Kirsty Cummin and Michelle Lambert - ACT Health - Australia's First Nurse Led Walk-in Centre

7th Annual Emergency Department Management

Conference

16th -17th July 2015

Michelle Lambert – Clinical Nurse Consultant

Kirsty Cummin – Advanced Practice Nurse

HISTORY, VISION &

MODEL OF CARE

Walk-in Centre: HistoryYour health – our priority, ready for the future

Increase in health care demand over next 10-15 years, needs an

increase in health services(1)

10 year redevelopment of health infrastructure, one of the

initiatives -Walk -in Centre (1)

ED demand is known to be rising in almost all first world countries including those

with a strong primary care network. Many of these countries are experimenting with

innovative methods to reduce demand on emergency services. Minor illness and

injury make a large proportion of these presentations (2)

Australia’s first public, nurse-led Walk-in Centre opened

to the public 18 May 2010 located at Canberra Hospital

in the ACT

Provide high quality, rapid access to health care for the

management of minor illnesses and injuries for the ACT

Community

Walk-in Centre: Vision

Walk-in CentresNorth Side – Belconnen Health Centre

South Side – Tuggeranong Health Centre

Canberra Image: https://en.wikipedia.org/wiki/File:Canberra_Map_Districts-MJC.png

01/07/2014

26/06/2014

Aims

1. Improve public health care access in the ACT;

2. Address projected demand for health care services;

3. Add value to the health journey - health promotion and

information; and

4. Relieve pressure on the public hospital system. (3)

Complements existing primary health care

services

Community

Pharmacy

healthdirectWalk-in Centre

General

Practice

ACT

Ambulance

Service

Emergency

Department

Minor illness or injury Life threatening emergency(3)

PrinciplesInnovative

use of technology

Population Health

approach

Safe and high Quality

Patient Centred

Collaboration

(3)

Model of Care - Governance

1. Decision making algorithms

2. Training – orientation and final assessment OSCE

3. Supervision – peer review, GP mentoring and support

4. Incident monitoring and risk management

Model of Care - Clinical Governance (3)

Clinical Advisory Group

DON Rehabilitation Aged &

Community Care (chair)

ADON WIC

DON Division of Critical Care

TCH GP advisor

Community Care Representative

Physiotherapy

Pharmacist

WiC Nurse Practitioner

WiC Advanced Practice Nurse

Consumer Representative

ACT Ambulance Service

ACT Medicare Local Rep - (PHN)

Rehabilitation Aged and Community

Care Executive

CHHS Executive

WiC Management Group

WiC ADON

CNC

Pharmacist

Nurse Practitioner

Staffing Model

Shifts are staggered across the day 0730am – 10 pm seven

days/week

The Walk-in Centres staffed by

1. Nurse Practitioners

2. Advanced Practice Nurses

3. Administrative Staff

Clinical Scope of Practice

Exclusions:

• Children under 2 years

• Ongoing care

• Chronic conditions

• Referrals to specialists

• General health checks

• Workers Compensation

Claims

Free, one-off treatment for minor illnesses and injuries:

Inclusions:

• Cuts and bruises

• Minor infections

• Strains/Sprains & Simple

Fracture

• Skin complaints

• Coughs and colds

• Gastroenteritis

Information Technology

The Walk-in Centre uses Decision Making Algorithm Software:

1. Triage Algorithms

2. Systematic assessment and treatment tabs

3. Medication Standing Orders

4. Clinical Treatment Protocols

Event summary’s are sent to the GP after each visit with

consent

EVALUATION

Evaluation

External review 2011: conducted by Australian Primary Health

Care Research Institute (APHCRI)(4)

Review highlighted:

• Safe, effective service that is supported and valued by the

Community

• Confirmed the positive impact of the WiC for patients and

Practitioners

Areas of Potential Improvement/Impact:

• Model of care

• Protocols & Clinical decision support software

• Potential impact on CH Emergency Department for CAT

4 & 5 presentations

• Relationship with the Emergency Department

• Education (Professional Development)

Recommendations from the Evaluation

(4)

Consumer FeedbackOver 313 written letters of compliment and 40 of complaints, received since opening

Developed using Wordle

WHAT DOES THE DATA TELL US?

1795320290 21414 22208

FY 10-11 FY 11-12 FY 12-13 FY 13-14

Presentation to WiC whilst located at Canberra Hospital by

Financial Year

0

500

1000

1500

2000

2500

3000

3500

4000

JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN

No

. o

f P

resen

tati

on

s

Month of the Year

No. of Presentations to WiC Financial Year 14/15

Tugg 14/15

Belc 14/15

14/15

*Invalidated data

Total Presentations for 2014/2105 = 32980

0

1000

2000

3000

4000

5000

6000

Mon Tue Wed Thu Fri Sat Sun

No

. o

f p

resen

tati

on

s

Day of the Week

Presenting Day - Financial Year 14/15

Both

Tuggeranong

Belconnen

*Invalidated Data

0

200

400

600

800

1000

1200

1400

1600

1800

2000

07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22

No

. o

f P

resen

tati

on

s

Time of day (24 hr clock)

Presentations versus Time of DayFinancial Year 14/15

Tuggeranong Belconnen

*Invalidated Data

0

100

200

300

400

500

600

1 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52 55 58 61 64 67 70 73 76 79 82 85 88 91 94 97

No

. O

f p

resen

tati

on

s

Age in years

Demographics: Female (Pink), Male (Grey) andAge for FY 14/15 *Invalidated Data

URTI -AllWounds

-ALLWound

DressingOtherMSK

GastroOther -

Skin Ear Wax

Other -Resp

Other -ENT

Other -GIT

PP 8078 3172 1769 1457 1387 1066 1060 702 679 524

0

1000

2000

3000

4000

5000

6000

7000

8000

9000

No

. o

f P

resen

tati

on

sTop 10 Presentations to WiC - FY 14/15

(combined common presentations)

*Invalidated Data

72%

8.30%

12.68%

5.62%1.10%

0.18%

Treatment Outcomes – FY 14/15 *Invalidated Data

Treated in WiC

Interim Plan and GPReferralRedirection to GP

Redirection to ED

DNW or left beforetreatmentOther Redirection

URTI-ALL

Wounds-ALL

Wounddressin

g

Gastro -V&D

EarWax

Other-MSK

Other -Skin

Sutureremoval

AnkleSprain

OtitisMedia

PP 7046 2661 1615 1174 1024 754 553 476 442 410

0

1000

2000

3000

4000

5000

6000

7000

8000

No

. o

f P

resen

tati

on

sTop 10 Presentations Treated in WiC - FY14/15

(combined common presentations) *Invalidated Data

Wounds- All

OtherMSK

ChestPain

Other -Eye

Acuteabdopain

Other -resp

Headinjury

NotwithinScope

Other -GIT

Other -Cardiac

PP 304 140 116 115 109 65 64 50 47 46

0

50

100

150

200

250

300

350

No

. o

f P

resen

tati

on

sTop 10 Redirections to ED - FY 14/15

(combining common presentations) *Invalidated Data

OtherMSK

Other -Skin

Other -Resp

NotwithinScope

WoundInfection

Other -GIT

Other -ENT

URTI-AllWounds

-All

Acuteabdopain

PP 317 307 280 187 183 179 171 155 153 127

0

50

100

150

200

250

300

350

No

. O

f P

resen

tati

on

sTop 10 Redirections to GP - FY 14/15

(combined common presentations) *Invalidated Data

WiC Presentations 149

Tuggeranong 81/Belconnen 68

Camera image: Commons.wikimedia.org

3.3%

29/06/2015

Treated in WiC, 112

Redirect to GP, 10

Redirect to ED, 5

Interim Plan & GP,

20

WiC definitively treated 75% and set up

treatment plans for a further 13% of pts

ACT Health Business Intelligence Unit and Finance Group

WiC Client Original Inclination –June 2015

47%

GP

16%

ED

16%

STAY

HOME

When asked: If the Walk-in Centre was not available, where would you

have gone instead today?

51% response rate (1453 respondents) for the month of June 2015

LESSONS LEARNT, EVOLUTION AND

THE FUTURE

Lessons and Evolution

• The WiC MOC has safely and effectively been implemented

• The WiC has successfully evolved into a valued community

service that has improved access to public health

• High staff and consumer satisfaction

Challenges and the Future

• Expansion of scope for clinicians and the service

• Enhancing collaborative partnerships with health providers

• Research and Education

• Recruitment and retention of staff

• Ongoing performance monitoring

• Growing the service

REFERENCES1. ACT Health, “your health –our priority, READY FOR THE FUTURE” (2008) accessed from

www.health.act.gov.au

2. Mason, S., Mountain, G., Turner, J., Mubashir, A., Revue, E. and Weber, E.J., (2014).

Innovations to reduce demand and crowding in emergency care; a review study.

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 22(55)

3. ACT Health, (2104) Walk-Centres: Operational Model of Care, May 2014

4. Parker, R., Forrest, L., Desborough, J., McRae, I and Boyland, T., (2011). Independent

evaluation of the nurse-led ACT Health Walk-in Centre.

https://au.search.yahoo.com/search?ei=utf-

8&fr=aaplw&p=Independent+evaluation+of+the+nurse-led+ACT+Health+Walk-in+Centre

QUESTIONS?

THANK YOU TO ACT HEALTH, ACT HEALTH BIU, FINANCE GROUP AND THE

DIVISION OF REHABILITATION, AGED AND COMMUNITY CARE (RACC)

Michelle.Lambert@act.gov.au

Kirsty.Cummin@act.gov.au