Emergency Department Review

Our commitment to improving care

One of the most important areas of focus for the Department of Health is the provision of care via Tasmania’s four major hospital Emergency Departments (EDs).

On 12 September 2023, the Minister for Health, announced an independent review into the operation of Emergency Departments at all four major hospitals in the state: (Major Tasmanian Hospital Emergency Department Review to Improve Patient Access and Flow).

This review is being carried out by an independent panel and the intent and purpose of this review is to independently examine the policies, protocols, systems, and culture to support safe, high quality, efficient, effective, and timely patient access and flow within the four major hospitals. 

Focus areas

As part of the ongoing review to tackle the long-term challenges relating to patient process and flow in Tasmania’s Emergency Departments and wider hospital system the Independent Panel has set out three key focus areas:

1. Organisational culture and management
2. Decision making and accountability
3. Demand Management 

Interim recommendations

In December 2023, the Independent Panel provided a set of interim recommendations with milestones and completion dates set for the first half of 2024.

The action plan also identifies the interface between EDs and the wider hospital system, and outlines actions and performance targets that will support the timely transfer or discharge of patients from hospitals, by ensuring early identification, intervention, and management of barriers using a range of evidence-based strategies. 

These include:

Implement best practice admission and discharge care.

• Each patient/client/carer will receive an estimated discharge date (EDD) on admission (within 24 hours).
• Increase number of overnight patient/clients discharged between 10:00am and 12:00noon.
• Implement Statewide Transit Lounge Policy that provides a principles approach to optimising the use of Transit Lounge. 
• Re-invigorate Criteria Led Discharge program.

Optimise the safe flow of patients to their next care environment, reducing unnecessary presentation OR length of stay in the emergency departments.

• Cease medically stable intra-hospital and health service transfers (including outpatient departments) being transferred through the ED through the implementation of the Inter-Hospital Transfers (IHT) Policy.
• Statewide Admission from Emergency Departments Policy to be operationalised (including Interim Inpatient Management Plans to be in place across all facilities) and compliance monitored.

Care of low acuity patients arriving by ambulance.

• Implement Emergency Department direct to waiting room pathway to proactively manage demand by considering the appropriateness of Transfer to the Waiting Room for low acuity patients.

Care of older people in residential aged care.

• Focus all In-Reach care programs on the highest admitting Residential Aged Care Facilities (RACFs) to improve the model of care and support care in place.
• Aim to provide alternative methods for assessment, care, and management for aged care residents.

Optimise patient care and workload distribution through a comprehensive review of acute medical admitting process and ongoing referral to subspecialities including aged care.

• Any revised Model of Care should consider re-distribution of staff to allow extended hours care and to meet current and anticipated service demands.
• Any new roster arrangements (if required) should consider re-distribution of staff to ensure appropriately skilled staff are available 24/7 and to meet anticipated service demands.

The Department of Health is committed to ensuring every Tasmanian receives the right care, in the right place, at the right time, and extensive work is already underway to ensure these recommendations are enacted within the established timeframes.

Download a copy of the Interim Action plan

Download a copy of the Interim Action Plan (full) 

Methodology

The independent review panel places a strong focus on evidence-based strategies that are readily in use across hospital and health services to support discharge planning and the safe flow of patients to their next care environment which helps to reduce unnecessary presentations or length of stay in the emergency departments.

By adopting a mixed methodology approach to the review, the panel has been able to identify the breadth and range of the issues impacting demand management across Tasmania’s health services.

Next steps

The Independent Panel will continue to undertake their work and are expected to publish a full set of informed recommendations in early 2024.

In addition to the independent review the Department of Health is undertaking a system-wide approach to addressing patient access and flow challenges at our hospitals. 

This includes increased bed capacity, recruitment of hundreds of additional staff each year, direct admission pathways where appropriate, and delivering more alternatives to attending hospital Emergency Departments by investing in community and primary health care.

Further details will be published here in future.