OzEMedicine - Wiki for Australian Emergency Medicine Doctors

see also:

• administrative aspects of Emergency Medicine in Australia
• ED overcrowding and bed access block
• "non urgent" patients in the ED

• in Australia, traditionally, ED's utilise the Australasian Triage Scale (ATS) to appropriately triage emergency presentations so they are seen in a timely manner.
• unfortunately, there are a number of true ED presentations who will be allocated lower priority triage scores of 4 or 5 (see "non urgent" patients in the ED), many of whom will be admitted or require rather brief medical interventions such as an Xray and plaster, but because of their triage score may end up waiting for some hours before receiving their care.
• this has become a particular problem with increasing ED overcrowding and bed access block.
• various “streaming” models have been trialled and the most popular of these has been streaming of “fast track” patients.

• different models will have different criteria for this which best suit the locale
• commonly used inclusion criteria include items such as:
  • likely to require brief medical and nursing attendance times
  • requires ED care (ie. not just a GP-type patient - as this would encourage a flood of patients to ED's)
• commonly used exclusion criteria:
  • do not require an ED cubicle, cardiac monitoring, oxygen or resuscitation
  • severe pain requiring iv opiate analgesia

• single limb injuries such as suspected fractured wrists, ankles, burns
• first trimester pregnancy bleeding (but not severe bleeding or pain which would suggest cervical shock or ruptured ectopic pregnancy)
• hospital in the home patients returning for reassessment or insertion of iv bung