Emergency Department

The Emergency Department (ED) at NHW sees approximately 16,000 patients annually. The Department is the designated rural trauma service for the central section of the Hume health region. The department's medical staffing profile consists of a Director who is an Emergency Medicine Specialist (FACEM), several part time senior clinicians who are General Practitioners with special interests in Emergency Medicine and a range of Resident Medical Staff on rotation from metropolitan teaching hospitals. The department is supported by Consultants and Registrars from the major medical specialities. The nursing workforce consists of approximately 24 full time equivalent nurses, most of whom have specialist training in Emergency Nursing or Critical Care Nursing.

The department is staffed and equipped to deal with most medical and surgical emergencies, and fills the role as the major referral centre for the Hume region. The department is staffed and operates on a 24 hour a day seven day a week basis.

Patients are seen in the ED according to their medical urgency. This is determined utilising the Australian Triage Scale, which allocates patients to a triage category and allocates an expected waiting time to be seen by a doctor for each triage category. The waiting times are estimates only, we strive to ensure that patient waiting times are kept to a minimum at all times. The ED at NHW currently meets all health department guidelines for waiting times in each triage category.

NHW ED is continuously striving to keep waiting times to a minimum and has introduced several innovative programs to shorten time taken to deliver treatment to our patients. Nurses at the triage desk can order x-rays and some blood tests for certain patient groups. Some of the ED nurses are also trained in the application of plaster to broken bones.

The ED also plays a role in the regional medical Displan (disaster plan) and has the capability to send Medical/Nursing teams to disaster sites if required. The ED enjoys good relationships with general practitioners in the referral area and works to ensure a coordinated approach to patient care wherever possible.

Triage in the Emergency Department

Triage is a process that originated during military conflicts and has been refined for use in a civilian setting. It literally means 'to sort by quality'. At NHW we currently use what is known as the Australasian Triage Scale to allocate a number rating based on urgency. There are 5 urgency categories under this system, each has its own recommended waiting time allocated and our aim is to see patients within the recommended waiting time. We measure our performance against these recommended times each month and we also compare our figures to other emergency departments.

Triage Category	What it means	Medical example	Recommended time to be treated	NHW patients treated in this time
1	Critically unwell and requires immediate treatment and cannot wait	Cardiac arrest, extreme asthma, severely injured patients from accidents	Immediately	100%
2	Serious condition that will deteriorate rapidly without treatment	Suspected heart attack, major stroke, head injury, severe asthma	Within 10 minutes	90%
3	Require urgent medical attention	Abdominal pain, moderate asthma, major fractures, severe uncontrolled pain, and pneumonia	Within 30 minutes	89%
4	Less urgent complaints	Minor limb fractures, lacerations, skin infections	Within 1 hour	76%
5	Non urgent complaints	Coughs and colds, minor injuries, sprains and strains	Within 2 hours	86%

Triage assessment is performed by a senior Registered Nurse who has completed appropriate education and assessment before being allowed to work in triage unsupervised. Patients are seen in order of triage category, and then by waiting time. This is done as there are only ever a maximum of two doctors in the Emergency Department at any given time. Unfortunately, at times there may be unavoidable delays as more urgent cases are seen first.