Overview
Initiative type
Service Improvement
Status
Deliver
Published
June 2026
Topic
Summary
Internal Medicine Acuity and Support Team (IMAST) is a nurse-led after-hours support team improving safety, staff support and patient flow while reducing agency use and one-on-one nurse specialling.
Dates: Sep 2025 - ongoing
Implementation sites: Logan Hospital
Aim
To implement a proactive after-hours nursing support model that improves patient safety, supports staff, and optimises workforce use.
Outcomes
- Over 4,000 after-hours support requests managed.
- 95% of staff survey respondents identified the service as essential.
- 85% reduction in agency nurse utilisation.
- 82% reduction in one-to-one specialling requirements.
- Improved staff-reported safety, support and confidence after hours.
- Improved coordination of admissions and discharges.
Background
Internal Medicine at Logan Hospital manages large patient volumes, frequent admissions, and discharges, and increasing clinical complexity. After hours, staff must manage high workloads, patient deterioration, and behavioural challenges with limited access to senior clinical support. Prior to implementation, there was no dedicated after-hours team to coordinate workload pressures or provide structured clinical support. Variability in leadership presence and workforce allocation created operational strain and potential safety risks.
IMAST was introduced to provide proactive, nurse-led clinical and operational support after hours.
Methods
IMAST was implemented as a quality improvement initiative using the Plan–Do–Study–Act method. The team consists of a Clinical Nurse Consultant, Registered Nurse, and Enrolled Nurse providing structured rounding, triage, and real-time support across Internal Medicine after hours. The service supports clinical escalation, workload coordination, and assessment of additional staffing needs. Activity and workforce data were collected prospectively. Staff feedback was obtained using a voluntary survey.
Discussion
The model improved staff perceptions of safety and support while reducing reliance on agency staff and one-to-one speciallsiing. Proactive rounding and structured triage strengthened clinical governance and resource use. The model is sustainable and transferable to other inpatient services experiencing after-hours workload pressures.
Limitations include finite team capacity during peak demand periods and the challenge of isolating impact in a complex hospital system were multiple operational roles influence outcomes. Ongoing monitoring and refinement of prioritisation frameworks remain essential.
The model aligns strongly with the “From Referral to Recovery – Patient Flow and Access Innovations” themes, whilst being an active support for workforce.
References
- Institute for Healthcare Improvement. Plan–Do–Study–Act (PDSA) methodology.
- National Safety and Quality Health Service Standards (2nd edition).
- Queensland Health workforce and patient flow strategic priorities.
Key contact
Darren Clark
A/Service Line Director Internal Medicine
Logan Hospital
Metro South hospital and Health Service