Improving emergency department care
We are working with consumers and clinicians to improve ED care for people who are older, are living with a disability or mental health condition, are Aboriginal and Torres Strait Islander, or come from multicultural backgrounds.
Project sponsor: The Australian Government Medical Research Future Fund
About the project
The demand for urgent hospital care is increasing in Australia and internationally, placing prolonged strain on acute care services provided by EDs.
Overcrowding is becoming more common and patients are staying longer, with fewer seen within four hours, leading to poor outcomes and adverse events.
Siloed efforts have not worked and a new, integrated system-level approach to ED care that incorporates evidence-based human factors principles, and a patient-focused collaborative co-design process, is needed.
Patients are not an homogeneous group; ED performance is worse for patients who:
- are older with multiple comorbidities
- are living with a disability
- present with a mental health condition
- are Aboriginal and/or Torres Strait Islander
- come from a culturally and linguistically diverse (CALD) background.
Understanding and addressing the specific needs of these five priority patient cohorts has potential to improve not only the outcomes and care experience for these people, but ED performance overall.
We are applying our accumulated expertise in consumer-focused co-design, human factors and emergency department care to improve:
- ED performance (eg shorter wait times and reduced length of stay)
- patient outcomes (eg fewer re-presentations and people who did not wait to be seen)
- patient experience (eg satisfaction, respect and feeling safe).
The MyED project adopts a system perspective over three stages:
Step 1.1: Ethnographic observations
The research team completed a total of 202 hours of observations in the three participating WSLHD emergency departments: Westmead, Blacktown and Mount Druitt. The team have analysed these data in conjunction with the interviews with clinicians and consumer cohorts.
Step 1.2: Qualitative interviews with ED clinicians and professional stakeholders
Qualitative interviews with ED clinicians and professional stakeholders. The research team collected and analysed over 20 hours of data collected through 44 interviews and one focus group.
Step 1.3: Qualitative interviews and focus groups with older people and people with a CALD background
We obtained many insights from the interviews and focus groups with people from the culturally and linguistically diverse (CALD) community and from older adults and their carers. We completed 14 focus groups and three interviews with a total of 48 people from over five different language groups including Arabic, Mandarin, Cantonese, Hindi and Korean, and with 12 older adults and carers. Many thanks to those who shared their ED experiences with us!
Step 1.4: Qualitative interviews and focus groups with people living with a mental health condition or disability
Interviews were conducted with 29 people who attended ED with mental health concerns and they shared many insights about their emergency department experiences. We also spoke with 16 mental health experts. We conducted interviews with 19 adults living with disability who generously shared their experiences of ED care, and we spoke with 17 other stakeholders including supported living home managers and academic experts. This stage is now complete and we are very grateful to the participants for sharing their stories and experiences.
Step 1.5: Qualitative interviews and focus groups with ED clinicians and Aboriginal peoples
All data collection associated with the Aboriginal peoples cohort will be determined in collaboration with an Aboriginal reference group. As of July 2025, we are awaiting approval from the Aboriginal Health and Medical Research Council (AH&MRC) to begin our yarning circles with community participants.
Consumers, ED clinicians and the research team will partner to co-design new or adapted models of acute care to meet the needs identified in Stage 1. We will refine and test the care models using our ED Work Domain Analysis model and select the most promising models via a business case for local implementation at Westmead, Blacktown, and Mount Druitt EDs.
ED performance, patient outcomes and patient experience will be analysed longitudinally using linked routinely collected data to determine performance trends for the participating EDs in comparison with NSW ED peer groups; comparative effectiveness of the new models of care will be assessed post-implementation, to inform further dissemination in Stage 3.
Stage 2 commenced in November 2024 with five co-design sessions with members of the CALD community and ED clinicians. The touchpoints, or priorities identified from Stage 1, guided the improvement areas.
We have completed the co-design with clinicians, and patients and carers from the older adult cohort and the mental health cohort, and will commence co-design with the disability cohort in late 2025.
We have completed business cases for co-designed interventions to improve delivery of care for people with CALD backgrounds, older adults and people presenting with a mental health concern. Once endorsed by the project Steering Committee, we will publish them on this site, so stay tuned!
More information on Stage 3 will be available at a later date.
Project goals
We aim to:
- elicit needs and preferences for delivery of acute care in the Western Sydney Local Health District (WSLHD) from the five priority cohorts
- co-design, develop and implement consumer-driven new or adapted models of care that enable EDs to meet the needs of our five priority cohorts
- use implementation science methods and work with the NSW Emergency Care Institute (ECI) to scale-up and spread the aforementioned successful models of care to EDs in public hospitals across NSW.
Contact: robyn.clay-williams@mq.edu.au for project-specific enquiries or myED@mq.edu.au to become a researcher.
- Professor Robyn Clay-Williams – Project Lead
- Dr Colleen Cheek – Project Manager
- Dr Elizabeth Austin – Research Fellow
- Dr Emilie Francis-Auton – Research Fellow
- Dr Natalia Ransolin – Postdoctoral Research Fellow
- Dr Magali Goirand Ampaire – Postdoctoral Research Fellow
- Dr Tolesa Okuba – Statistician
- Shai Grigg – Indigenous Coordinator
- Lieke Richardson – Research Assistant
- Dr Ling (Christina) Zheng – Research Assistant
- Amanda Dominello – PhD candidate
Project lead: Professor Robyn Clay-Williams
Chief investigators
- Dr Reza Ali (ED Blacktown Mount Druitt Hospital Hospital)
- Dr Elizabeth Austin
- Professor Jeffrey Braithwaite
- Dr Kate Churruca
- Professor Robyn Clay-Williams (Lead)
- Professor Henry Cutler
- Associate Professor Louise Ellis
- Dr Donna Gillies (NDIS Commission)
- Professor Reema Harrison
- Professor Peter Hibbert
- Professor Leanne Holt (Chair Aboriginal Advisory Group)
- Professor Rebecca Mitchell
- Dr Matthew Vukasovic (ED Director, Westmead Hospital)
- Dr Ramesh Walpola (UNSW)
- Professor Yvonne Zurynski
Associate investigators
- Dr Ann Carrigan
- Aaron De Los Santos (ED CNC, Blacktown Mount Druitt Hospital)
- Anne Dwyer (DSS)
- Shai Grigg (WSLHD)
- Dr Kylie Gwynne
- Jacqueline Hrast (DSS)
- Dr Karen Hutchinson
- Dr Janet Long
- Dr Satish Mitter (ED Blacktown Mount Druitt Hospital)
- Dr Margaret Murphy (ED CNC, Westmead Hospital)
- Dr Bronwyn Newman
- Professor Paul Salmon (USC)
Other members and collaborators
- Dr Anthony Brown (Health Consumers NSW)
- Dr Trevor Chan (ACI)
- Alison Derrett (WSLHD)
- Dr Nema Hayba
- Associate Professor Jennifer Heath
- Graeme Loy (WSLHD)
- Dr Alicia Norman (Health Economist)
- Dr Rezwanul Rana (Health Economist)
- Kylie Smith (ACI)
The Australian Institute of Health Innovation at Macquarie University is leading this research, together with our partners:
- Department of Social Services
- Health Consumers NSW
- NDIS Quality and Safeguards Commission
- NSW Agency for Clinical Innovation
- Western Sydney Local Health District.