Doctors, nurses and surgeons are divided over whether a high-speed emergency department process proposed for the New Royal Adelaide Hospital would be safe or dangerous.

An SA Health consultation paper on the process, seen by InDaily, says one senior emergency department clinician – understood to be a senior nurse – would have to decide on patient admission, transfer or discharge in under two minutes.

Triage at the existing Royal Adelaide Hospital takes between three and five minutes. The triage desk is staffed by two registered nurses.

According to the medical officers’ union, the new process, called “Quick Look”, would threaten patient safety.

“I think it’s going to look essentially the same as what we do now (but) there will be much worse ambulance ramping and difficulties with people accessing urgent care in the hospitals,” senior emergency department doctor and South Australian Salaried Medical Officers’ Association (SASMOA) spokesperson David Pope told InDaily.

“When you are forced to make those sort of end-decisions at the beginning of the assessment process, then you’re effectively jumping to conclusions which could be wrong, quite wrong; dangerously wrong.

“The problem is the lack of time to make some pretty critical decisions, and the only people that could possibly do that safely would have to have 20-plus years experience doing it.

“Those people used to exist, but they don’t any more.”

Pope said any nurse who made a decision to discharge a patient in under two minutes would do so “at peril of their registration” and “would be breaching their duty of care”.

The fast-tracked triage process – which SA Health insists is only a partial triage process – would also require a senior nurse to direct patients to wards, to medical teams or to the emergency department for treatment, without a doctor assessing the patient first.

According to the surgeons’ representative body, this would put patients at risk.

“From a patient safety perspective, we would say that a patient who is seriously ill enough to require admission to hospital should be seen by a doctor before they’re admitted to the ward, and not triaged directly to a ward by a nurse,” said chair of the SA Regional Board of the Royal Australasian College of Surgeons Sonja Latzel.

“That person is making a decision to admit a patient to a hospital without medical review within two minutes, which is very unusual.

“It begs the question why it’s taking three to five minutes now, but it will only take two minutes then.”

However, SA Branch CEO of the Australian Nurses and Midwifery Federation Elizabeth Dabars said the “Quick Look” system would reduce emergency department waiting times and improve safety for patients.

“We are extremely supportive of the concept,” Dabars said.

“We’ve actually been advocating a system of this nature for some time.

“It ensures that there’s an extremely senior skilled clinician which would be a nurse, providing an immediate assessment the patients who are presenting in to the emergency department and put them onto an immediate pathway that would facilitate the best patient flow through the system.”

Dabars said it would be possible for a highly experienced senior nurse to decide a patient was on “a discharge pathway rather than an admission pathway” in under two minutes.

“That is absolutely entirely possible in some circumstances,” she said.

Dabars said the 11-page consultation paper did not provide enough detail to judge the “Quick Look” system and that the union would await a pilot of the system at the existing Royal Adelaide Hospital to make further judgements about its effectiveness.

“We absolutely believe that this is a safe and effective model that would have great benefit,” she said.

“It is a model that has been used elsewhere successfully. It does occur in other locations, such as the United Kingdom and the like.”

SA Health told InDaily in a statement that the “Quick Look” process “will mean patients spend less time in the emergency admissions area and begin receiving their treatment sooner”.

“The Quick Look function is a streaming process, which aims to quickly move patients to the appropriate area of the hospital where a full assessment of their needs can be made.

“It is not expected that a full ‘triage’ will be completed in under two minutes.

“The new Royal Adelaide Hospital Emergency Department will have 25 per cent more cubicles than the current RAH ED, as well as having direct admission routes so patients can directly access the care they need without going through the ED.

“Consultation on Quick Look is open until 20 October and all feedback will be reviewed before any final decisions are made.”

The $1.85 billion New Royal Adelaide Hospital is expected to open in 2016.