Queensland Health

Business Planning
Framework:
a tool for nursing and midwifery
workload management
5th Edition 2016

Emergency Department Addendum 2018

Published by the State of Queensland
(Queensland Health), January 2018

This document is licensed under a Creative Commons

Attribution 3.0 Australia licence. To view a copy of
this licence, visit creativecommons.org/licenses/
by/3.0/au

© State of Queensland (Queensland Health) 2018

You are free to copy, communicate and adapt

the work, as long as you attribute the State of
Queensland (Queensland Health).

For more information contact:

Office of Chief Nursing and Midwifery Officer,
Clinical Excellence Division, Department of Health,
GPO Box 48, Brisbane QLD 4001,
email: [email protected],
phone 07 3328 9237.

An electronic version of this document is available

at http://qheps.health.qld.gov.au/nmoq/workforce-
sustainability/bpf/addendums.htm

Disclaimer:
The content presented in this publication is distributed
by the Queensland Government as an information source
only. The State of Queensland makes no statements,
representations or warranties about the accuracy,
completeness or reliability of any information contained
in this publication. The State of Queensland disclaims all
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for liability in negligence) for all expenses, losses, damages
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Contents
Introduction........................................................................................................ 2

Module 1: Development of a service profile.......................................................... 3

Business planning in the context of emergency departments......................................... 3
Business planning considerations................................................................................. 5
Nursing core demand considerations............................................................................ 8

Module 2: Resource allocation........................................................................... 15

Establishing total nursing and midwifery resource requirements.................................. 15

Module 3: Evaluation of performance................................................................. 21

Data collection for emergency departments................................................................ 21
Forecasting and benchmarking................................................................................... 25

References........................................................................................................ 26
Appendix 1: Example activity measures identified for emergency departments............ 28

Emergency Department Addendum 1

 Introduction
The Business Planning Framework: a tool for The emergency department addendum was
nursing and midwifery workload management created by a statewide emergency department
5th Edition (BPF 5th Edition) is the industrially nursing Specialty User Group in partnership
mandated tool to support business planning for with QNMU and the Department of Health.
the purpose of managing nursing and midwifery
This addendum will assist nursing staff within
resources and workloads in public sector
emergency departments to:
health facilities. The principles of the BPF 5th
Edition apply to all remote, rural, regional and • determine and manage the unique
metropolitan nursing and midwifery services in circumstances within their service that require
Queensland Health. This addendum is designed special consideration when applying the
to recognise the unique challenges for nurses principles of the BPF 5th Edition
working in emergency departments and must
• articulate productive (direct and indirect)
be used in conjunction with the BPF 5th Edition.
nursing and midwifery activity within
The Emergency Department Addendum was their service
developed to meet the commitment between • understand the current and emerging demand
Queensland Health (QH) and the Queensland considerations for nursing hours within
Nurses and Midwives' Union (QNMU) under their setting
the provisions of the Nurses and Midwives
• develop planning tables identifying
(Queensland Health and Department of
productive and non-productive hours relevant
Education and Training) Certified Agreement
to emergency departments
(EB9) 2016. The agreement identified the
need to further contextualise the BPF 5th • identify and describe client and service
Edition for a range of settings, including complexity and activity indicators to improve
emergency departments to support compliance consistency in the application of the BPF 5th
with the Nursing and Midwifery Workload Edition in emergency departments
Management Standard.

2 Emergency Department Addendum

Module 1: Development
of a service profile
This section relates to BPF 5th Edition module 1: pages 13-26

Business planning groups from neonatal to geriatric presenting with

acute and urgent aspects of illness and injury,

in the context and referral to ongoing care.3,4,5

Emergency departments are not

of emergency stand- alone facilities. To provide safe
and effective service delivery, emergency
departments departments rely on a suite of support services
from both within and external to the service. 6

There are a number of common nursing workload Factors that should be considered when
management and workforce planning issues contextualising the BPF 5th Edition to emergency
within emergency departments. These are departments include consideration of:
recognised as critical areas of concern.
• the amount of activity/number of
The most frequently discussed issues involve:
presentations the department delivers
• articulating nursing work in the
• the Clinical Services Capability Framework
emergency department,
(CSCF) Emergency Services level
• validating indirect emergency nursing
• distance to higher CSCF Emergency Services
hours and;
(i.e. tertiary centres, retrieval services)
• applying standard business planning if relevant
definitions to emergency department settings
• proximity of public transport (e.g. if
Emergency departments are the front door of the accessibility of emergency department is
health facility and, for many people, form their more convenient than access to a General
primary contact with the health care system, Practitioner clinic)
providing an important interface between the • the population and demographic of patients
community and the health facility.1,2
»» consideration of remote, rural, regional,
Emergency services are responsible for
or metropolitan facility
the reception, triage, initial assessment,
stabilisation, management of patients of all age »» socioeconomic status of population

1 www.acem.org.au/Standards-Publications/Policies-Guidelines.aspx
2 https://www.health.qld.gov.au/__data/assets/pdf_file/0027/444276/cscf-emergency.pdf
3 www.acem.org.au/Standards-Publications/Policies-Guidelines.aspx
4 http://www.health.gov.au/internet/main/publishing.nsf Content/387970CE723E2BD8CA257BF0001DC49F/$File/Triage%20Workbook.pdf
5 https://www.health.qld.gov.au/__data/assets/pdf_file/0027/444276/cscf-emergency.pdf
6 https://www.health.qld.gov.au/__data/assets/pdf_file/0027/444276/cscf-emergency.pdf

Emergency Department Addendum 3

 »» Aboriginal and Torres Strait The application of Nursing Hours Per Patient
Islanders population Day (NHPPD) or Nursing Hours Per Occasion of
»» Changes to population in line with Service (NHPOS) or Nursing Hours Per Unit of
tourist events/seasons Activity (NHPUA) does not provide an adequate
representation of the full scope of activity
• the introduction/benchmarking of targets
and/or acuity demands upon nursing within
such as Emergency Length of Stay (ELOS)
the emergency department. The calculation of
targets, Queensland Emergency Access
productive hours needs to incorporate staffing
Targets (QEAT) and Patient Off Stretcher
requirements for direct and indirect activities
Targets (POST)
that may not regularly occur in other health
• emergency departments are the first point of settings (refer to Table 1: Key productive and
contact for emergency management situations non productive nursing hours).
(e.g. influenza epidemics, acts of terrorism)
These requirements further emphasise the
• ‘ambulance bypass’ should not be utilised by importance of professional judgement in the
facilities unless in cases of internal or external calculation of the productive nursing hours.
disaster,7 therefore it is difficult for emergency
departments to redirect activity if balance
of demand for services outweighs supply
of workforce
• direct impact of inpatient occupancy on
emergency department patient flow
• increasing exposure to occupational violence 8
• infrastructure and emergency
department design
»» aging building infrastructure and building
design impacts upon workflow efficiency,
occupational health and safety and security
of staff.
»» consideration of department size –
ensuring staffing numbers to support
square meterage of department
»» consideration of department layout –
isolation rooms, proximity to designated
off-site smoking areas, location of allied
health services (i.e. radiology department)

7
https://www.health.qld.gov.au/__data/assets/pdf_file/0030/365448/qh-gdl-956.pdf
8
https://www.health.qld.gov.au/__data/assets/pdf_file/0024/443265/occupational-violence-may2016.pdf

4 Emergency Department Addendum

Business planning considerations

This section relates to BPF 5th Edition Module 1.4: page 15

The BPF 5th Edition outlines the general of each factor on their environment and make
factors a service should consider when the necessary adjustments to the allocation
analysing the internal and external of nursing hours.
environment as part of developing their
Table 1 provides examples of several
service profile. However, there are a variety
business planning considerations relevant
of business planning factors which influence
to the emergency department, based on
the emergency department and result in
recognised internal and external influences.
service demand fluctuations. These internal
Consideration of the impact and level of
and external factors need to be considered
influence these have on nursing and midwifery
when analysing service demand. Wards and
workloads to support the productive hours
services should annually assess the impact
is required.

Emergency Department Addendum 5

 Table 1: Business planning consideration for emergency departments

Influences Service impact Examples of workload

(internal and external) management considerations

Locality of service The locality, type and catchment area of a Direct nursing and midwifery hours :
service will influence the balance of service
(Internal) Calculation of clinical hours for direct
demand and supply.
care, allocation of clinical hours
(Metropolitan, regional, rural
Examples: (rosters), selection of service activity/
and remote)
acuity measures, use of minimum safe
The higher CSCF level sites are the referral
staffing requirements.
sites for lower CSCF level emergency
departments, it must consider this activity
Type of Service as part of service demand e.g. inter-hospital Indirect nursing and midwifery hours:
transfers, burns, spinal, neuro surgery,
(Internal) Calculation of clinical hours for indirect
paediatrics, ICU.
care, travel, program/service based
(e.g. Emergency care, resus,
Any emergency department of CSCF level 4 education, succession planning, quality
Nurse Practitioner lead model,
and above become referral site for feeder activities and research.
fast track, short stay unit,
hospitals. This leads to workload impact of
mental health acute care team,
transfers, inter-hospital transfers,
diagnostics)
and direct admissions.

Catchment area All services need to consider the impact of Workforce planning:
skill mix on optimal service delivery.
(Internal) Development of strategic local/
Statewide workforce plans to inform Full
(Local Hospital and
Time Equivalent (FTE) requirements,
Health Services versus
skill mix profiles and macro workforce
Statewide Services)
planning formulas.

Nursing and midwifery The model of care selected for a service will Direct nursing hours:
structure influence the nursing and support structures
Calculation of clinical hours for direct
required. Nursing and midwifery roles, and
(Internal) care provided in and outside the service,
how they relate with other clinical roles, will
position classifications for the clinical
(Roles, functions, impact on the balance of service demand
hours required, allocation of clinical
accountabilities and and supply.
hours (rosters), selection of optimal
relationships between all
Examples: service activity/acuity measures,
categories of nursing staff )
safe staffing levels.
In emergency, nursing roles can be
categorised by the skills required to
Support structure meet patient demand (i.e. orthopaedic, Indirect nursing hours:
correctional, mental health, endocrine, renal,
(Internal) Calculation of clinical hours for non-direct
paediatrics, geriatric). To accommodate
care networking/collaboration (internal
(Providing support to other the wide range of skills required, a level of
and external) travel, staff training,
services and/or receiving flexibility in the scope of the role is necessary
professional development, quality
support from other services) which can impact on the number of nursing
activities and research.
staff employed and their workloads.

Model of care Different models of care may be required Workforce planning:

depending on acuity and skill mix of staff.
(Internal) Nurses within these environments may be Development of role descriptions and
required to practice autonomously at an skill mix profiles suitable for the context
(Multi-functional teams)
advanced level. of practice (internal and external)
to the service.
The accessibility and level of support
available to and from other services may vary. Devising operational and organisational
Nursing services should account for the structures to support staff in applying the
productive hours required to manage the chosen model of care.
demand from these interactions. Development of operational workforce
plans to inform FTE requirements and
macro workforce planning formulas.

6 Emergency Department Addendum

Table 1: Business planning consideration for emergency departments

Influences Service impact Examples of workload

(internal and external) management considerations

Policy/legal factors Changes in health policy and legislation Direct nursing hours:
will influence service delivery and staff
(External) Calculation of clinical hours for direct care
requirements. Common change drivers
(based on available funding), position
include governments (commonwealth/state),
classifications for the clinical hours
licensing organisations, professional and
required, registration commitments for
industrial groups.
clinical hours, allocation of clinical hours
Examples: (rosters), selection of optimal service
activity/acuity measures, and use of
Legislation – Work Health and Safety Act 2011
minimum staffing requirements.
Commonwealth - health reform
Queensland Health – strategic plan
Occupational violence – task force
recommendations
Mental Health Act and Public Health
Act resulting in changes in service
delivery requirements.

Economic factors Funding policies, the national economy and Indirect nursing hours:
the interface between public and private
(External) Calculation of hours for indirect and
health care providers will influence the
non-productive activities such as policy
delivery of outpatients and ambulatory
development, business planning,
health services and the number of
service interfaces, travel, staff training,
staff required.
professional development, quality
Examples: activities and research.
Service improvement initiatives can provide
non-recurrent funding increases for services
which achieve the targeted results. These
incentives could impact the skill and number
of nurses required for service delivery.
This builds community expectation for
service delivery not aligned to recurrent
funding model.

Social/population factors Population demographics and community Workforce planning:

expectations will impact on the types of
(External) Development of role descriptions and
emergency health services offered, how the
skill mix profiles suitable for the context
services are offered, staffing numbers and
of practice (internal and external) to the
skill mix required for service delivery.
service.
Examples: Devising operational and organisational
Delivering health services to a community structures to support staff in applying the
with a disproportionate number of homeless chosen model of care.
people, lower socio-economic demographic, Development of operational workforce
and those with substance abuse will impact plans to inform FTE requirements and
the number and type of clinical hours required macro workforce planning formulas.
to operate the service.
Increasing number of emergency
presentations to public hospitals related
to substance use and/or abuse results in
increased risk of occupational violence which
necessitates appropriate resourcing to meet
training requirements.
The risk of occupational violence in an
emergency department is disproportionate to
an acute health centre.

Emergency Department Addendum 7

 Nursing core Services and Queensland Police Service in the
one setting at the same time

demand considerations • vulnerability to occupational violence due to

consumers being in stressful, unpredictable
and potentially volatile situations.
To improve the consistency and transparency in
Causal factors of aggression and violence
the application of the BPF 5th Edition, specific
include medical conditions such as dementia,
demands on direct and indirect nursing hours
delirium, mental illness or head trauma.
in the emergency department have been
Other factors include substance abuse or
categorised to assist in articulating nursing work.
anti- social behaviours11
The categories are based on the most common
and frequent demands placed on nurses within • being aware that procedures often require
the emergency department. The following additional staff, with specific skills and
section will explore the relationships between training to provide safe care, for example,
core demand considerations and the context of cardioversion, suturing and plastering
practice in emergency departments. • being aware that some procedures and
treatments are undertaken in a dedicated area
Client/service complexity away from the bed space or outside of the
department e.g. procedure room for plastering
When reviewing client and/or service requiring additional nursing time for patient
complexity there are many unique preparation and transport
considerations for the emergency setting,
• managing patients with broad diversity of
these include:
conditions/diagnoses, multiple comorbidities
• complexity of caring for patients from with varied chronicity and complexity,
neonatal to geriatric age groups all within the one department
• the unique family dynamic in times of high • provision of emotional support and education
stress and uncertainty 9 to family members and carers, particularly
• caring for patients who are experiencing discussions about diagnosis, care planning,
mental health issues. This creates additional and health education. This includes support to
challenges including; demand on numbers families whose loved one has died within the
and skill mix of nurses for the provision of emergency department
safe care and managing risk. For example • the need to facilitate patient movement
specialling of patients who are at risk of between departments and external services.
self-harm and consideration of co-location The nurse or midwife may need to escort the
of patients patient for care e.g. to inpatient wards or
• increasing presentations by older people, offsite for Royal Flying Doctor Service transfers
from both the community and residential aged • being aware of the availability of 24 hour
care facilities, which have special needs and primary care providers in the community, and
considerations for care and discharge 10 limited availability of bulk-bill services which
• managing multiple patient traumas, can increase the number of presentations to
resuscitation bays, acute and sub-acute emergency departments
presentations and collaborating with • community perceptions of emergency access
other service providers such as mental targets e.g. impression that you will be seen
health services, Queensland Ambulance in four hours or less regardless of acuity
of presentation

9
https://www.health.qld.gov.au/__data/assets/pdf_file/0024/443265/occupational-violence-may2016.pdf y
10
https://link.springer.com/article/10.1186/s40886-016-0049-y
11
https://www.health.qld.gov.au/__data/assets/pdf_file/0024/443265/occupational-violence-may2016.pdf

8 Emergency Department Addendum

• predictable unpredictability of presentations
to the emergency department e.g. influenza
season variances, major events (such as
concerts, sporting events) bringing an influx
of population
• provision of culturally safe care for people,
including time spent to ensure valid consent,
for example, engagement of interpreter
services to ensure patient and family are
appropriately informed for decision making

Model of care/service delivery

There are varied models of care for service
delivery in the emergency department.
Additional to traditional emergency service
delivery, models of care include:
• Short Stay Unit (SSU)
• Fast Track
• Medical Access/Assessment
Planning Unit (MAPU)
• Nurse Practitioner-Led Clinics
• Geriatric Emergency Department
Intervention (GEDI)
• Medical Emergency Team (MET)
response coordination
• Senior Early Assessment Team (SEAT)

Models of care will vary depending on:

• staffing availability and skill mix
• patient acuity
• patient age (i.e. some facilities have separate
paediatric emergency and adult emergency
departments)
• patient demographics
• proximity to higher CSCF facilities, for example
tertiary Intensive Care Units or facility
• ward layout and proximity to associate/
support services
• access to mental health services
• access to community health service providers

Emergency Department Addendum 9

 There are a broad range of service activity • access to technology at the point of
types at level 1 to level 6 CSCF in emergency care (workstation on wheels, iPads) and
settings (including Children’s Emergency management of information communication
Services). The CSCF determines the level of technology related assets
service to be provided based on the service
• stable connectivity to the internet (Wi-Fi drop
description criteria.
out issues)
• asset management of emergency specific
Technology and equipment including obtaining quotes,
materials management maintenance coordination, education for
The introduction of digital systems and implementation and Health Technology
eHealth technology requires significant Equipment Replacement (HTER) management
input from nurses. Often systems require • ensuring that equipment (such as cardiac
modification to meet the needs of emergency monitors) are interchangeable, not only within
departments, resulting in staff needing to assist the unit, but within the facility/HHS
other streams to customise the systems, for
• ensuring that assets range from neonatal,
example, integrated electronic Medical Record
paediatric, adult and bariatric sizing
(ieMR) in emergency settings.
• imprest and drug management processes –
The time spent on accessing and recording electronic systems such as Pyxis
of information on a number of systems also
needs to be considered. Nursing staff should build indirect hours into
the service profile to account for training and
Additional considerations include; ongoing systems management.
• introduction of digitalized hospitals
requires additional training, for example,
ieMR downtime processes

10 Emergency Department Addendum

Community interface Quality and safety
Community and consumer engagement is Quality and safety activities within emergency
pivotal to the delivery of emergency care. departments are primarily governed by
Emergency departments have connections legislation and organisational policy.
with a variety of service providers which The productive nursing hours of the health
impact service delivery including patient service are influenced by quality and safety
presentation and discharge or transfer from processes. This distribution of direct and indirect
the emergency department. hours needs to be contextualised for the health
service based on variables such as type of
The emergency department may directly and/or
service delivered, staff competency required,
indirectly interact with the following groups:
and location of unit or program.
• Queensland Ambulance Service (QAS)
Some key quality and safety components which
• Queensland Police Service (QPS) may impact productive nursing hours include:
• Aboriginal Community Controlled • patient/family safety, for example the level
Health Service of supervision required for mental health
• community respite residential care providers patients at risk of self-harm

• community health service providers • staff safety, for example management

of aggressive behaviour in patients
• Department of Community Services
(which includes dementia and delirium,
• National Disability Insurance Scheme and and drug or alcohol-fuelled aggression)
associated private sector service providers
• mandatory and requisite training
• Non-Government Organisations, e.g. requirements, for example paediatric
homeless support services, alcohol and drug and adult advanced life support (further
addiction support services, youth and adult detailed in Education and service
mental health support services capacity development)

• primary health care providers including local • policy, procedure and clinical guideline
General Practitioner practices development and review, at facility and
HHS level
• Hospital in The Home (HiTH) services
• clinical portfolio extension beyond
• Community Advisory Networks
department, providing specialist emergency
• specialised statewide services such as nursing advice throughout the hospital and
Retrieval Services Queensland (RSQ), health service
transplant services
• incident and near miss reporting in the
• private sector service providers emergency setting. This involves identification
and management of challenging patient and
The time staff commit to these activities needs to
family behaviours
be considered when calculating the productive
nursing hours for the service. Both quantitative • ergonomics and design requirements
and qualitative information regarding community to ensure a safe environment e.g. safe
interface activities needs to be considered. environments for mental health patients,
safe environment for triage nurse

Emergency Department Addendum 11

 • emergency specific audits e.g. triage auditing »» Trauma Nursing Core Course (TNCC)
• implementation of Root Cause Analysis (RCA), »» Maternity Emergency Course
Human Error and Patient Safety outcomes • travel to tertiary and other relevant
education facilities that provide specialist
As this is not an exhaustive list, a review of your
emergency training
local activities, quality planning and incident
reporting process is recommended. • develop a unit specific education plan
• engage in succession planning
Education and service capacity • develop as an emergency nurse, progressing
development from novice to expert
The CSCF identifies training recommendations/ • utilise professional development leave
requirements for nurses and midwives. As part
• strike the balance between “growing our
of the service profile, consideration should be
own” (i.e. new to the emergency setting) and
given to the CSCF modules that are relevant for
recruiting experienced staff to support team
the emergency service for establishing education
growth and service requirements
and requisite training requirements including
associated travel time. In the emergency setting, there may be limited
access to a casual workforce that has the skill
Consideration needs to be given to supporting
set or required training to support management
staff to:
of emergent leave and short term planned leave
• undertake the Transition to Emergency in the department. This needs to be considered
Practice Program when developing the service profile.
• attend additional training and upskill for roles
such as: Leadership and management
»» triage nurse
The emergency service activity has direct
»» resuscitation/medical emergency support effects on the inpatient and outpatient activity
team member of the hospital. As such, consideration needs
»» emergency flow coordinator to be given to the individual leadership and
»» Clinical Initiatives Nurse (CIN) management requirements, and support
»» Geriatric Emergency Department systems to ensure streamlined patient flow.
Intervention team member This may impact the level of demand placed
on productive nursing hours. The demand
»» trauma review nurse
considerations include:
• achieve training requirements across the
• skill and knowledge requirements to lead and
lifespan and roles in the emergency setting,
manage in the unique emergency context,
such as:
including management of higher grade nursing
»» paediatric advanced life support and adult positions (i.e. NG7 Nurse Unit Manager
advanced life support (NUM) managing a team including NG8 Nurse
»» ventilation skills competency for neonatal, Practitioner roles)
paediatric and adult patients
• service accountabilities and responsibilities
»» geriatric emergency care beyond the emergency department
»» Emergency Triage Education Kit (ETEK) (e.g. Medical Emergency Team, Disaster
Management Planning, Occupational
Violence committees)

12 Emergency Department Addendum

 • management of staff, noting that emergency
departments are exposed to acute and
traumatic stressors more frequently than
other areas 12 and therefore need to consider
time for staff support/debriefing
• organisational and HHS engagement,
including influencing clinical practice and
providing emergency expertise in committees
• supporting and sustaining the specialist
emergency nurse staffing profile which
includes classification, scope of practice and
training/ skills development
• interactions with nursing and multidisciplinary
team members for management of
complex care
• managing consumer expectations in line with
agreed service provision
• facilitating a peer support network for NUM,
Clinical Nurse Consultants (CNCs) and Nurse
Educators across the state

Research and evidence

based practice
Undertaking research and evidence based
practice activities will influence the number
of indirect nursing hours required for service
delivery. Research and evidence based practice
is essential to improve the standards of care that
will produce better health outcomes for patients.

Consideration should be given to the impact

on nursing hours when implementing research
outcomes into clinical practice.

12
https://www.ncbi.nlm.nih.gov/pubmed/17365896
 Health policy, clinical guidelines, • Mental Health Act 2016 16
strategic plan and health legislation • National Safety and Quality Health Service
(NSQHS) Standards17
There are a number of legislative and policy
requirements that influence the emergency • Memorandum of Understanding – Queensland
department setting. These should be Health and Queensland Police Service Mental
considered when developing service profile, Health Collaboration 2016 18
resource allocation and evaluation of • Use of Retrieval Services Queensland – Health
performance. Key examples listed below: Service Directive19
• Occupational Violence Prevention in • Queensland State Disaster Management
Queensland Health’s Hospital and Plan 2016 20
Health Services13
• Chronic Conditions Manual 21
• Implementation plan for the National
Aboriginal and Torres Strait Islander Health • Service improvements and delivery models –
Plan 2013 – 2023 14 Care in the emergency department 22

• Hospital and Health Service strategic plans15 • Department of Health Guideline: Emergency
Department Access23

13
https://www.health.qld.gov.au/__data/assets/pdf_file/0024/443265/occupational-violence-may2016.pdf
14
http://www.health.gov.au/internet/main/publishing.nsf/Content/AC51639D3C8CD4ECCA257E8B00007AC5/$File/DOH_
ImplementationPlan_v3.pdf
15
https://www.health.qld.gov.au/system-governance/strategic-direction/plans/hhs-plan
16
https://www.legislation.qld.gov.au/browse/inforce
17
https://www.safetyandquality.gov.au/our-work/national-standards-and-accreditation/
18
https://www.health.qld.gov.au/__data/assets/pdf_file/0034/573991/mou_qh_qps_mhcollab.pdf
19
https://www.health.qld.gov.au/__data/assets/pdf_file/0020/151193/qh-hsd-005.pdf
20
http://www.disaster.qld.gov.au/Disaster-Resources/Documents/Queensland-State-Disaster-Management-Plan-2016.pdf
21
https://publications.qld.gov.au/dataset/ef6d9f9e-e8aa-445e-a345-02a016e7251b/resource/bbe5439c-be87-45b6-b704-
3b557fbee1e0/download/chronicconditionsmanual1stedition.pdf
22
https://www.health.qld.gov.au/improvement/improving-services/service-models
23
https://www.health.qld.gov.au/__data/assets/pdf_file/0030/365448/qh-gdl-956.pdf

14 Emergency Department Addendum

Module 2:
Resource allocation
This section relates to BPF 5th Edition Module 2: pages 27-47

Establishing total nursing

resource requirements

STEP Calculate total annual productive nursing and/or

Go to BPF 5th Edition page 31
1 midwifery hours required to deliver service.

STEP Determine skill mix/category of the nursing/

Go to BPF 5th Edition page 35
2 midwifery hours.

STEP Convert productive nursing/midwifery hours into

Go to BPF 5th Edition page 38
3 full-time equivalents.

STEP Calculate non-productive nursing and/or

midwifery hours in accordance with nursing and Go to BPF 5th Edition page 39
4 midwifery award entitlements.

STEP Convert non-productive nursing and/or Go to BPF 5th Edition page 43

5 midwifery hours into full-time equivalents.

STEP Add productive and non-productive full-time

Go to BPF 5th Edition page 44
6 equivalents together and convert into financial
resources in partnership with business team.

STEP Allocate nursing and/or midwifery hours to meet

Go to BPF 5th Edition page 47
7 service requirements.

Emergency Department Addendum 15

 Productive nursing hours include both direct Defining productive hours increases the
and indirect clinical hours. Calculating the understanding of the nursing work being
number of productive hours required for an performed and provides an excellent
emergency department is the first step in foundation when developing a service profile.
managing nursing workloads, and establishing
Table 2 provides examples of key productive
the total operating budget, specifically
and non-productive nursing activities for
identifying the FTE required.
an emergency department and should be
Creating a list of standard direct and indirect used in conjunction with the BPF 5th Edition
nursing activities in your unit or practice area (pages 27- 47).
will assist in articulating and monitoring the
use of productive hours. As outlined in the BPF
5th Edition, this consultation process should
be undertaken with unit staff.
Total productive hours =
Information gathered about productive hours
can be used to inform a number of service
requirements such as staffing numbers, skill mix,
direct hours
models of care and education/training
programs. It is important to document all
nursing activities relevant to your service, indirect hours
especially those considered unique to your
unit or practice area.

16 Emergency Department Addendum

Table 2: Examples of key productive and non-productive nursing hours

Productive Non-
Activity Examples
Productive
Direct Indirect
Service management

Operational and x Business and strategic planning

strategic planning

Models of service delivery x x Case management/integration

Patient area management

x Resus, triage, short stay, procedural, ambulatory,
(infrastructure and
waiting room
equipment)

Inventory and stock x Consumable management and ordering

control

Service data collection x Data integrity, activity review, validation, analysis

and analysis

Service delivery

Patient assessments x Physical assessments, mental health assessments

x x Triaging and prioritising diagnostics testing, outpatient

Referral management
referrals, integrated care pathways

Triaging patients, information gathering, collateral,

data collecting, decision making to direct patient flow,
Triage x consumer engagement, streaming, resource allocation,
level of expertise, liaise with QAS/QPS etc., nurse initiated
care, time to meaningful cares

Patient and family x Delivering health education

education

Follow-up phone clinics, dressing clinics, outreach clinics,

Clinic delivery x x re-presentation management, consideration for remote
and rural areas

Consumer liaison/patient x x Public phone calls, answering calls, directing phone calls,
follow-ups patient enquiries

Includes set ups, procedures and clean ups, patient

Clinical procedures x x monitoring, patient education, patient and family support,
patient preparation, procedure sedation, documentation

x x Patient to tertiary, TEMSU, resus management, nursing

Telehealth services
homes, RSQ, consultancy to lower CSCF level services

Client related arrangements such as patient travel,

Care planning and patient x x translators and complex diagnostics,
journey coordination
time pressured, QEAT

Medical records; client related charts; multiple

x information systems with no interoperability; correlation,
Clinical documentation
collation and dissemination of information, screening
tools, national standards

Patient transfers – inter-hospital and intra-hospital (for

x example: public to private, radiology, wards), child safety,
Clinical handover
QAS QPS, inter-service (residential aged care facility),
inpatient service, shift to shift, break to break

Intra and inter-hospital, push/pull, procedural and

x diagnostic transfers, wait time related to transfers (areas
Patient escorts
ready for accepting), waiting for retrieval services
(e.g. QAS)

Emergency Department Addendum 17

 Table 2: Examples of key productive and non-productive nursing hours

Productive Non-
Activity Examples
Productive
Direct Indirect
Transfer management Management of ramped patients, collating information
(pre and post emergency x x to do transfer, conflict resolution, QAS liaison and
department care) shared care

x Staff coordination, patient management, patient flow,

Clinical team leading
safety, data management, complexity

Clinical care facilitation x Opportunistic bedside teaching

and education

Staff management

Rostering x Daily, weekly and monthly rostering of staff

Annual, sick, fatigue and study/research leave, PDL,

Leave management x QSuper/WorkCover management, psychological support –
bereavement leave etc.

Team leader duties, resource allocation, 24/7

Skill mix management and x management, succession planning implementation
allocation
and support

Human resource x Pay enquires, staff movement forms, performance

management improvement, managing up

Recruitment and retention x Advertising, interviewing, developing retention strategies

HR and finance delegate x Labour expenditure, leave management, monthly reports

responsibilities

Staff travel x Organising staff travel, undertaking travel

Staff development

Clinical supervision x Professional support/learning, reflective practice

Undergraduate, postgraduates and new starters,

x facilitation between skill set in ED (for example, resus to
Clinical facilitation
triage to subacute to short stay), staff progression novice
to expert

Child safety, advanced life support, paediatric advanced

life support, Suicide Risk and Management in Emergency
x Department settings, ETEK, occupational violence,
Speciality training
Aggressive Behavioural Management, domestic violence,
cannulation, venepuncture, TNCC, Trauma Nurse
Paediatric Course

Mandatory training x Localised to each HHS, e.g. ergonomics, basic life support

Staff education x Internal (including in-service training, ward-based

(in clinical area) education/training sessions) and external

Professional development/ x Clinical portfolios

portfolios

Performance appraisal and x Participation in PAD process and Performance

development (PAD) Improvement Process, career progression pathways

x Workplace shadowing, professional development,

Succession planning
secondment management

Staff meetings x Unit/ workplace based

Evidence-based practice x Research activities/service based projects

18 Emergency Department Addendum

Table 2: Examples of key productive and non-productive nursing hours

Productive Non-
Activity Examples
Productive
Direct Indirect
Policy development and enforcement

Committee participation x Internal and external committees

Quality audits/safety x Designated by legislation, policy or quality programs

checks

Health service planning x Service capacity building and workforce planning

Clinical governance x Policy review and development, clinical guidelines and

practices work unit guidelines

Patient feedback x Patient complaints, service delivery issues, patient

management feedback, ministerial

Information management

Balanced scorecard/ x Evaluation tools

operational reporting

Data analysis x Service improvements, KPI management

Business planning and x Service profile development

management

x Client related information and storage record,

Electronic medical records
multiple systems

Other

x Travel associated with service delivery

Travel
e.g. outreach clinics

Equipment and
x Building repairs, clinical equipment repairs, HTER
infrastructure
management, general asset management
maintenance

Procurement and plant x HHS dependent, asset acquisition

maintenance

Preparedness and staff training (hospital exercise)

x for events such as mass casualty; epidemic;
Disaster Management
natural disasters ; special event management e.g.
commonwealth games, sport events, schoolies, concerts

Please note: Education and training programs provided within the clinical service/program/facility are considered indirect hours.
Clinical hours associated with mandatory training and professional development leave for education purposes is allocated within
non- productive hours.

Emergency Department Addendum 19

Service activity
The professional judgement of nursing staff
informs the minimum skill mix required to build
a staffing roster to meet the demand created by
the models of care.

Financial activity does not always easily or

directly translate into nursing activity. In the
emergency setting, there are varied types of
service activity which require nursing hours,
but this activity may not be accurately reflected
in emergency financial activity.

• Did-not-wait presentations
»» When a patient presents to the emergency
department, they are seen by the triaging
nurse and assessed. They may also be
reviewed in the waiting room by a nurse,
such as a CIN. If this patient chooses not to
wait for treatment, this presentation does
not attract any activity based funding, even
though a nurse spent time with, and has
triaged and assessed that patient.
• Transfer activity
»» Some lower-level CSCF emergency services
are required to provide higher level services
until transfer of patients can occur (e.g.
invasive ventilation for an extended period
until RFDS transfer can be arranged). This
has impacts on staffing requirements.
»» If there is no bed availability for a patient
to transfer (either intra-hospital or inter-
hospital), this increases the demand
on nursing hours in the emergency
department, whilst also limiting availability
of rooms to treat waiting emergency
patients which impacts on patient flow.

In the absence of a nursing data set for

emergency departments, clinical discretion
and professional judgment is exercised.
Some examples of activity measures that are
commonly used have been identified and listed
in Appendix 1.
Module 3:
Evaluation of performance
This section relates to BPF 5th Edition Module 3: page 48-54

Data collection for emergency departments

Data collection supports the measurement of Figure 2 outlines key identified information
financial outcomes and service performance systems available in the emergency department.
and partially, workload demand. The available These may not provide all of the information
information systems may not always capture the required, so local data collection and analysis
data required for conducting a comprehensive processes may be developed.
environmental analysis of nursing in the
emergency department.

Emergency Department Addendum 21

 Table 3: Emergency department information systems and data collections

Information system/collection Purpose Informs

Emergency Department Information EDIS was designed based on clinical input and follows the Activity
System (EDIS) progression of a patient through the ED. The system is able Acuity
to monitor patient progress and provide alerts, and record Client outcomes
treatment details. Data collection is a key component of
this program.

FirstNet Registration and clerical functions, triage and tracking Activity

electronic orders and result viewing, including laboratory, Acuity
radiology, consult, and diet orders and results, electronic Client outcomes
medications management, emergency specific nursing and
medical documentation, discharge summaries, decision
support, including alerts and notifications, operational and
regulatory reporting

Hospital Based Corporate Queensland Health’s enterprise patient administration Activity

Information System (HBCIS) system, capturing and managing both admitted and Workforce
non-admitted patient, clinical, administrative and Services
financial data.
Performance
Client demographics
Referral/waitlist
Financial reporting

Queensland Hospital Admitted The QHAPDC is the morbidity collection for all patients Activity
Patient Data Collection (QHAPDC) who have been admitted and separated from a hospital in Client complexity
Queensland. The information collected is used to manage, Client trends
plan. Research and fund facilities at a local state and
Performance
national level.
Client outcomes
Funding

Enterprise Discharge The EDS application uses information from a number Client trends
Summary (EDS) of existing Queensland Health specialist systems Client complexity
to create a legible, consistent, electronic discharge Client outcomes
summary. It allows the summary to be delivered
Performance
electronically to general practices in a secure, timely and
standardised format.

Monthly Activity Collection (MAC) Collects aggregate (or summary level) data on ‘admitted’ Activity
and ‘non-admitted’ patient activity from public acute Provider type
Note: MAC reporting to become
hospital facilities, public residential psychiatric hospitals Client type
obsolete in 2018/19
and public nursing homes/hostels/independent living
Service type
units and multipurpose health services each month. Data
is routinely reported on Queensland Health’s internet and Performance
internet sites. Financial reporting

Consumer Integrated Mental Health Supports mental health's strategic, reporting and Client information
Application (CIMHA) functional requirements through a single statewide reporting
data base.

Queensland Health Enterprise Online application through which Queensland Health Reporting
Reporting Service (QHERS) employees can access a number of custom made statistical
reports. QHERS provides users the ability to view, print
and save reports designed to increase the capability and
effectiveness of management reporting.

22 Emergency Department Addendum

Table 3: Emergency department information systems and data collections

Information system/collection Purpose Informs

Management Information This application is an end to end management system Patient flow
System - Emergency Department of emergency care including, not only details of current Shift planning
Flow Monitor patients in the emergency department (ED) and patients Short-term activity
expected to arrive in the coming hours but, more projection
importantly, the current actions required to improve
patient flow, patient treatment times and specific KPIs
every 5 minutes. This application also provides in-depth,
interactive reporting recent shifts and the last 10 days in
the Emergency Department.

Pyxis® MedStation ES Advanced system that automates the distribution, Medication management
management and control of medications. The system
includes a network of secure storage units located in
patient care areas such as emergency departments

Primary Related Incident Management of clinical incidents and health Performance

Management and Evaluation care complaints Service safety
System (PRIME) Client outcomes

RiskMan Replacing PRIME with a staged release over 2017-2018 Performance

throughout each HHS Service safety
Client outcomes
Staff outcomes
Consumer feedback
system

Decision Support System Provides summary data reports displaying aggregate Workforce
(DSS Panorama) expenditure, budgets, variances and balances for cost Expenditure
centres and account codes for services. Reports are Performance
available for agency use, overtime, leave/ absenteeism,
position occupancy and work centres.

WorkBrain / myHR myHR is a new application that provides real-time access Workforce information
to establishment and employee information located within
SAP HR, providing users with enhanced capability to
manage their workforce.

Patient Flow Manager / The Electronic Patient Journey Board (EPJB) displays Patient occupancy
Journey Boards patient information for clinical staff and allows patient dashboard
information to be entered and updated throughout the care Patient flow planning
delivery process, from admission to discharge. EPJB are
highly visible and promote a multidisciplinary approach to
patient care and discharge planning. Often coloured flags
are utilised in the form of a ‘traffic light system’ to indicate
whether a referral or patient requirement is complete
or incomplete.

Emergency Department Addendum 23

 Figure 3: Remote setting health services information systems and data collections

Information system/collection Purpose Informs

TrendCare TrendCare is a workforce planning and workload Training record

management system that provides dynamic data for Performance
clinicians, department managers and hospital executives. development plans
It supports care planning to ensure best practice, patient
nurse dependency measurement and equitable workload
allocation; human resource and fiscal management, roster
development and patient dietary information.

McKesson Capacity Planner An on line tool used to forecast patient demand and align Workload allocation
staffing resources Capacity management

As per the BPF 5th Edition, when a balanced Examples of workforce specific
scorecard is available, it assists in identifying quality indicators in the emergency
service objectives, selecting appropriate department include:
performance measurements and monitoring
• vacancy rate
the progress of those objectives. The balanced
scorecard highlights both successful and • staff turnover
unsuccessful performance trends and allows • overtime used
service comparisons to be made internally
• casual/agency hours usage
and externally. If a balanced scorecard is not
available it will be necessary to determine local • workload issues
performance indicators.
• absenteeism
There are a number of nurse-sensitive • mandatory education completion rate
indicators suitable for evaluating the quality
• requisite and/or unit specific education
of emergency department nursing services
completion rate
such as:
• patient satisfaction Measurement of performance should include
quality indicators including results from
• use of evidenced-based clinical practice
accreditation cycles and periodic reviews,
guidelines and tools
further examples can be seen on page 50 of the
• patient education practices BPF 5th Edition.
• median wait time to treatment Key performance indicators should be
• percentage of patients who did not wait chosen based on the individual service, with
for treatment consideration of the consumer, staff, and the
greater organisation.
• number of unplanned re-presentations
• number of in-department falls
• hand hygiene compliance
• medication administration

24 Emergency Department Addendum

 Forecasting and A key component of the BPF cycle is evaluating
performance, this will assist in assessing

benchmarking results against the planning as well as form

key information when commencing the next
annual cycle, this is depicted in Figure 1.
Benchmarking like emergency departments
within Queensland can prove to be challenging
due to the varied factors that impact Figure 1: The cyclical process of BPF
demand on an emergency service such as
geographical location, community services,
socioeconomic status of the population and
more, as discussed in Module One. Emergency
departments within Queensland Health have
01
Develop service
the ability to benchmark against the Emergency profile (demand)
Length of Stay Key Performance Indicator in the
System Performance Reporting 24 platform, and
the Hospital Performance Reporting 25 website.

Whilst there is a standardised framework for

classification of emergency presentations,
03
Evaluate
02
Resource
being the Australasian Triage Scale (ATS), 26 performance allocation
there may still be inconsistency in application (supply)
of this scale 27. This may have further impacts
on the ability to accurately benchmark with
other emergency departments.

24
http://qheps.health.qld.gov.au/spr/home.htm
25
http://www.performance.health.qld.gov.au/hospitalperformance/HHS.aspx?id=87
26
http://www.health.gov.au/internet/main/publishing.nsf/Content/casemix-ED-triage+Review+Fact+Sheet+Documents
27
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4458479/

Emergency Department Addendum 25

 References
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Clinical Services Capability Framework Service Modules version 3.2
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Overtime Human Resources Policy
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Queensland Health Governance of Outpatient Services
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Queensland Hospital and Health Services Performance Framework 2016
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Queensland Health Performance Framework 2016
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ada71f6379bc/download/pmffinal11.8.16.pdf
Queensland Health Procurement Procedures
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Queensland Health Strategic Plan for Multicultural Health 2007-2012
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Statement of Government Health Priorities
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Child Protection Act 1999
http://www.legislation.qld.gov.au/LEGISLTN/CURRENT/C/ChildProtectA99.pdf
Child Protection (Offender Reporting) act 2004
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Child Protection Regulation 2011
https://www.legislation.qld.gov.au/LEGISLTN/CURRENT/C/ChildProtectR11.pdf
Chronic Conditions Manual 2015
https://publications.qld.gov.au/dataset/ef6d9f9e-e8aa-445e-a345-02a016e7251b/resource/bbe5439c-be87-45b6-b704-
3b557fbee1e0/download/chronicconditionsmanual1stedition.pdf
Coroners Act 2003
http://www.legislation.qld.gov.au/LEGISLTN/CURRENT/C/CoronersA03.pdf
Environmental Protection Act 1994
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Environmental Protection Regulation 2008
https://www.legislation.qld.gov.au/LEGISLTN/CURRENT/E/EnvProtR08.pdf
Guardianship and Administration Act 2000
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Health (Drugs and Poisons) Regulation 1996
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Health and Hospitals Network Act 2011
http://www.legislation.qld.gov.au/LEGISLTN/ACTS/2011/11AC032.pdf
Health Practitioners Regulation National Law Act 2009
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Health OmbudsmanAct 2013
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Industrial Relations Act 2016
https://www.legislation.qld.gov.au/LEGISLTN/CURRENT/I/IndustRelA16.pdf
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26 Emergency Department Addendum

Power of Attorney Act 1998
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Public Sector Ethics Act 1994
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Queensland Health Nurse and Midwives Award – State 2015
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Right to Information Act 2009
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https://www.legislation.qld.gov.au/LEGISLTN/CURRENT/W/WorkHSA11.pdf

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Aboriginal and Torres Strait Islander Health Performance Framework
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Australian Bureau of Statistics
http://www.abs.gov.au/ausstats
Australian College of Emergency Nursing
https://www.acen.com.au/
Australian Government Department of Health and Ageing Website
https://agedcare.health.gov.au/
Australian Indigenous Health Info Net
http://www.healthinfonet.ecu.edu.au/health-facts/summary
Australian Institute of Family Studies
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Australian Institute of Health and Welfare
http://www.aihw.gov.au/
Australian Safety and Quality Framework for Health Care 2010
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Emergency Department Addendum 27

 Appendix 1: Example activity measures
identified for emergency departments
• triage category (admitted and non-admitted) • number of Medical Emergency Team (MET)
responses provided by the emergency
• number of did not wait presentations
department, including number of nurses in
• number of left after treatment attendance and location within the facility of
commenced presentations the MET responses
• number of transfer presentations, including • Short Stay Unit admissions (including length
mode of transfer (e.g. QAS vehicle, fixed wing of stay)
aircraft located offsite, helicopter transfer
• number of interventional treatments/
on- site)
procedures (e.g. casting fractured limbs,
• number of inpatient admissions from suturing)
emergency department (including
• influenza ‘season’ presentations
escort requirement)
• number of patients requiring escorts outside
• number of planned return visits
of department (e.g. to radiology department)
(including triage category)
• number of bariatric patients who require
• number of unplanned return visits
multiple-person assist, and additional
(including triage category)
equipment resourcing
• number of mental health presentations
• number of occasions/length of time for
(e.g. requiring one on one care)
inpatient admissions remaining in emergency
• number of geriatric presentations department due to unavailable inpatient beds
• number of paediatric presentations • number of presentations transferred to
• time and day of presentations theatre from emergency department

• length of time in emergency department • number of i-Stat (point of care blood testing)
(Emergency Length of Stay [ELOS], Queensland occasions of service
Emergency Access Target [QEAT]) • walk-ins versus ambulance presentations
• Patient Off Stretcher Time

28 Emergency Department Addendum

Acknowledgements
Queensland Health acknowledges the authors, The BPF Strategic Addenda Project Team -
reviewers and editors of the Business Planning
• Andrew Stevens, Principal Industrial Advisor, DOH
Framework EB9 Addenda Project from which this
document is derived. • Greg Moore, EB9 Project Manager, DOH

This addendum was authored by Queensland Health, • Kylie Badke, Industrial Officer, QNMU
Office of the Chief Nursing and Midwifery Officer • Tarryn Mullavey, Speciality Practice Lead: Remote
(OCNMO), and Queensland Nurses and Midwives Setting Addendum
Union (QNMU) by:
• Jillian Richardson, Speciality Practice Lead: Rural
• Debbie McCarthy, Speciality Practice Lead: Setting Addendum
Emergency Departments Addendum
• Denise Sticklen, Speciality Practice Lead:
• Sandra Eckstein, Assistant Director of Nursing, Correctional Services Addendum
OCNMO (co-lead)
• Debbie McCarthy, Speciality Practice Lead:
• Tarryn Mullavey, Acting Assistant Director of Nursing, Emergency Departments Addendum
OCNMO (co-lead)
• Colleen Glenn, Speciality Practice Lead: Maternity
• Sharyn Hopkins, Professional Officer, Services Addendum
QNMU (co-lead)
• Desley Horn, Speciality Practice Lead:
Queensland Health would also like to thank its nurses Paediatric Addendum
and midwives for contributing to this project and
delivering excellent standards of evidence-based The BPF Subject Matter Expert Reference Group - Glenn
patient care to the people of Queensland. Hokin, Jane Davies, Jane Walker-Smith, Jeff Dippel,
Jeffrey Souter, Juliet Graham, Linda Zimitat, Lynne
Special acknowledgement is given to members of: Cameron, Michelle Eley, Neil Pratt, Paolo La Penna,
Rachelle Cooke, Rohan Harbert.
The Emergency Department Speciality Users Group –
• Debbie McCarthy, Speciality Practice Lead: The EB9 Executive Directors of Nursing And
Emergency Departments Addendum Midwifery Services -

• Tarryn Mullavey, Nursing Director – Service • Chris Small, EDNM, South West HHS
Planning, North West HHS • Veronica Casey, EDNM, Metro South HHS
• Lesley Laffey, DON Cloncurry, North West HHS • Judy Moreton, EDNM, Townsville HHS
• Allan Rowe, NUM ED, The Prince Charles Hospital, • Alanna Geary, EDNM, Metro North HHS
Metro North HHS
The statewide Executive Directors of Nursing and
• Amanda Smith, NUM Children’s ED, The Prince Midwifery Services.
Charles Hospital, Metro North HHS
Special acknowledgement is given to the
• Amanda Scanlon, Nursing Director and Facility
following contributors:
Manager, Mackay HHS
• Shelley Nowlan, Chief Nursing and
• Graeme Poole, NUM, Atherton Hospital, CHHHS
Midwifery Officer, OCNMO
• Desley Horn, Nurse Manager, LCCH, CHQ
• Diana Schmalkuche, Director of Nursing,
• Melissa Heather, NUM, Ipswich Hospital, West Workforce Sustainability, OCNMO
Moreton HHS
• Rachel Borger, Director, Industrial Relations,
• Juliet Graham, Nursing Director of Workforce, West Employment Arrangements Unit
Moreton HHS
• Renee Muggleton, Project Support Officer,
• Robin Stocks, NM Informatics, Wide Bay HHS Employment Relations
• Muireann Wynne, CNC, Logan Hospital, • Denise Breadsell, Professional Officer, QNMU
Metro South HHS
• Susan Krimmer, Acting Assistant Director of Nursing,
• Julie A Oliver, A/Nursing Director, ED, MHHS OCNMO for her contribution in co- leading and
commencing the project.
30 Emergency Department Addendum