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What can we do?

We need to acknowledge the severity of access block and its impact on patient care and staff

It is unsustainable for emergency clinicians to work in an access-blocked, overcrowded and under-resourced environment. In the COVID-19 era, there can be no tolerance for over-capacity hospitals, overcrowded emergency departments, and ramped ambulances. From 2011-12 to 2018-19, emergency department presentations increased by 14 per cent and admissions from the emergency department into an inpatient ward increased by 25 per cent. The number of available public hospital beds decreased by five per cent.

We need to improve data and information sharing, to provide an evidence base that informs the best destination for the patient at any point in time.

Access block is not new. For more than a decade, acute care access failures such as extensive wait times for admission due to access block has frequently resulted in poor health outcomes for patients presenting to the emergency department. Access block prevents others from receiving the timely care they need and creates unnecessary burdens and costs for the healthcare system.

We need system-wide assessment of the patient journey, with a commitment to redesigning processes to ensure patients to do not become ‘stuck’ at any point of their healthcare journey.

It has been conclusively demonstrated that positive changes can occur when a whole-of-system approach is taken to address access block. Long-term strategies are needed to provide coordinated care not only for people presenting to emergency departments, but also for vulnerable populations in the community.

Hospital Access Targets

ACEM has developed ‘Hospital Access Targets’, a new access measure that describes three patient streams and sets distinct targets for those streams. Hospital Access Targets are intended to reflect the complexity of patient needs and the diverse pathways patients may take following attendance at emergency department. The maximum length of emergency department stay recommended by Hospital Access Targets for any one stream is 12 hours.

For patients needing to be admitted to hospital or transferred to another hospital:

  • ≥60% should have an emergency department length of stay no greater than four (4) hours;
  • ≥80% should have an emergency department length of stay no greater than six (6) hours;
  • ≥90% should have an emergency department length of stay no greater than eight (8) hours; and
  • 100% should have an emergency department length of stay no greater than twelve (12) hours

For discharged patients:

  • ≥80% should have an emergency department length of stay no greater than four (4) hours;
  • ≥95% should have an emergency department length of stay no greater than eight (8) hours; and
  • 100% should have an emergency department length of stay no greater than twelve (12) hours.

For patients who need to be admitted to a short stay unit (SSU) for observation:

  • ≥60% should have an emergency department length of stay no greater than four (4) hours upon SSU admission;
  • ≥90% should have an emergency department length of stay no greater than eight (8) hours upon SSU admission; and
  • 100% should have an emergency department length of stay no greater than twelve (12) hours upon SSU admission.

Contact

ACEM Policy Team
61 (3) 9320 0444
[email protected]

ACEM Media Team
Andrew MacDonald, Manager - Media Relations
+61 3 8679 8813 or +61 498 068 023
[email protected]

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