The role of nurses and nurse-led models of care
The Queensland Nurses and Midwives Union (QNMU) believes nurses play an important role in providing care differently so that patients don’t need to attend emergency departments. Adopting nurse-led models of care such as nurse navigators and nurse practitioners helps patients navigate the healthcare system and aids in increasing their health literacy. Nurse-led models of care ensure a more accessible, productive and safer healthcare system.
We acknowledge the work of Metro South in employing nurse navigators including the Disability Nurse Navigator and Dementia Nurse Navigator and their unique roles in helping patients navigate the healthcare system and keeping patients out of hospital. We also commend Logan Hospital’s Emergency Department in its Trifecta of Nursing Autonomy Initiative where nurse practitioners are able to initiate diagnostics, pathology and medications.
We also suggest more multi-disciplinary community-based teams including nurse-led models who assist in keeping patients in the community and not presenting to an emergency department. After-hours GPs who visit patient’s home can be part of this team who are then able to refer patients to the appropriate health practitioners and avoid hospitalisation. We would also suggest that this GP service is bulk billed for this after hours visit which would be an incentive for patients to use this service and thus alleviate the strain on emergency departments.
GPs can also work in emergency departments. Studies have shown that when GPs were put in emergency departments GPs could resolve between 20% and 40% of emergency department presentations as they were primary care-type presentations (Whyatt, et al., 2019).
The QNMU suggests there are several patient groups in the community that can have care provided differently to ensure they do not need to present at an emergency department.
The QNMU believes the capacity for aged care facilities to provide appropriate clinical care to residents on site rather than in emergency departments is a necessity to ease the strain on emergency departments.
According to the Queensland Health Minister, over 25,000 aged care residents were transported to emergency departments in the period in FY2016-17, a 17% increase in the past year (Bita, 2018). An increase of 25% in emergency department transfers from aged care facilities has also been reported in Victoria (Bachelard, 2017).
According to the Australian Medical Association (2018), in one review, a third of presentations of residents to emergency departments who subsequently returned to their facility could have been avoided by incorporating primary care services at the facility level. Such services include both the physical infrastructure and the skilled staff needed, e.g. RNs and general practitioners (GPs). The capacity of aged care facilities to provide clinical care and to practice hospital avoidance has been significantly impacted though systemic deskilling of the aged care workforce and a model of care that deemphasises the clinical aspects of residential aged care.
The QNMU acknowledges the work already being undertaken in Queensland Health with the CARE-PACT Expansion Project and the Geriatric Emergency Department Intervention (GEDI) nurse-led models of care. There are also models used in other states such as the Geriatric Rapid Acute Care Evaluation (GRACE) Model of Care developed in New South Wales. Under this model hospital staff, including nurses, GPs and aged care facilities collaborate to avoid hospital admissions and reduce length of stay by providing rapid treatment and appropriate care either in the hospital or home environment to residents of aged care facilities (NSW Government, 2015). Key to this initiative is the Clinical Nurse Consultant who is responsible for telephone triage and case manages the aged care patients.
Another category of patient who presents at emergency departments is the patient with mental health concerns. The QNMU suggests that mental health nurses and/or nurse practitioners in emergency departments could be one way of providing care differently.
The evidence shows that those patients who present at emergency departments for mental health issues are waiting longer than those with a similar severity of physical illness and enduring a longer period of treatment in the emergency department. Mental health nurses and/or nurse practitioners would be well placed to increase access in emergency departments for mental health patients (Australasian College for Emergency Medicine, 2018).
One such initiative is at the Gold Coast University Hospital (GCUH) where the rapid response triage trial has been designed to streamline the right care for each patient who is identified as benefitting from a fast response. These patients are seen by a mental health nurse from the Mental Health, Alcohol and Other Drugs Service (AODS) and an emergency department doctor. Preliminary results are positive and are showing patients are receiving targeted care plans from mental health nurses and earlier patient discharges (Queensland Government, 2018).
We also acknowledge and support the initiatives Metro South are trialling with a responder team riding with the Queensland Police Service and the upcoming trial of a grade 7 clinical nurse consultant riding with the Queensland Ambulance Service.
Australasian College for Emergency Medicine. (2018). The long wait: An analysis of mental health presentations to Australian emergency departments. Retrieved from https://acem.org.au/getmedia/60763b10-1bf5-4fbc-a7e2-9fd58620d2cf/ACEM_report_41018
Bachelard, M. (2017) ‘Old and sick: the accelerating rate of transfers from nursing homes to hospitals, The Age, October 9.
Bita, N. (2018) ‘Nursing home residents dumped on hospitals more than 25,000 times’, Courier-Mail, April 9.
NSW Government. (2015). Geriatric Rapid Acute Care Evaluation (GRACE) Model of Care. Retrieved from https://www.aci.health.nsw.gov.au/ie/projects/grace-model-of-care
Queensland Government. (2019). Promising signs for patients in rapid response care trial. Retrieved from https://www.goldcoast.health.qld.gov.au/about-us/news/promising-signs-patients-rapid-response-care-trial
Whyatt, D., Tuson, M., Haynes, E., Mountain, D., Nagree, Y. & Vickery, A. (2019). Burden of primary care‐type emergency department presentations using clinical assessment by general practitioners: A cross‐sectional study. Emergency Medicine Australasia
Why the contribution is important
We believe that nurse-led models of care improve patient safety and care and alleviate the pressure on emergency departments.
by QNMU on August 22, 2019 at 06:57PM