Emergency department staffing Flashcards
Discuss essentials to consider when planning staffing
1) an emergency department staff structure that is appropraite in numbers and skill mix is required to provide high quality and timely clinical care, while maintaining sustainable working conditions for staff
2) Senior medical and nursing staff have clinical roles that include direct patient care as well as supervision and teaching of junior staff, co-ordination of patient flow and liaison with other clinicians
3) The seniour clinical staff profile should provide protected time for administrative educational and research roles
4) In calculating the staff numbers required it is essential to consider not only the hours of extent of senior cover required but also the volume of the direct clinical and clinical support workload
5) precise number and types of staff required depend on individual and institutional work practices and hospital roles
Discuss aim of staffing for an ED
Treatment goals
-Provide safe, high quality emergency care in an acceptable time according to the patietns clinical urgency
Staff goals
- safe and manageable working conditions
- reasonable job satisfaction.
Discuss staffing and size of ED
Total internal area of the ED should be at least
- 50m2/1000 yearly attendance
- at least 700 m2
Estimated FTE for seniour staff
10 FTE for every 25000 presentation with 1.6 FTE to cover leave
The total size and number of treatment areas are influrenced by
- patient numbers
- growth
- changes in technology
- acuity of illness
- lab and medical imaging turnaround
- inpatient bed access
- staffing number and structure
Briefly discuss layout of SSU
Should have similar facilities to hospital ward
8 beds is considered to be the minimal functional size
there should be minimum of 1 bed per 4000 attendances per year
all beds should be capable of physiological monitoring similar to an acute cubicle
There should be a separate staff station of an appropriate size and an office for the NUM
STAFF
- clinical governance as delegated by ED director
- sufficient number and seniority to provide timely quality care
- supervision of JMO same as on the floow
- Review and handover at least once a shift
Layout
- physically seperate with close proximity to the ED
- Static beds with oxygen and suction
- sepeate beds to the ED bed base
- dedicated staff station
- patient toilet and shower facilities
- appropriate separation of paeds from adults if available
If possible
- infectiout/isolation room with ensuite
- kitchen area
- clean and dirty utility
Briefly discuss layout of SSU
Should have similar facilities to hospital ward
8 beds is considered to be the minimal functional size
there should be minimum of 1 bed per 4000 attendances per year
all beds should be capable of physiological monitoring similar to an acute cubicle
There should be a separate staff station of an appropriate size and an office for the NUM
STAFF
- clinical governance as delegated by ED director
- sufficient number and seniority to provide timely quality care
- supervision of JMO same as on the floow
- Review and handover at least once a shift
Discuss admission criteria for SSU
Inclusion
- clinically stable
- expected LOS 4-24 hours
- lower to moderate risk symptoms
- clear documented management and disposition plan endorsed by a senior clinician
Exclusion
- clinically unstable
- anticipated LOC >24 hours
- admitted under inpatient team or was trnasferred to the hospital for admission under the inpatient team
- undifferentiated or unclear plan
- ssu admission of the sole purpose of meeting time based targets
- complex care needs or exceeds avaiable SSU resources (e.g need for telemetry)
Tox
- appropriate with support of tox service
- LOS may be extended in accordance with anticipated toxidrome
ACEM does not support the use of ED SSU as a way to ameliorate ED overcrowding and access block
Discuss KPI of SSU
1) <15% patient transferred to the inpatient ward
2) <10% LOS >24 hours
3) monitor % with combined ED + SSU LOS <4hours
4) patients with SSU LOC <1hour have documentation confirming appropriate admission and care provided
