16.8 Administration And Management Access Block And Ed Overcrowding

Front 1

What is the definition of "Access Block" ?

Back 1

It is the % of all patients

( Admitted / For Transfer / Dying ) in the ED , where their total ED time exceeds 4 hours.

[ According to new NEAT Targets ]** 2015

It is an "Absence of Flow".

The aim is < 10 %

Front 2

What are the 3 main complications of Access Block ?

Back 2

1. Increased patient

ED Length of Stay. (ED LOS)
2. Increased Patient mortality
3. Increase in Patient "Did Not Wait" rate.

Front 3

There are ED and Hospital Interventions for

improving Access Block.
What are 10 ED Interventions ?

Back 3

1. Structural eg. Redesign ED
2. Staffing eg. Increased Dr / RN / Ancillary Staff
3. Flow eg. Fastrack / Nurse-initiated bloods
4. Short Stay Unit 24 Hour supervision AND discharge
5. Investigations Access eg. On-site radiology and rapid labs.
6. Allied Health eg. 16 hour coverage of Social worker
7. Admission / discharge policies
8. 24 Hour Acute Mental Health Team
9. Aged Care Coordination Team
10. Revision of Ambulance Diversion Policies

Front 4

Which of the following is not a specific

Emergency Department Intervention for

Access Block ?
A. Having a Senior-Supervised 24 hour Short Stay ward.
B. Having 16 hour /day Social worker Coverage.
C. Having Transitional-Care beds.
D. Nurse-initiated imaging / blood tests.

Back 4

C. = Inpatient / Hospital Intervention

eg. Off-Site accommodation ( Medihotel)

Front 5

List the 6 main Inpatient / Hospital

Interventions for Access Block.

Back 5

1. Administrative [ Centralised Bed Mx Service ]

2. Patient care Models [ HITH ; Day Procedure Units ]

3. Medical Assessment / Planning Units .
4. Investigations

[ Adequate 24 hour On-Site Radiology / Pathology ]
5. Transit Lounge / Free Transport
6. Transitional Care Beds ( Off-Site Accommodation )

Front 6

Which of the following is not considered a

Hospital / Inpatient intervention for

Access Block ?
A. Day Procedure Units
B. Centralised bed Management service
C. Overnight discharge for next-day Surgery.
D. Daily bed management meetings.

Back 6

C. Considered more an ED Intervention.

Front 7

(Braitberg)
In regards to Access Block and the Ageing

Population, which of the following is incorrect?
A. Older patients are 4.9 times more likely to require admission to

hospital than patients aged less than 30 years.
B. Older patients average length of stay compared with those aged less than 30 is 3 times longer.
C. There has been a disproportionate increase in the number of Elderly presentations to ED over the last 2 decades.
D. Elderly patients occupy more ED-bed days than the young.

Back 7

B. Older Patients Hospital Average length of stay (LOS) is 6.9 (7) times longer than those aged < 30 years.

Front 8

What has been shown to be the benefits of the "Hospital Admission Risk Program" (HARP) ?

[ 3 main]

Back 8

1. Reduced ED attendances ( 35% fewer)
2. Reduced ED admissions ( 52% fewer)
3. Reduced Hospital Length of Stay (LOS)

( 41% fewer days)