Nurse-Led Care Coordinator - Emergency Triage Service

Aim

The Care Coordination Service aims to reduce the waiting and ramping time for those who  are brought into the Emergency Department (ED) under and Emergency Examination Authority (EEA). The team assesses the person at point of triage and facilitates seamless transition through the ED; undertakes a timely and comprehensive assessments; and co-ordinates refererals.

Outcomes

Preliminary data over the first 12 months shows that of the people presenting under an  EEA who were assessed by the Clinical Care Coordinators, 49% were able to be diverted to appropriate services, preventing unnecessary Emergency Department Mental Health (EDMH) assessments. The program has contributed to better alignment of clinical services  with actual people needs, including referrals to other services offered by ED or community

Background

Under the public health act 2005, Queensland Ambulance Service (QAS) and Queensland Police  Service (QPS) can invoke an Emergency Examination Authority (EEA) to transport a person whose behaviour warrants immediate health examination. This includes people who are at risk of suicide, or, harming themselves.

Over the past years, there has been an increase  in the amount of EEA’s presenting to the emergency department. However, not all EEAs warrant acute mental health assessment, but are typically still referred for a mental health assessment. Many EEAs are revoked and the person is discharged once seen by the  mental health service. This process increases people’s waiting times. Furthermore, while people are waiting to be seen by the mental health team in the ED, the emergency responders cannot attend other incidents and ramping are often lengthy as a result.

To  manage these complex mental health presentations, the Princess Alexandra Hospital (PAH) has developed an innovative approach to streamline processes and enhance people’s outcomes. A nurse led Care Coordination Service has been integrated into the ED triage  process, since May 2024. This new service was made possible by funding under the Queensland Health Putting Patients First Plan. The funding facilitates a 12 hour a day seven days per week coverage, with no backfill.

Discussion

To make this model sustainable, we introduced standardised assessment tools, clear documentation,  and targeted staff education, especially for ED teams and first responders. This helps build confidence and consistency when managing EEA presentations. The model shows that advanced practice nurses can safely lead triage for complex cases, streamline flow,  and improve care decisions. It also highlights how a nurse-led approach can reduce pressure on EDs by linking people with the right services from the start. By diverting consumers who don’t need acute mental health care, we’ve seen better outcomes for patients,  fewer delays, and more appropriate use of ED resources. Most importantly, it’s a person-centred approach focused on getting people the right help at the right time and has improved relationships with external partners such as QPS and QAS with improving waiting  and ramping times.

Weaknesses

Confusion with referral pathways when there is no coverage for Care Coordinators through triage due to demand of referral numbers, it is difficult to allocate time for the development of Acute Management plans in a timely manner.

Opportunities

• Aligning shifts with ED for Care Coordinators to facilitate ability to actively participate in handover - (fits in with 12hr shift, 24hr service)
• Ability to move forward with a continuous service, improving relationships within the greater ED.
• Ability to review data longitudinally and identify further opportunities to present the effectiveness of the Care Coordinator model

Threats

Funding is critical for the expansion of this model to a 24hrs CNC-led service.

References

Better Care Together: A plan for Queensland’s State-Funded Mental Health, Alcohol and  Other Drug Services to 2027