22 August 2016

What can you do to improve patient flow in your Emergency Department?

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The Royal Melbourne Hospital is Victoria’s second largest public health service. The hospital receives more emergency ambulance transports than any other hospital in the state. Last year, there were a total of 65793 patient attendances and close to 30000 inpatient admissions seen at the hospital. Therefore, a new model of care was designed and implemented to improve patient flow with the ED.

Professor George Braitberg, Director of Emergency Medicine at the Royal Melbourne Hospital recently sat down with us to share some of the hospital’s successful implementations, particularly, the newly created 6 bed behavioural assessment unit to cater for the care of substance affected patients and mental health problems.

Please give a brief overview of what your session will cover at Improving Patient Flow in Emergency Departments 2016?

The Behavioural Assessment Unit (BAU) was designed to improve the care of patients with acute behavioural disturbance due to any cause; mental health, dual diagnosis, drug usage, acute drug toxicity and/or psychosocial problems. The area is nursed appropriately to care for patients post chemical restraint, post overdose and all staff are trained in de-escalation techniques. Our emergency mental health clinicians and addiction medicine clinician have been co-located in the unit.

The unit improves flow by freeing up general ED cubicles for this challenging cohort of patients. By providing monitoring facilities and ALS trained nurses patients do not spend long periods of time in resuscitation and monitored ED cubicles. In addition police and paramedics can take appropriate patients directly to the area and bypass an ED cubicle altogether.

What do you consider to be the key focus areas for development in your area of patient flow and patient centred models?

BAU facilitates a team approach to a challenging but increasing cohort of patients. The unit is designed around patient needs, taken from the “behavioural” perspective not the diagnosis.

What are the main challenges in these areas of development?

The main challenge was to ensure there was a collective understanding of the aims of the unit and in particular what it was not – it was not a secluded mental health ward or a psychiatry unit.

What are your priorities for the 6-12months ahead?

Bed down the unit – ensure that the appropriate cohort is consistently identified and staff are confident to move patients into the area from triage.

What will be the key takeaways from your session?

How to transition from a thought bubble to a new model of care.

Professor Braitberg will be speaking at Akolade’s Improving Patient Flow in Emergency Departments Forum being held on the 28th-30th September 2016 in Melbourne.


Don’t miss his practical case study on examining the success of 6 newly created bed behavioural assessment units as he shares with us how to improve quality and safety of patients, develop and encourage strategic relationships, and foster a culture of innovation.

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