Releasing the Metropolitan Emergency Department Access Initiative report by tabling it in Parliament, Minister Springborg confirmed that all fifteen recommendations would be adopted by the Government to improve the flow of patients through the Emergency Departments of Queensland hospitals.
“When the new arrangements are implemented, hospital bypass will be a thing of the past,” Minister Springborg said.
Ambulance ramping occurs when there are no immediately available beds or treatment areas in the Emergency Department to transfer patients arriving by an arriving ambulance. It leads to what is commonly known as bypass, where ambulances are re-directed to other Emergency Departments.
“The report makes it clear that simply going on bypass, which is effectively diverting a patient to another facility, is an unacceptable mechanism for managing demand on Emergency Departments,” the Minister said.
“Addressing ambulance ramping and hospital bypass requires a ‘whole of hospital’ approach to improving the flow of patients through the entire facility, not just the Emergency Department. These recommendations will make those changes happen.
The report’s recommendations will be implemented by Queensland Health, and Minister Springborg indicated he had written to the Chair of each Hospital and Health Board to confirm the Government’s commitment to addressing the issues raised by the report.
The report was commissioned by Queensland Health and prepared by Dr David Rosengren, the Director of Emergency Medicine at Greenslopes Private Hospital and a Senior Staff Specialist Emergency Physician at the Royal Brisbane and Women’s Hospital.
The Queensland Ambulance Service, numerous other clinicians with emergency medicine expertise, paramedics, unions and agency representatives – at both senior executive and operational levels – also had input into the report.
“This Government recognises that access to the Emergency Departments of Queensland’s hospitals is a key indicator of how the health system is performing,” the Minister said.
“By adopting a whole-of-hospital approach as recommended by the report, we will be improving the efficiency of our facilities and delivering faster, more appropriate care to the patients of Queensland.
A copy of the report is available on Queensland Health’s website at www.health.qld.gov.au under What’s New.
- RECOMMENDATION 1 – Each Hospital and Health Service provide a 24-hour single point of non-ED Executive Director level (or higher) contact for the QAS on ED access issues.
- RECOMMENDATION 2 – Queensland Health includes a key performance indicator relating to Patient off-Stretcher Time (POST) in future Service Level Agreements for Hospital and Health Services.
- RECOMMENDATION 3 – Queensland Health reviews the current hospital capacity escalation framework and mandate implementation by 1 January 2013.
- RECOMMENDATION 4 – Queensland Health review the role of the Emergency Capacity Hospital Overview (ECHO) and internal ED capacity (SAPhTE) scores.
- RECOMMENDATION 5 – Patient flow and bed management strategies are implemented into all Queensland public hospitals and each Hospital and Health Service must demonstrate active use of same.
- RECOMMENDATION 6 – As at 1 January 2012 no hospital will have the authority to divert ambulances (activate ambulance bypass) to another hospital.
- RECOMMENDATION 7 – QAS is responsible for ambulance load share into emergency departments.
- RECOMMENDATION 8 – Triage must occur on arrival.
- RECOMMENDATION 9 – The i ntroduction of senior level Clinical Initiative Nurses to the waiting room of all major EDs.
- RECOMMENDATION 10 – Patients are not to return to the back of an ambulance post triage.
- RECOMMENDATION 11 – Queensland Health and QAS introduce formal education modules into respective mandatory training ensure QAS paramedics and Queensland Health triage staff have a clear understanding of each other’s role and scope of practice.
- RECOMMENDATION 12 – That a Patient off Stretcher Time (POST) Policy directed at ensuring the time from arrival to clinical handover from QAS to the hospital is less than 30 minutes, be reviewed and implemented as a mandatory directive from Queensland Health by 1 January 2013.
- RECOMMENDATION 13 – QAS review the role of the QAS Hospital Liaison Officer (HLO), to optimise its contribution in the environment created by implementation of these recommendations.
- RECOMMENDATION 14 – Development of an Inter-hospital transfer Directive wh ereby patients not requiring specialist emergency medical care do not transit through the ED.
- RECOMMENDATION 15 – Establishment of a high-level Emergency Services Management Committee (ESMC) to provide policy advice to the Minister on issues affecting consumer access to (and delivery of) public hospital emergency and monitor implementation of the MEDAI recommendations.