Overview
Initiative type
Model of Care
Status
Deliver
Published
June 2026
Summary
The Surgical Rapid Access Unit (SRAU) is a medical lead multidisciplinary team providing timely access to specialty surgical teams for patients requiring acute surgical consult in the Emergency Department (ED) and Outpatients Department (OPD).
Dates: March 2025 - Ongoing
Implementation sites: Metro South HHS
Partnerships: Healthcare Imporvement Unit
Aim
Provide rapid surgical speciality review and management of patients in ED to reduce wait times, reduce ED length of stay, improve patient flow by utilising alternate care pathways or streamlining existing pathways. Promoting enhanced theatre efficiencies and early discharge with OPD follow-up.
Outcomes
- 827 patients consulted by SRAU Service
- 81% acceptance rate (currently >120consults/month)
- 74% of patients referred and reviewed within 60 minutes from triage (<5% previous to SRAU)
- SRAU pt LOS 1.03 (Pre SRAU LOS 2.6 days, 59.7 saved bed days)
- ED LOS 4hrs 51mins (pre SRAU 9hrs 13mins), 47% reduction in ED LOS or more than four hours faster in wait/treat time.
- 80% of SRAU admissions had surgery (previously 54% had surgery)
- Reduced DAMA/LAMA rates Patient and Staff satisfaction has remained above 4/5 star for duration of imitative
Background
- Extended ED wait times, increasing patient risk of morbidity and mortality
- Decreasing quality care secondary to time and capacity pressures - not meeting person-centred care pillar
- Poor patient flow, bed-blocking, increased risk
- Reduced theatre efficiencies and extended LOS
- Increasing cost to health service
- Increasing patient complaint and workplace violence
- Increasing staff burnout
Methods
- With the overarching support of the Health Improvement Unit Logan Hospital went live with the SRAU model in March 2025.
- Regular Stakeholder meetings internally/externally
- Queensland-wide benchmarking
- MoC, inclusion/criteria, escalation workflows, key contacts, governance pathways developed
- ieMR digital platform (and accesses) developed
- Data reports and dashboards developed
- ESM clinics set up and implemented as OPD service which collects ABF
- Interdivisional collaboration
- External consultation to other satellite MSH facilities
- Set up and now Live on GP HealthPathways for GPs
Discussion
Identifying the current service strengths and limitations, assessing as a wider group what operational risks may present to meet initiative targets and measures. Recruitment into FTE funded positions. Collaboration and benchmarking to develop MoC and inclusion/ exclusion criteria to fit the needs of our consumers, primary health network and health service. As a multidivisional project, collaboration and mutual understanding of each differing service, resources and the focus of the division was instrumental in the success of the model.
Lessons learnt: Expand clinical inclusion/exclusion criteria earlier, whilst actively bringing on additional speciality teams more rapidly.
Strengths: Model very successful when working consistently. Profound improvements (supported with data) on earlier speciality review, staff and patient satisfaction.
Weaknesses: Single points of failure. ie Sick leave, rosters, new staff, large volume of staff, education dissemination, evolving model
Do differently: SMO led, ED rounding
The RBWH has adopted the SRAU model into an existing team with clear parameters of roles, SMO led, clear patient cohort / inclusion/ exclusion criteria, extended SRAU operating hours.
Next Steps: Continue to expand service in ED and OPD capacity. ED (increase clinical criteria/hours), OPD (streamline and capitalise on existing pathways). Commence ED rounding, stabilise model of care and future plan for the increased theatre capacities in 2027.
References
doi: https://doi.org/10.1136/bmj.r1008 (Published 15 May 2025) doi: https://doi.org/10.1136/bmj.r119
(Published 20 January 2025) 10.1136/emermed-2021-212106 (Published 18 January 2022
Key contact
Jaimee Ginn
Clinical Nurse Consultant
Logan Hospital
Metro South Hospital and Health Service