Why use a 3-2-1?
3-2-1 Process
Patient flow is an essential component of the ideal patient journey, particularly for complex high acuity patients who require timely access to initial care and work up. The processes of care that occur within the ED setting (some of which are out of the control of the ED) are often subject to delays that fragment a patient journey and may not add value to patient care.
In order to improve the flow of patients through the ED it is essential that the barriers to patient flow and decision making are identified and resolved and that key time points of the patient journey are defined, time limited and proactively managed.
The 3-2-1 process breaks down a patient’s journey through the ED into manageable ‘chunks’ of time. It works by identifying measurable time points for each part of the journey and uses pre-agreed protocols and policies to expedite admission or discharge.
The underlying principle governing 3-2-1 is that patients should only stay in the ED for the minimum amount of time required to safely assess, stabilise and transfer care to the inpatient environment or discharge home safely.
How it works
3-2-1 assigns the following time targets:
- 3 hours for the ED to examine a presenting patient, run diagnostic tests, commence initial treatment and determine whether the patient is a likely admission
- 2 hours for specialty medical teams to consult with a view to admission
- 1 hour for inpatient wards to be ready to take over the care of the admitted patient and move the patient.
Time targets are identified after arrival of each patient to the ED. These are monitored and issues are identified and resolved in a timely way so that patient transfers out of ED can occur before decision-making and exit times are breached.
Resuscitation
Patients requiring resuscitation are a subset of 3-2-1 care. Sufficient staffing and skill mix should be available to provide care for the expected caseload of such cases without significantly impacting on the flow of the other patients through the Emergency Department.
ED responsibilities (3)
To decrease the time taken to work-up patients for admission to 3 hours, ED staff should:
- Expedite assessments, investigations and initial therapy
- Make timely decisions about the need for admission at a senior level
- Streamline the process for obtaining an appropriate ward bed
- Ensure communication between ED and specialty teams can occur accurately and in a timely manner (eg use IT systems or use a communications clerk).
Inpatient team responsibilities (2)
To ensure the review and acceptance for admission of patients from the ED within 2 hours inpatient teams should do the following.
- Ensure the availability of admitting staff to be able to respond within 2 hours
- Review the patient in the ED and accept responsibility for care within 2 hours
- If specialty team review is not possible within 2 hours, accept the ED decision to admit.
ED and inpatient team responsibilities (1)
To ensure the patient is transferred to the ward after a bed has been identified requires cooperation between the following parties:
- ED Supervising Senior Clinician and ED Clinical NUM/Nursing Team Leader
- ED and Inpatient Clerical Staff
- Inpatient Clinician and ward NUMs
- Bed Manager
- Portering Services.
