None listed
Conditions
Brief summary
Improving public hospital performance and efficiency has become an important health policy priority with the introduction of the National Emergency Access Target initiative. Reducing patient length of stay in the emergency department is an important component of this initiative and various strategies have now been introduced and proposed to try and tackle this problem. One such proposal is improving access to senior clinicians in the emergency department as soon as possible after a patient arrives. A flexible model of senior workup and assessment teams have been implemented at RPAH which consists of an Emergency Physician, Senior Emergency Nurse and Resident Medical Officer with the aim of performing limited and directed patient assessments, initiating treatments and arranging imaging studies and consultations before formal assessment has been completed within the emergency department. These SWAT (Senior Workup Assessment and Treatment) teams are rostered from 10AM to 5PM on days that a SWAT shift can be staffed. The objective of the present study is to evaluate the impact of this clinical redesign on patient length of stay and the ability to discharge or admit a patient from the emergency department within four hours of patient arrival. the results of this quality improvement initiative will be useful in assessing the effectiveness of such models of care and redesigning processes of care in the emergency department.
Interventions
RCT design with shift days randomized to three arms - intervention (SWAT shift), standard care (extra consultant) or control (no consultant). The SWAT shift is the intervention arm in which the consultant will have a specific job role and description aimed at facilitating early assessment and treatment of patients in the Emergency Department (ED). The role of the SWAT doctor is to see patients in an early treatment area, take a very brief history and provide instructions to a nurse and junior do
RCT design with shift days randomized to three arms - intervention (SWAT shift), standard care (extra consultant) or control (no consultant). The SWAT shift is the intervention arm in which the consultant will have a specific job role and description aimed at facilitating early assessment and treatment of patients in the Emergency Department (ED). The role of the SWAT doctor is to see patients in an early treatment area, take a very brief history and provide instructions to a nurse and junior doctor for investigations, consults and likely disposition that the patient will need. These can therefor be started earlier than would have happened had they had to wait to be seen by the next available emergency doctor. If the patient requires a bed, monitoring, or further treatment and investigations they will be moved to the appropriate area for this and their care handed over to one of the emergency doctors in that area to continue and follow up on these. This role will exist for and average of two 7 hour shifts per week for 5 months. We have conformed to CONSORT guidelines for RCT and Clustered trials.
Sponsors
Royal Prince Alfred Hospital
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Blinded (masking used) (Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
16 Years to 100 Years
Healthy volunteers
No
Inclusion criteria
Age >15 years of age No immediate need for resuscitation or cardiac monitored bed Triaged to waiting room, subacute or acute with bed pending Early treatment area (ETA), including patients brought in by ambulance Presenting between 0930-1700
Exclusion criteria
mental health patients paediatric patients triage category 1 patients patients requiring immediate treatment where a resuscitation bay is available Streamed directly to fast track
Outcome results
None listed