who needs a waiting room? · • waiting room is high clinical risk and generates negative feedback...
TRANSCRIPT
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Who needs a waiting room?
Daniel Crompton Director of ED Training Adjunct Lecturer UNSW Albury Wodonga Health
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CARE - ED
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CARE - ED
• Core Assessment
• Rapid Evaluation
• Early Decision 3
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Department Overview • Casey Hospital
• 50,000 presentations annually • 140/day
• 45% Cat 1-3 • 30% paediatric presentations • 11% admission rate • 8% transfer rate
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Why Change? Increased presentations Multiplication of work Time spent doing nothing Patient recruitment in their journey Threat of reduced services
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What are the issues? • Current process of waiting is not patient centred
• Waiting room is high clinical risk and generates negative
feedback
• Insufficient assessment spaces in emergency
• Patient demand does not match staff and bed supply
• Senior doctor decision making occurs late
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Department Overview • Triage area which includes chairs and bed • Cubicles
• 2 Resus • 4 Paeds • 14 General (Including negative pressure and Behavioural Assessment
Room) • 3 Fast Track • 1 Eye/ENT • 1 Procedure room • 1 Plaster room
• SSU • 8 beds
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CARE - ED • Core Assessment
• Triage limited to quick acuity assessment • Bedside or <1min registration
• Rapid Evaluation • No waiting room • ED clinician within 15 minutes of arrival
• Early Decision • Senior doctor to consult within 30 mins of arrival • Determine disposition within 1hr of arrival
• Vertical (chair) or Horizontal (trolley)
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CARE - ED • Enhanced inpatient processes
• Safe and Timely Care
• Enhanced rosters • Disco shifts • Team based approach
• New jobs
• communications clerk
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Staffing restructuring
• 8am to 11pm • identified leaders • close communication
• Night shift unchanged
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Department Zoning - CARE - ED • Triage area with 3 month trial of triage nurse still • Cubicles
• 2 Resus • 4 Assessment chairs • 10 Assessment beds • 11 Horizontal treatment zones -beds (Including negative pressure and
Behavioural Assessment Room) • 16 Vertical treatment zones (chairs) • 1 Eye/ENT • 1 Procedure room • 1 Plaster room
• SSU • 8 ED beds + 4 flex mental health beds
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Overview
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Limb injury (11%) e.g. ?# Wrist
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Limb injury (11%) e.g. ?# Wrist
ATV • Doctor < 15 mins
• Analgesia/Splinting/Decision re X-ray order
• No X-ray then home with EDLOS <25 mins
• X-ray then to ATC (Patient Mx reminder completed)
Consistent with “Patient First” Tool & Permission to advocate
on own behalf
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ATC • X-ray completed & doctor notified < 60 min
• X-ray checked by Senior doctor
• Management Decision at EDLOS < 85 mins
Limb injury (11%) e.g. ?# Wrist
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Outcome / Results
CHAOS
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Outcome / Results • Too early to make definitive statement
• Early data suggest that significant improvement on Triage
KPIs
• We all love the communications clerk
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Lessons learnt
• Communication
• Remove bottlenecks
• Beware of modifications
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www.ecinsw.com.au
Level 4, Sage Building , PO Box 699 T 02 9464 4674 www.ecinsw.com.au
67 Albert Avenue, Chatswood NSW 2067 Chatswood NSW 2057 F 02 9464 4728 ABN 89 809 648 636