ADMIN/NON MEDICINE
DNW
PromptKey aspects of DNW management to include in protocol
ResponseEarly notification of senior medical staff
Daily audit of DNW by senior MO
Identification of high risk patients
Attempts to contact patient to ensure care has been sought
Notification of referring doctor if DNW
Documentation of alternate care options provided to pt
Daily audit of DNW by senior MO
Identification of high risk patients
Attempts to contact patient to ensure care has been sought
Notification of referring doctor if DNW
Documentation of alternate care options provided to pt
PromptContributors to DNW
ResponseWaiting time
Overcrowding
Low SWS
Arrival after hours
Young adults
Parents with young children
Less urgent triage categories
NESB
Overcrowding
Low SWS
Arrival after hours
Young adults
Parents with young children
Less urgent triage categories
NESB
PromptPatient based reasons why patients do not wait to be seen
ResponseReason for attendance resolved
Feel their problem is inappropriate for ED
Perceived triage ineqety
Other activities prioritised over healthcare
Too adgitated/anxious to wait
Prolonged wait times, Rude ED staff (? not patient based)
Feel their problem is inappropriate for ED
Perceived triage ineqety
Other activities prioritised over healthcare
Too adgitated/anxious to wait
Prolonged wait times, Rude ED staff (? not patient based)
PromptStrategies to minimise DNW discharges
ResponseEducation – Ready access to information about triage process/what to expect
Comfort – toilets, vending machine, TV
Communication – about wait times, clear escalation
Policy for concerned pts/change in condtion
Assessment + treatment – Nurse initiated analgesia, XR, Dedicated WR Nurse +/- MO
Frequent re-evaluation of triaged patients
Decrease overcrowding, direct admission to short stay unit, hospital wide to decrease access block.
Reduce waiting times
Ongoing communication with waiting patients
Manage expectations of waiting pts
Information provided about alternate ways to seek care
Relatives/friends able to wait with pt
Physical layout of waiting room – high risk pts visible
Comfort of waiting area – TV/vending machine etc.
Internal waiting areas for high risk patients (Stream to FT)
Comfort – toilets, vending machine, TV
Communication – about wait times, clear escalation
Policy for concerned pts/change in condtion
Assessment + treatment – Nurse initiated analgesia, XR, Dedicated WR Nurse +/- MO
Frequent re-evaluation of triaged patients
Decrease overcrowding, direct admission to short stay unit, hospital wide to decrease access block.
Reduce waiting times
Ongoing communication with waiting patients
Manage expectations of waiting pts
Information provided about alternate ways to seek care
Relatives/friends able to wait with pt
Physical layout of waiting room – high risk pts visible
Comfort of waiting area – TV/vending machine etc.
Internal waiting areas for high risk patients (Stream to FT)
PromptHigh risk presentations for adverse outcome in DNW
ResponseMH (high % of DNW)
Children (High % of DNW)
D+A intoxicated
High risk presentations (Chest pain, head injury, Sepsis criteria)
High triage categroeis
GP concern
Children (High % of DNW)
D+A intoxicated
High risk presentations (Chest pain, head injury, Sepsis criteria)
High triage categroeis
GP concern
Prompt2 groups who commonly don’t wait to be seen
ResponseChildren
MH patients
MH patients
PromptManagement once DNW
ResponseAlternatives to care – GP/urgent care/telehealth
Liaon team to follow up
Regular audits + KPI’s benchmarking
Liaon team to follow up
Regular audits + KPI’s benchmarking