Gardner Glenn, Gardner Anne, Middleton Sandy, Considine Julie, Fitzgerald Gerard, Christofis Luke, Doubrovsky Anna, Adams Margaret, O'Connell Jane
School of Nursing, Institute of Health and Biomedical Innovation, Queensland University of Technology, Victoria Park Road, Kelvin Grove, Qld 4059, Australia. Email:.
School of Nursing, Midwifery and Paramedicine, Australian Catholic University, PO Box 256, Dickson, ACT 2602, Australia. Email.
Aust Health Rev. 2018 Jun;42(3):340-347. doi: 10.1071/AH16231.
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.
目的 澳大利亚及国际上的医院急诊科面临的需求不断增加，导致医院服务质量下降、就诊不便及不良健康后果。有效评估新的急诊科服务模式及其对结果的影响，依赖于对所研究急诊科人员配置和组织特征的基线测量。本研究的目的是全面测量澳大利亚急诊科的这些变量。方法 确定有24小时医疗和护理服务的澳大利亚医院急诊科，并邀请其参与研究。与护理或医疗部门经理进行电话访谈，以收集与医院特征、急诊科工作人员及培训以及急诊科服务和运营模式相关的数据。结果 在87%的抽样人群（n = 135）中完成了调查。大都市的急诊科在几个医疗岗位（专科医生、住院医师、实习医生和实习生）和护理岗位（执业护士、护士教育工作者、护士长和注册护士）保留更高全职等效人员（FTE）的可能性显著更高。总体而言，52%的澳大利亚急诊科聘用了执业护士，但根据辖区不同，这一比例在40%至75%之间。最常用的运营模式是快速通道团队（72%的急诊科）、短期住院/观察单元（59%）以及老年护理（84%）和心理健康（61%）的患者联络模式。聘用执业护士的急诊科使用快速通道的可能性显著更高（P = 0.002）。这些急诊科最常提供的辅助医疗服务是放射科（60%）、社会工作（69%）、物理治疗（70%）和药房（65%）。结论 本研究建立了澳大利亚急诊科人员配置和组织特征的基线测量。关于该主题已知的情况是什么？急诊科过度拥挤，部分原因是服务需求增加和就诊障碍的综合影响。卫生部门已实施创新的服务和人员模式，旨在改善服务和绩效。这些服务和人员创新在全国的采用情况尚不清楚。本文补充了什么？本研究是迄今为止对澳大利亚急诊科最全面的描述，涵盖医院特征、人员配置、运营模式及执业护士服务模式和实践。对从业者有何影响？本研究的信息将帮助卫生服务规划者评估人员和服务改革模式，并监测急诊服务发展趋势。
