs Hui (Grace) Xu1,2,3, Dr Amy Johnston2,4,5, Dr Jaimi Greenslade6,7, Professor Marianne Wallis2,8, Ms Elizabeth Elder3, Professor Julia Crilly2,4
1Department of Emergency Medicine, Logan Hospital, Meadowbrook, Australia, 2Menzies Health Institute Queensland, Griffith University, , Australia, 3School of Nursing and Midwifery, Griffith University, , Australia, 4Department of Emergency Medicine, Gold Coast Health, Southport, Australia, 5Department of Emergency Medicine, Princess Alexandra Hospital, Ipswich, Australia, 6Emergency and Trauma Centre, Royal Brisbane and Women’s Hospital, Herston, Australia, 7Faculty of Medicine, The University of Queensland, Herston, Australia, 8School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Sippy Downs, Australia

Background: Emergency Departments (EDs) are stressful workplaces in which to work. Emergency staff are exposed to high levels of stress around excessive workload, and time pressures associated with meeting care time targets (1, 2). In low socio-economic areas, EDs have high demand for GP-like services. Some ED staff experience low job satisfaction and eventually seek leave (3). Little research addresses workplace components that ED staff find stressful and how they cope with such stressors. This study describes perceptions of working environment from ED staff based in a busy ED in a low socio-economic outer-urban region.
Methods: This cross-sectional descriptive study was conducted in 2017 in a public teaching hospital ED in Queensland. Clinical staff responded to the 4-part survey that captured their perceptions of workplace stressors, work environment and coping strategies. Descriptive and comparative data analyses were undertaken.
Results: A total of 161 of the 400 invited nurses and doctors responded to the survey (40% response rate). Respondents were relatively young (median age: 32 years) with a median of three years ED experience. Staff reported high workload, moderate self-realisation, and low levels of conflict and nervousness. Heavy workload, poor skill-mix and overcrowding were ranked as high stress, high exposure (daily) events. The death or sexual abuse of a child and inability to provide optimal care were ranked highly stressful but occurred less commonly. Coping strategies most often used were: trying to keep life as normal as possible; considering different ways to handle the situation; and considering how they handled previous problems.
Conclusion: This young cohort of ED staff, with limited ED experience, are exposed to various levels of modifiable and non-modifiable stressors. This presents challenges and opportunities around promoting positive staff perceptions of this unique working environment and for introducing site-specific interventions in future.

Grace (Hui) Xu is a Nurse Practitioner, academic, nurse researcher and staff wellness advocator in a teaching hospital emergency department (ED) within Queensland Health. She provides emergency care to adults and children who present the ED within the Ambi-Care model of care service. She also works as an academic and research staff member at Griffith University School of Nursing and Midwifery and Menzies Health Institute Queensland. Grace started to develop her research capacities in 2017 with the support of some experienced ED researchers. Her passion in promoting staff wellness drives her interest in becoming a key driver and stakeholder of the Staff Wellness Committee in her ED.

Dr Amy Johnston currently holds a conjoint position between University of Queensland and Metro South ED (based at Princess Alexandra hospital). She works across academic and healthcare environments to conduct research as well as supporting clinicians to develop the skills and confidence to participate in, and conduct research projects relevant to their clinical work. Amy is a neurobiologist and nurse with a particular interest in Emergency Department service delivery and patient flow. Her research experience includes co-authoring in excess of 70 publications, 98 abstracts, and supporting 10 PhD students towards their PhD qualifications.