Breaking nursing silos: A collaborative approach to improving transitional care

Emma Staines1

1Clinical Nurse, Emergency and Trauma Center, Royal Brisbane and Women’s Hospital, QLD

The transfer of patients from emergency to the ward environment is a critical point in the patient’s journey, with wide ranging impacts on patient safety, patient flow, and staff relationships. Poor interdepartmental transitional care and nursing handover are associated with increased adverse events, errors, and poorer patient outcomes. Communication between emergency and inpatient departments must be clear, collaborative, and consistent, in order to ensure patient safety during this transitional point in their care. The Collaborative Care Enterprise (CCE) is a project developed at the Royal Brisbane and Women’s Hospital (RBWH) in 2017, specifically to address the relationship between emergency and inpatient nursing staff.

The CCE has been a collaboration between emergency and inpatient staff, bringing front-line nurses together to discuss issues and concerns related to transitional care, and forge actionable strategies for improved teamwork and patient care. Initiatives of the CCE include conducting education sessions regarding patient flow and scope of emergency care, inviting ward staff for structured walk-throughs of the department to increase understanding of departmental processes, and providing case studies of occasions when the transfer of a patient was concerning to ward staff.

The CCE has provided nurses in emergency and inpatient departments a platform for open dialogue regarding concerns, constructively discuss options for process and policy change, and develop a better understanding of their colleagues work environment. This has resulted in improved relationships and communication between departments, and process changes that have optimised transitional care for patients, such as facilitating ward staff to collect patients from emergency and collect data from the Emergency Department Information System.

Building on the success of the past six month, there are plans for the CCE to expand and incorporate other wards within RBWH, in order to further improve the safety of patients as they are transferred out of the emergency department.


Emma Staines is a Clinical Nurse in the Emergency and Trauma Center at the Royal Brisbane and Women’s Hospital. Emma holds post-graduate qualifications in Acute Care, Immunisation and Emergency Nursing and is currently undertaking her Master’s in Public Health, majoring in Disaster Health and Humanitarian Assistance. For the past year, Emma’s focus has been designing and implementing a quality improvement project targeted toward improving interdepartmental nursing team work, relationships and transitional care. Leading a multi-specialty nursing team, Emma is working toward breaking down departmental silos, turning clinical incidents in transitional care into practical change and thereby developing forward-thinking, professional, evidence-based clinicians.