TranslateEmergency Department Review
The Independent Review of Tasmania’s Major Hospital Emergency Departments
The Department of Health is committed to delivering improvements across all areas of our health system to ensure Tasmanians have access to the health care they deserve.
However, sometimes we experience additional pressures on our emergency departments, ambulance services, hospital wards, and other health services.
To find out why and to provide recommendations and actions to help us make improvements, the Minister for Health, commissioned the Independent Review of Tasmania’s Major Hospital Emergency Departments on 12 September 2023.
The review was Chaired by Adjunct Professor Deborah Picone, and included Ann Maree Keenan, RN, GAICD, Professor Tony Walker ASM and Dr Niall Small, FACEM.
The final report containing a full set of final recommendations aimed at improving bed usage across the health system was published on 10 May 2024.
Work to complete these actions by 30 June 2025 started immediately and the key recommendations are listed below.
Read the full report from the Independent Review of Tasmania’s Major Hospital Emergency Departments
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
The Independent Panel set out three key focus areas:
- Organisational culture and management
- Decision making and accountability
- 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 identified 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 included:
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 put into operation (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)
Final report
The Independent Panel published its final report, which contained a full set of informed recommendations, on 10 May 2024.
The report outlines a series recommendations aimed at improving bed usage across the health system, alongside improved pathways to primary care alternatives and new solutions to improve the effectiveness of care.
These actions build on the work already underway as part of the interim recommendations set out by the panel in December 2023 highlighted above.
The final recommendations focus on improvements to five key areas and step out a series of actions to be delivered before 30 June 2025.
These include:
Capacity and Service Delivery Models (State Level)
- Establishment of a Statewide Integrated Operations Centre
(To be completed by 1 January 2025) - Improvements in Demand Management Governance and Accountability
(To be completed by 1 June 2024) - Healthcare Innovation
(To be completed by 30 June 2025) - Increase in Commonwealth Funding*
(*All states and territories have committed to Agreement by 31 December 2024)
Demand Management Strategies (Local Level)
- Demand Management Plans and Coordinated Response*
(*Various actions and completion dates) - Program Restructure – Statewide Patient Access and Flow Program
(To be completed by 31 July 2024) - Role and Application of Predictive Analytics
(To be completed by 31 August 2024)
Community and Home-Based Care
- Leadership and Accountability Care@home
(To be completed by 30 June 2024) - Care@home Chronic Disease Management Program
(To be completed by 31 December 2024) - Governance Review Sub Acute and Multi-Purpose Services
(To be completed by 30 June 2025)
Statewide Mental Health Services
- Mental Health Emergency Response
(To be completed by 31 December 2024) - SMHS Demand Management and Discharge Practices*
(*Various actions and completion dates) - Business Improvements and Efficiencies
(To be completed by 30 June 2025)
Ambulance Tasmania Redesign
- Clinical Hub Expansion*
(*Various actions and completion dates) - Community Paramedic Program *
(*Various actions and completion dates)
Emergency Departments Review Action Plan
To help keep track of our commitments we have created our Emergency Departments Review Action Plan.
It provides an overview of the recommendations and actions against each of the five key areas identified within the final report as well as the timeframes they need to be delivered by.
We will update this document regularly to communicate how we are doing and to report on our progress against the actions listed.
Download a copy of the Emergency Departments Review Action plan
Methodology
The independent review panel placed 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 was able to identify the breadth and range of the issues impacting demand management across Tasmania’s health services.
What else are we doing
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.
Find out more about what the Department of Health is doing.
