Emergency department staffing

General principles

There are over 7.8 million attendances to Australian emergency departments (EDs) each year. Patients requiring emergency care have the right to timely care by skilled staff. The aim of staffing an ED is ultimately to provide safe, high-quality emergency care in an acceptable time according to the patient’s clinical urgency (triage category). Staff working in the ED also have the right to safe and manageable working conditions and reasonable job satisfaction.

As the activity of an ED fluctuates in both volume and acuity, a threshold level of staffing and resources is required in order to be prepared for likely influxes of patients. In addition, the staffing number and mix needs to take into account the important teaching role of EDs.

The precise numbers and designation of medical, nursing, allied health and other staff employed will be determined by the local work practices (which tasks are carried out and by whom). This chapter discusses staffing requirements under the current Australasian model of ED work practices. This includes a major supervisory and teaching role for consultants and a significant proportion of specialist trainees and junior medical staff in the medical workforce, with a range of tasks, including venipuncture, test requisitioning and documentation. In addition, roles are expanding into wider realms, such as toxicology, ultrasound and academic and observation medicine. Emergency nursing roles are focused on patient assessment, initiation of interventions and investigations, monitoring the response to therapies, escalation of care if required, and prevention of complications. In addition, there are a number of advanced practice roles for emergency nurses that include the initiation of tests and treatment, and emergency nurse practitioners who can independently manage the patient’s episode of ED care.