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TRICSI Translational Research Institute Clinical Service Improvement and Innovation
Dr Andrew Staib-
Deputy Director Emergency Medicine,
Co-Director TRICSI,
Senior Lecturer University of Queensland, Research Fellow UQ- MMRI,
Systems Physician QH Clinical Excellence Division
@AndrewStaib
Digital Hospital-
Emergency Department
Transformation
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TRICSI Translational Research Institute Clinical Service Improvement and Innovation
Outline
• Challenges
• Advantages of DH ED
• Disadvantages of DH ED
• ED Digital Transformation
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TRICSI Translational Research Institute Clinical Service Improvement and Innovation
Challenges
• ED is a complex system – Touches on almost every aspect of the hospital system
– Highly dependent in technical and clinical interfaces
• Highly Measured – NEAT, benchmarked, executive KPI’s
• High profile – Media, ambulance, rest of hospital
• Large numbers of staff – Multiple disciplines
– High turnover
– Staff from other areas in the hospital involved
• EDIS was pretty good
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TRICSI Translational Research Institute Clinical Service Improvement and Innovation
So why do it?- Advantages
• “i” is the critical letter
• Integration – With the rest of the patient’s record- locally and statewide
– Between nursing and medical management and documentation
– With ordering and results
• No doubt it is a better system for looking after an individual patient in ED already
• Richness of data being collected will transform the way we do clinical redesign. – eg 300000 sets of observations
– Integrated data, so not just ED research
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TRICSI Translational Research Institute Clinical Service Improvement and Innovation
Disadvantages
• Not as good for overall department flow management
(yet)
– Failure if just considered an EDIS replacement
– Data and reporting is different and challenging
• Different
– From previous
– From other sites
• Multiple ways to do the same thing (also an advantage)
– Makes training and consistency difficult
– Hard to know the “best way” initially
• We aren't doing this to allow us to do the same things
the same way faster or cheaper
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TRICSI Translational Research Institute Clinical Service Improvement and Innovation
Requires significant change leadership
• This is not controllable in every aspect
• This is not an EDIS replacement project
• This is not a static target- the product, environment
and staff are changing at the same time
• So here’s what I think are the 5 main points
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TRICSI Translational Research Institute Clinical Service Improvement and Innovation
1. Accept that you will be slower and less
efficient for a while
• Digital deceleration is
– Normal
– Temporary
– Necessary
• To bed in new processes safely
• To avoid frustration
• Articulate this as part of the vision- both to staff and
management.
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TRICSI Translational Research Institute Clinical Service Improvement and Innovation
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TRICSI Translational Research Institute Clinical Service Improvement and Innovation
2. Traditional training will not be enough
• Need extra specialised training
• Simulation training
– For specific tasks (eg blood collection)
– For routine processes (end to end in your own environment)
• Disaster exercises
– External and internal ( eg downtime)
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TRICSI Translational Research Institute Clinical Service Improvement and Innovation
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TRICSI Translational Research Institute Clinical Service Improvement and Innovation
3. Go-live Support
• Local at the elbow support by your people who work in
your department is key.
0%
1% 0% 1%
5%
21%
10%
19%
43%
Pharmacists
Problem notfixedThemselves
ReferenceGuidesAdmin
Nurse
At ElbowAdvice
PAH
1%
70%
7%
7%
1%
3% 10% 1%
Administration
Crew
Doctor
Nurse
CBH
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TRICSI Translational Research Institute Clinical Service Improvement and Innovation
Going back to paper is rarely necessary
77%
8%
4% 9%
2%
Resolved
Workaround (digital)
Workaround (paper)
PAH CBH
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TRICSI Translational Research Institute Clinical Service Improvement and Innovation
4. Go-Live is just the beginning
• Post go live change management
• Local, across sites, development of work arounds
• Dealing with fragmentation
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TRICSI Translational Research Institute Clinical Service Improvement and Innovation
FirstNet/ED relevant groups
• Local
• Statewide user group
• Firstnet Sub CAG
• QEDSAP
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TRICSI Translational Research Institute Clinical Service Improvement and Innovation
5. Most importantly, keep patients at the centre
of all PAH eHSMR
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TRICSI Translational Research Institute Clinical Service Improvement and Innovation
Requires Significant Change Leadership
1. Acceptance that we will be slower and less efficient for a while.
• Articulate as part of the vision about why we are doing this and create the expectation that this is normal and OK
2. Traditional training methods not enough • Extra training
• Simulation training- tasks and processes
3. Go-live support
4. Management of post go-live change
5. Keep patients and patient outcomes at the centre of everything
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TRICSI Translational Research Institute Clinical Service Improvement and Innovation
Dr Andrew Staib-
Deputy Director Emergency Medicine,
Co-Director TRICSI,
Senior Lecturer University of Queensland, Research Fellow UQ- MMRI,
Systems Physician QH Clinical Excellence Division
@AndrewStaib
Thank-you
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TRICSI Translational Research Institute Clinical Service Improvement and Innovation