Mapping workforce configuration and operational models in Australian emergency departments: a national survey
Glenn Gardner A H , Anne Gardner B , Sandy Middleton C , Julie Considine D , Gerard Fitzgerald E , Luke Christofis F , Anna Doubrovsky A , Margaret Adams A and Jane O’Connell GA School of Nursing, Institute of Health and Biomedical Innovation, Queensland University of Technology, Victoria Park Road, Kelvin Grove, Qld 4059, Australia. Email: anna.doubrovsky@qut.edu.au; m5.adams@qut.edu.au
B School of Nursing, Midwifery and Paramedicine, Australian Catholic University, PO Box 256, Dickson, ACT 2602, Australia. Email: anne.gardner@acu.edu.au
C Nursing Research Institute, St Vincent’s Health Australia (Sydney) and Australian Catholic University, Level 5, DeLacey Building, St Vincent’s Hospital, Darlinghurst, NSW 2010, Australia. Email: Sandy.Middleton@acu.edu.au
D School of Nursing and Midwifery, Deakin University, 1 Gheringhap Street, Geelong, Vic. 3220, Australia. Email: julie.considine@deakin.edu.au
E School of Public Health and Social Work, Queensland University of Technology, Victoria Park Road, Kelvin Grove, Qld 4059, Australia. Email: gj.fitzgerald@qut.edu.au
F Emergency Department, Lyell McEwin Hospital, Oldham Rd, Elizabeth Vale, SA 5112, Australia. Email: Luke.Christofis@health.sa.gov.au
G School of Nursing, University of Technology Broadway, 15 Broadway, Ultimo, Sydney, NSW 2007, Australia. Email: Jane.OConnell@uts.edu.au
H Corresponding author. Email: ge.gardner@qut.edu.au
Australian Health Review 42(3) 340-347 https://doi.org/10.1071/AH16231
Submitted: 19 October 2016 Accepted: 14 March 2017 Published: 18 May 2017
Journal compilation © AHHA 2018 Open Access CC BY-NC-ND
Abstract
Objective Hospital emergency departments (ED) in Australia and internationally have been experiencing increased demand, resulting in reduced hospital quality, impaired access and adverse health outcomes. Effective evaluation of new ED service models and their effect on outcomes is reliant on baseline measures of the staffing configuration and organisational characteristics of the EDs being studied. The aim of the present study was to comprehensively measure these variables in Australian EDs.
Methods Australian hospital EDs with 24-h medical and nursing cover were identified and invited to participate in the study. Telephone interviews were conducted with nursing or medical department managers to collect data related to hospital characteristics, ED workforce and training and ED service and operational models.
Results Surveys were completed in 87% of the population sample (n = 135). Metropolitan EDs were significantly more likely to retain higher full-time equivalents (FTEs) in several medical (staff specialist, registrar, resident and intern) and nursing (nurse practitioner (NP), nurse educator, nurse unit manager and registered nurse) positions. NPs were employed by 52% of Australian EDs overall, but this ranged from 40% to 75% depending on jurisdiction. The most commonly used operational models were FastTrack teams (72% of EDs), short-stay/observational unit (59%) and patient liaison models for aged care (84%) and mental health (61%). EDs that employed NPs were significantly more likely to use FastTrack (P = 0.002). Allied health services most frequently available within these EDs were radiology (60%), social work (69%), physiotherapy (70%) and pharmacy (65%).
Conclusions The present study has established a baseline measure of the staffing configuration and organisational characteristics of Australian EDs.
What is known about the topic? EDs are overcrowded due, in part, to the combined effect of increased service demand and access block. Innovative service and workforce models have been implemented by health departments aiming to improve service and performance. National uptake of these service and workforce innovations is unknown.
What does this paper add? The present study is the most comprehensive to date profiling Australian EDs covering hospital characteristics, workforce configuration, operational models and NP service patterns and practice.
What are the implications for practitioners? Information from the present study will assist health service planners to evaluate workforce and service reform models, and to monitor trends in emergency service development.
Additional keyword: models of care.
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