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2009 CENA International Conference for Emergency Nursing
placed on a sign for the curtains of the bed which instructedany external staff or visitors to see the nurse looking afterthe patient before entering the bed space. Enough equip-ment to don appropriate level of PPE was stocked on thetrolleys with extra waste bins and linen skips.
doi:10.1016/j.aenj.2009.08.024
Three Streams are Better
Vanessa Tran1,∗, Rose Chapman2, Shane Combs3
1 Joondalup Health Campus-Emergency Department, Shen-ton Ave, Joondalup, WA 6027, Australia2 Curtin University of Technology, School of Nursing andMidwifery and Joondalup Health Campus, Shenton Ave,Joondalup, WA 6027, Australia3 1 Joondalup Health Campus, Shenton Ave, Joondalup, WA6027, Australia
E-mail address: [email protected] (V. Tran).
The aim of this presentation is to provide an overviewof an initiative to improve patient flow in the EmergencyDepartment. Discharge/Paediatrics streaming was imple-mented as a result of a clinical redesign project at JoondalupHealth Campus.
The department was originally designed to see 25,000presentations, however in 2008 it reached close to 60,000presentations. It was evident that in order to cope with theincrease in presentations an improvement to patient flowwas required.
Due to the demographic surroundings, the departmentsees approximately 22% paediatric patients and approxi-mately 35% minor injuries/illnesses presentations. In 2004Fast Track, a second stream was introduced to see the35% of minor injuries/illness presentations, which improvedpatient flow and reduced waiting times.
The introduction of Fast Track required the addition of 3consultation rooms and a nurse 7 days a week. It is run by aNurse Practitioner in the morning and a nurse and doctor inthe evening.
In addition to Fast Track and to further improve patientflow, Discharge/Paediatrics streaming was introduced. Thisinitiative required an addition of 4 bays and an increase innursing hours of 2 doctor and 2 nurse teams.
The addition of the 3rd streaming, Discharge/Paediatricsnot only improved patient flow but also reduced did notwait’s. A further improvement of the streaming also resulted
in a less congested waiting room.Keywords: Patient flow; Emergency Department; Streaming
doi:10.1016/j.aenj.2009.08.025
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oes type of clinician influence ED fast track perfor-ance?
ulie Considine1,∗, Matthew Kropman2,∗, Helen E Stergiou2
Deakin University-Northern Health Clinical Partnership,chool of Nursing, Deakin University, 221 Burwood Hwy, Bur-ood, V. 3125, AustraliaEmergency Department, The Northern Hospital, Northernealth, 185 Cooper St, Epping, Vic. 3076, Australia
-mail addresses: [email protected],[email protected] (J. Considine).
Emergency department (ED) fast track systems aim tomprove management of patients with non-urgent com-laints by decreasing waiting time and ED length of stayLOS), and increasing patient and staff satisfaction withD care. The aim of this audit was to examine effectf clinician designation on ED fast track performance. Allatients managed in ED fast track at The Northern Hos-ital during 2008 were included (n = 8714). Waiting timesn relation to Australasian Triage Scale (ATS) recommen-ations and ED length of stay for non-admitted patientsere examined for each clinician group: Intern, Junior Med-
cal Officer, Senior Medical Officer, Registrar, Emergencyhysician, Nurse Practitioner and Locum Medical Officer.verall 54.4% of patients (n = 4744) were seen within theirTS time frame: compliance ranged for patients seen by2.5% for Nurse Practitioners to 48.2% for patients managedy Junior Medical Officers. There were 7316 non-admittedatients: patients managed by Nurse Practitioners and Emer-ency Physicians had a significantly shorter ED LOS (M = 1.7 h;= 2.1 h) than patients managed by Junior Medical Offi-
ers and Interns (M = 2.7 h for both groups) (p < 0.001). Theroportion of non-admitted patients with ED LOS less thanh ranged from 95.9% for Nurse Practitioners to 78.9% for
nterns. ED fast track systems function more efficiently whentaffed by senior clinicians however balancing managementf increased demand for emergency care and training ofess experienced medical and nursing staff in care of minoromplaints remains a challenge.
eywords: Fast-track; Nurse practitioner; Emergencyepartment; Performance indicators
oi:10.1016/j.aenj.2009.08.026
he art of streamlining flow—–The impact of innovativeesign, utilisation of expert nursing skills and lean think-
ng
enny Price
Redcliffe Hospital, Australia
Redcliffe is tackling the challenge of managing flow,inimising waiting times and improving client outcomesy implementing care which concentrates resources at thentry point. Efficiency and improved client outcomes arechieved by use of a rapidfocused multidisciplinary model
f care at triage. Experienced nurses and senior medicalfficers ensure that early expert assessment and responseith initial treatment is achieved. Ordering of imaging andathology, ordering and administration initial pain relief and
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escue medications, diagnostic ECG, cannulation and thestablishment of a working diagnosis are elements of theodel.Triage is approached through three tiers. Non-urgent
ases are traditionally triaged and may be sent to the nurseractitioner led fast track area or to the waiting room.
Emergent cases where a workup would be beneficial arerocessed through the Primary Intervention and Triage (PIT)rea. Urgent cases are taken immediately to the resuscita-ion area. Efficiency of flow is supported by the design ofhe triage, PIT and resuscitation bays.
Improved client outcomes, particularly in relation toength of stay, avoidance of near misses, pain managementnd general satisfaction have been achieved. Staff satisfac-ion is high as extended skills are encouraged and utilised.
The art of traditional nurse led triage has thus beennhanced by the addition of a scientific approach.
oi:10.1016/j.aenj.2009.08.027
RAL PRESENTATIONS 2C — Paediatrics & Triage
vidence-based practice translation project in a paedi-tric emergency department: Antipyretic interventionsor children with fever
uth Hollin
Nursing Research Centre, Mater Health Services, Brisbane,ustralia
Background: Fever is frequently seen as the primary indi-ator of illness in children and is the leading reason forresentation to primary care facilities. Benefits of feverre well documented within the literature and best prac-ice guidelines promote the administration of antipyreticsnly as clinically indicated. The routine use of antipyreticsolely to reduce fever is not supported. Further research hashown that currently nursing management of children withevers is inconsistent, ritualistic and belief focussed.
Methods: An evidence-based translation project, usingudit and feedback, was designed to examine the extento which practice achieved evidence-based recommenda-ions for the nursing management of children with fever.he evidence-based audit criteria were extracted fromystematic reviews and guidelines on paediatric fever man-gement. A baseline audit was conducted to identify currentractice, results were analysed and strategies were devel-ped. A post-implementation audit was carried out followinghe implementation of strategies to improve practice.
Results: Improvements in practice were evident follow-ng the second audit. This project has: increased knowledgef fever by healthcare staff and children’s caregivers;ncreased consistency in the care of children with fevery healthcare staff which is now evidence-based; increasedwareness by staff of the translation between theory andest practice and its utilisation at the bedside; identifiedimitations in current documentations within the emergencyepartment.
Discussion: This project has led to the development ofvidence-based resources within the paediatric emergencyepartment for medical and nursing staff as well as chil-ren’s caregivers. During the project several barriers tohe translation of evidence into practice were encountered.
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CONFERENCE ABSTRACTS
urther strategies were implemented to overcome thesearriers. In addition, areas for further research have alsoeen highlighted.
eywords: Evidence-based practice; Fever; Paediatrics;mergency healthcare settings; Health education
oi:10.1016/j.aenj.2009.08.028
he triage encounter from the patient perspective
atarina E. Göransson ∗, Anette von Rosen
Department of Emergency Medicine and Department ofedicine, Karolinska University Hospital, 171 76 Stockholm,weden
-mail address: [email protected] (K.E.öransson).
Triage is the patient’s first encounter with the emergencyepartment (ED). The first impression made during triageay influence the patient’s entire ED visit, and hence the
verall impression. Since few studies have been conductedhere the patient perspective of ED triage is in focus, theurrent study was conducted in order to investigate theriage encounter from the patient perspective.
This descriptive study was carried out in a level onerauma centre in Sweden and included 146 patients seekingare at the ED in March 2008. Patients filled out a question-aire comprising questions about basic patient data such asge and sex, experience of length of and information aboutaiting time, respect of privacy in the triage area and triageurse competence.
The majority of patients perceived that they were triagedmmediately upon arrival to the ED or that the waiting timeas acceptable. Information about waiting times was given
o a limited extent, and the majority of patients felt thathe triage nurse was partly or fully competent to performriage. Nearly all patients felt that they were treated withespect and consideration.
To conclude, patients rated several areas known to bemportant factors for patient satisfaction with ED care asell functioning. However, information about perceivedaiting time was communicated to the patients to a limitedxtent.
eywords: Emergency department; Triage; Patients
oi:10.1016/j.aenj.2009.08.029
‘They just don’t like to wait’’: A comparative study ofboriginal and non-Aboriginal people who do not wait forreatment or discharge themselves against medical advicerom rural emergency departments
eanne Wright
ECCC/Emergency Department, Port Macquarie Base Hospi-al/Kempsey District Hospital, Australia
-mail address: [email protected].
Australian Aboriginals presenting to emergency depart-ents are consistently over reported in urban data that
ooks at those people who do not wait for treatment, or
