Who needs a waiting room?

Daniel Crompton Director of ED Training Adjunct Lecturer UNSW Albury Wodonga Health

CARE - ED

CARE - ED

• Core Assessment

• Rapid Evaluation

• Early Decision 3

Department Overview • Casey Hospital

• 50,000 presentations annually • 140/day

• 45% Cat 1-3 • 30% paediatric presentations • 11% admission rate • 8% transfer rate

Why Change? Increased presentations Multiplication of work Time spent doing nothing Patient recruitment in their journey Threat of reduced services

5

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

6

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

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)

8

CARE - ED • Enhanced inpatient processes

• Safe and Timely Care

• Enhanced rosters • Disco shifts • Team based approach

• New jobs

• communications clerk

9

Staffing restructuring

• 8am to 11pm • identified leaders • close communication

• Night shift unchanged

10

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

Overview

Limb injury (11%) e.g. ?# Wrist

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

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

Outcome / Results

CHAOS

Outcome / Results • Too early to make definitive statement

• Early data suggest that significant improvement on Triage

KPIs

• We all love the communications clerk

Lessons learnt

• Communication

• Remove bottlenecks

• Beware of modifications

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