Background/Introduction:

At the height of the COVID pandemic there was concern that patients presenting to the Emergency Department (ED) of a large tertiary hospital in Western Australia, could face long queues and significant delays to triage, registration and emergency care.

Aim/Purpose:
To create an application allowing a ‘voice in the queue’ for consumers in order to facilitate rapid identification of high-risk patient's pre-triage.

Methods/Intervention/Activity:
The quality improvement
project utilized both Innovation Design methodology and PRINCE Agile approaches to implement the ED Self Registration and Triage application. The South Metropolitan Health Service (SMHS) Karrtdijin Innovation Team worked with FSH ED innovators to test their idea through rapid phases of development. The application, using Microsoft 365 and QR codes, allowed patients awaiting triage to complete a questionnaire on their presenting complaint, which alerted the Triage Nurse to patients requiring immediate attention during periods of high demand.
Three workshops were held with Triage Nurses in order to assess the sensitivity of the triage questions and refine as required.

Results
Consumer satisfaction with usability of the application was evaluated via a consumer audit. 98% of patients (n=50) surveyed found the questions and instructions easy to understand, 96% found the self-triage questionnaire easy to use.

Conclusion/Recommendations:
Following the proof of concept a pilot study is required to test the reliability and validity of the application question set in a business-as-usual environment. The intent is to scale to the SMHS catchment and explore where and how the application would be relevant for metropolitan wide expansion.

Background:
In the wake of COVID our Emergency Department(ED) in a tertiary facility faced numerous workforce challenges. Our permanent workforce was exhausted and skill mix was diluted. When the recruitment freeze lifted we had new staff en-masse and gaps were identified in emergency nursing preparation and support post orientation. Our leadership team recognised the need to develop opportunistic training and education processes within a high activity ED.
Purpose:
The goal is to improve the basic standards across the department by investing early in ED education teaching the 'Building Blocks' and providing clinical support to new staff.

Intervention:
The Clinical Nurse(CN) Preceptor project developed the 'Building Blocks' as a systematic categorisation of the information staff needed to work in our ED. The teaching is delivered by a group of dedicated CNs to assist staff to deliver a safe, effective, consistent standard of care to patients and significant others. The concept is supported by a 'Building Blocks' App which is accessible to all staff.

Outcome:
The benefits are targeted at our Registered Nurses for upskilling and support; our CNs with an increased scope of practice and improved job satisfaction; and Department wide with greater patient and staff safety, enhanced teamwork processes and strong professional development pathways.

Conclusion:
The CN preceptor model represents innovative thinking translated to the clinical setting in a format utilising current experienced staff offering face to face support backed by existing cost-effective technology. In essence it involves nurses empowering nurses to deliver consistent optimised care to patients and families.

Background:
In September 2022 we established a Clinical Nurse Preceptor(CNP) role to assist an influx of new staff to deliver a safe, effective, consistent standard of care to patients. We developed the 'Building Blocks' as a systematic categorisation of the information staff needed to work in our Emergency Department(ED).

Purpose:
To support the CNP role we developed the 'Building Blocks' App as a technological solution to deliver training and optimised care in an accessible user-friendly format.

Activity:
The CNP role provides the face to face clinical support to teach the Building Blocks but we felt a digital resource was a valuable addition. The digital App was conceptualised using a microsoft platform and created by our project team of CNPs. Content was obtained from current ED policies, guidelines, role statements, orientation programs and education documents. The information is navigated via tabs covering Basic Standards, ED processes, Model Of Care & Common Presentations as phase one. In Phase two additional tabs were developed for Resus, Triage, Team Leaders and Coordinator Resources for our senior staff.
Outcome:
The initial concept was to help new staff with quick “cheat sheets” for common presentations and department specific processes. From this it has evolved into a comprehensive resource accessible to all nursing staff working in our ED.

Conclusion:
The Building Blocks App is being utilised across the Deparment to help new, experienced and visiting staff. We have had very positive feedback and received an Innovation Award for the App at our organisation's International Nurses Day Awards.

Objective:
To determine the effects of the COVID-19 pandemic on the proportion, population characteristics and treatment of patients presenting in pain to a large inner-city adult emergency department (ED).
Materials and Methods:
We interrogated triage nursing assessments using a clinical text deep learning model to identify the prevalence of pain on arrival to the ED. We assessed the impact of the COVID-19 pandemic using interrupted time series analysis and described this population for three years peri-pandemic in terms of their demographics, arrival patterns and treatment.
Results:
Before the pandemic 546/1000 patients presented with pain. The COVID-19 pandemic precipitated a sudden decrease of 4.6%, followed by a sharp, sustained rise to 3.1% above the baseline prevalence of pain on arrival. The population presenting in pain changed in terms of their age, socioeconomic status, urgency and re-presentation rate. Patients post-pandemic were less likely to receive any analgesia or opiate analgesia than the pre-pandemic population.
Discussion
COVID-19 altered the prevalence and characteristics of patients presenting in pain to ED. It influenced how health providers treat pain, with alterations in both the provision of medications and the types of medications provided. The causes of these changes are unclear at present but may be related to changes in societal expectations of care from EDs.
Conclusion
In a post-pandemic world, who accesses ED care and how providers treat them has changed and must be considered when improvements in pain care are made in the ED setting.

Background/Introduction:
Pain is the most common reason for patients to present to emergency departments (ED), yet pain management in ED is often suboptimal. Although intravenous patient controlled analgesia (PCA) is commonly used for post operative pain relief, it is not routinely used in the ED.

Aim/Purpose:
This presentation will outline a complex study protocol and reflect on the challenges encountered and resourceful solutions employed during a study to explore the feasibility of using PCA in ED.

Methods/Intervention/Activity:
The study protocol involved a sequential mixed methods design in three phases. Phase 1 involved semi-structured interviews with clinicians to determine perceptions of PCA use in ED. These findings informed phase 2 in which surveys were developed, tested, and distributed to ED clinicians via the Australasian College for Emergency Medicine (ACEM), College of Emergency Nursing Australasia (CENA), and College of Emergency Nurses New Zealand (CENNZ). In phase 3, a feasibility pilot randomised controlled trial was conducted to evaluate the feasibility of using PCA in ED.

Results/Outcome:
Several challenges were encountered during this study that required creative solutions. For example, to increase low survey response rates, several unique initiatives were mobilised including publishing a news article in an ACEM newsletter and promoting the survey to members of a health research network.

Conclusion/Recommendations:
This study protocol highlighted the complexity of sequential mixed methods studies in an ED and provided insights into the power of creative and innovative solutions in enhancing research.