The Health Roundtable

Improving the patient journeythrough ED

Presenter: Kate JurdHealth Service: Toowoomba Hospital

Innovation Poster SessionHRT1215 – Innovation AwardsSydney 11th and 12th Oct 2012

11-1a_HRT1215-Session_JURD_TWOOMBA_QLD

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KEY PROBLEM THS not meeting the National Emergency Access Targets

The new Emergency Access Target is based on a patient’s total Length of Stay within an Emergency Department and is intended to reduce access block and the associated negative outcomes.

NEAT is measured from first patient contact in the ED, and should be recorded by the clinician carrying out the initial triage/assessment or ED reception, whichever is earlier. The clock stops when the patient physically leaves the ED whether they are admitted, transferred, or discharged home.

As at March 2012, Toowoomba Health Service did not meet NEAT

Future projected performance targets:

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AIM OF THIS INNOVATION

This is an education innovation to ensure a whole of hospital support to the delivery of a clinical redesign process to ensure NEAT is achieved:

Achievement within the Emergency Department of 70% of patients admitted, transferred or discharged within 4 hours

Benefits include: Improvements to patient flow within the ED Patient and staff satisfaction Reduce access block Reduce mortality rates

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BASELINE DATA

Whilst case load for non admitted patients is higher, the average length of stay for all non admitted patients is 2.84 hours and the average length of stay for all admitted patients is 7.9 hours. THS is not achieving NEAT and experiences high occupancy rates and access block across the hospital on a regular basis.

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KEY CHANGES IMPLEMENTED Key stakeholders involved in the development of the

training materials A multidisciplinary online training package produced to

provide all staff with an understanding of their roles (and their colleagues) and how they can contribute – buy in of staff

Effective design of training module that takes the user on the patient journey through ED and illustrates all roles and responsibilities of those caring for the patient (see next slide)

Interactive component to promote decision making, not just click and reveal txt.

Access to training via moodle website for medical staff and on work area computers for nursing staff. Mobile version for access via ipads

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KEY CHANGES IMPLEMENTED

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OUTCOMES SO FAR

Implementation of training commenced 16th August 2012

147 staff to be trained Completion of training tracked (medical)and

recorded on Moodle website 13 junior doctors completed training (over two term

rotations) Feedback 100% agreed presentation above

expectations with regard to relevance to workplace experience.

10% improvement of NEAT over 3 month period

Positive impact with hospital wide awareness 7

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Chart Title

0.0%

10.0%

20.0%

30.0%

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50.0%

60.0%

70.0%

80.0%

90.0%

1/07

/201

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11/0

7/20

12

21/0

7/20

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31/0

7/20

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10/0

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30/0

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9/09

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19/0

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29/0

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% NEAT

Linear (% NEAT)Training commenced

Go live

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LESSONS LEARNT Early involvement of training package developer. Involvement of staff from the identified streams (ie

key stakeholders) in development of training package – to identify their needs

Training package that engages and motivates staff to participate in training

Concepts presented in a way to ensure understanding of the new procedure

Scenario presentation to illustrate the different roles of each staff member – to provide an understanding of how others are part of the patient flow process

Marketing through departments of the innovative package.

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