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Ambulance Victoria Arrivals – Patient Flow Processes

This document provides a summary of best practice in relation to Ambulance arrivals and patient flow processes. The summary has been created to support staff during the Sunshine Hospital Emergency Department Redevelopment transition and early post-move period, and has been endorsed by the ED Leadership Team.

Overview

This QRG aims to provide guidance on the flow and movement of patients through the department that arrive by Ambulance. In particular the QRG provides specific guidance on:

  1. Transferring patients from AV/AV triage and placing them in the SHED ambulatory waiting room.
  2. Treatments that can be appropriately initiated in the AV triage corridor.
  3. Offloading patients and utilisation of the SHED AV Offload Cubicles.
  4. Offloading patients and utilisation of the Behaviour Assessment Unit (BAU) including Behaviour Assessment Rooms (BARs) and The Hub.

Applicability

This QRG applies to SHED and provides a framework to enable consistency and standardisation of Access and Flow issues in an effort to utilise both internal and external resources appropriately and the commencement of safe treatment.

Responsibility

It is the responsibility of the ED NUM’s and Medical Directors to ensure all relevant staff are appropriately orientated and educated to the content of this QRG and their respective responsibilities.

Guideline/Process Details

Transferring patients from AV/AV triage and placing them in the SHED ambulatory waiting room.

Table 1 details the cohorts of patients who should not be transferred to the wait room, when arriving via Ambulance.

Table 1: Ambulance arrival offload to the wait room exclusion criteria.

EXCLUSION CRITERIA
·         ATS CAT 1 or 2

·         Requires cardiac monitoring or regular observations (e.g. Post ictal < 2hrs or episodes of hypotension)

·         Severe pain requiring IV analgesia and not suitable for a chair (e.g. Possible # femur, severe back pain or unable to sit in a chair)

·         Risk of absconding unless deemed safe by EMH or senior doctor

·        Vulnerable if unsupervised in waiting room (e.g. dementia, nursing home patients, children without parents/guardians)

Treatments that can be appropriately initiated in the AV triage corridor.

  • Collection of pathology
  • Insertion IVC
  • ECG – in BOC room
  • Simple/oral analgesia
  • Oxygen therapy (with AV staff)
  • Cardiac monitoring (with AV staff)
  • Vital signs and / or Head injury observations
  • BOC observations

Offloading patients and utilisation of the SHED AV Offload Cubicles

The SHED AV Offload Cubicles are intended to be rapid turnover cubicles that facilitate the departments patient streaming model of care. The cubicles can only be utilised by patients who arrive via Ambulance.

Patients Inclusion / Exclusion Criteria:

INCLUSION

  • Stable Vulnerable patients that cannot be offloaded into waiting room e.g. NH, Elderly (See Table 1)
  • Patients requiring urgent IV analgesia e.g. renal colic, back pain or suspected #’s that are unsuitable for WR
  • Others as deemed appropriate after consultation with NIC and/or Senior Medical officer

EXCLUSION

  • ATS Category 1 or 2
  • Patients with triage assessment observations in UCR/MET call criteria or BOC score >0 (Certain cohorts of patients can be deemed suitable post review by Senior medical officer and ECG review e.g. tachycardia – gastro/hyperemesis for IVT)
  • Mental Health clients
  • On-going chest pain requiring dynamic cardiac monitoring
  • Patients with management/care plans that would exclude them – e.g. behavioural contracts
  • Patients currently located in Triage waiting rooms

Communication pathway prior to offload – being mindful of AV Offload 40/60 KPI:

  • NIC will contact AV triage nurse and discuss appropriateness surrounding offload of a certain patient currently in AV corridor.
  • If deemed appropriate the AV Triage Nurse will liaise with AV Offload Nurse and direct AV crew with agreed cubicle space.
  • The AV Offload Cubicle Nurse is to continually communicate with the NIC regarding movement and flow through the AV Offload Cubicles.

Length of Stay in AV offload cubicle space

  • These cubicles are a temporary location for patients and ideally the LOS should not exceed 60 minutes.

AV Offload Cubicles

  • Cubicle 33 – 35 (1 nurse)
  • Cubicle 36 – 38 (1 nurse)
  • Cubicle 39 – 41 (1 nurse)

Offload into the Behaviour Assessment Room

The Ambulance Triage Nurse will liaise with the BAU & Resus ANUM/Team Leader regarding the suitability of offloaing patients into this area. Patients requiring:

  • mental health assessment with acute behaviour management concerns
  • chemical and mechanical restraint in the Behaviour Assessment Rooms
  • an immediate assessment by a mental health clinician
  • Section 351, Assessment Order, Temporary Treatment Order and Varied Treatment Order patients requiring closer supervision or at high risk of absconding

Supporting Documents

Document Governance

Title: Ambulance Victoria Arrivals – Patient Flow Processes
Version: 2.0
Date Published: June, 2022
Date of scheduled review: 01/06/2023
Author:  Approver: 
ED Leadership Team ED Leadership Team

 

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