Pull from Emergency Department

Initiative Type
Model of Care
19 July 2017
Last updated
21 June 2020


The Pull from emergency department (ED) model refers to the concept of patient flow based on the 'downstream' units (i.e. wards) asking for patients rather than the 'upstream' unit (i.e. ED), pushing patients to the units or wards.

Key principles

This model prescribes a pull not push process for internal hospital transfers.

Units should:

  • actively pursue the transfer of an incoming patient
  • build strong communication links between inpatient and ED staff
  • complete a comprehensive handover that enables smooth admissions and discharges
  • have key person responsible for ensuring a coordinated patient transfer
  • adopt this model as standard hospital practice.
Key dates
Nov 2016
Implementation sites
Queensland Health Emergency Departments


  • To have a proactive system of patient flow to reduce delays with admission
  • Enhance capacity of emergency departments
  • Maximise optimal bed management
  • Reduce need to put patients in wards as an outlie separate from home wards and eliminate inefficiencies caused by distributing admitted patients to other wards


  • Reduced ramping in the ED
  • Reduced length of stay in the ED
  • Reduced length of stay in inpatient areas
  • Reduced access block
  • Reduced risk of adverse events


The Australian National Emergency Access Target (NEAT) was introduced in 2011 in response to mounting evidence and public concern about the quality and timeliness of care provided by hospital emergency departments (EDs) across Australia.

A substantial literature review has shown that ED overcrowding in Queensland has long been associated with sub-optimal clinical outcomes and patient dissatisfaction. In the last ten years various governments have been politically pressured to introduce solutions that respond to increasing ED demand and worsening ED overcrowding. The Pull from Emergency Model of Care is one of these solutions.

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Key contact

Laureen Hines
Director Statewide Access
Healthcare Improvement Unit
(07) 3328 9937