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Quality Standards for Rural Emergency Departments
“A roadmap to excellence”
Associate Professor Didier Palmer OAM MRCGP FRCP FRCS FRCEM FACEMChair, Standards Committee, ACEM
• History of ACEM in rural / remote Australia• Federal Government Funding 2011‐2015
“Improving Australia’s Emergency Medical Workforce”
– 15 projects• EMET / Certificate & Diploma• Quality Standards• Mentoring• Indigenous health / cultural competence• Others
• A model for how it can work (in the Top End)– Warts and all
EMET
• EMET Hubs– Dedicated specialist time (certificate / diploma / outreach education)
– PSO’s for administrative support– 50% of the 356 public hospitals in Australia & 75% of rural and remote hospitals involved in the program
– >400 credentialed FACEM trainers– 500th Certificate enrollment/ 20 diploma passes (60 currently enrolled
Certificate & Diploma ACEM• Certificate: 6 months EM
– Online learning modules / WBAs (mini‐CEXs, DOPs, CbDs, procedural checklist) / ALS and BLS workshops / e‐portfolio / MCQ
– Skills to work in a rural ED on shift (with support)
• Diploma: 16 months (12 months EM / 6 months ICU and or Anaesthesia)– As above but aimed at complex emergencies in all systems / retrieval / disaster management / quality assurance / leadership & management / education skills
– Skills to lead a rural ED in a network
Quality Standards Project
• Is quality related to a patient with chest pain being seen by a doctor within 10 minutes?
• Quantitative KPIs are valid but qualitative measures are where real improvement lies
• Set out to map and measure all EM & ED processes / domains
ACEM’s Quality Framework
Standards Framework
• Domain: Overarching themes providing categorisation for quality standards
• Standard: Overall goal stating expected objectives; is achieved if all indicators are met
• Indicator: Measureable elements of service provision related to desired outcome
• Criteria: Requirements to achieve indicators, may include qualitative, auditable measures
Project Governance
• ACEM National Program Steering Group • Standards Committee
– Responsibility for project outcomes
• Project reference group including CENA and 2 ED patient representatives – Internal consultation– External consultation (metro / regional / rural hospitals & 45 other organisations
Consultation on draft Quality Standards
• Internal ACEM and CENA, through relevant committees and then all members.
• External consultation – range of metro, regional and rural hospitals– 45 other organisationsMost feedback incorporated
Drafting Standards
Quality Standards Pack
• Launch: Alice Springs July 2015 (ASM)– Quality Standards– Patient guide to quality standards– Self Audit Workbook
• Quality Standards and Patient Guidance • Hard copy to all EDs and rural hospitals• ACEM and CENA websites
• Self audit workbook in interactive format
Top End EMET Hub
• RDH / KDH / GDH • 2 diploma candidates / 11 cert passes / 7 enrolled• Having to knock back Cert candidates• > 250 hours of formal EM education delivered on site per year
• 11 weeks of rural doctor EM upskilling in RDH in the last year (trying to build this into EBA)
• Emergency Nurse upskilling in RDH
Top End EMET Hub
• FACEM visit to KDH 2/52 per month• Developing funding model for 1/52 per month visit to GDH
• Review of both KDH & GDH emergency departments
• Developing emergency nurse educator outreach model
Top End EMET Hub
• ED meetings & M&M processes at local hospitals with FACEM input (but always led locally)
• Real time video link for critical care cases with FACEM advice
• Much more two way communication• The Health Service has recognised that this model works and is becoming supportive
AIMS
• More skilled rural workforce• More communication • Systems development in a network• Local ownership• Real time support in crisis• Access to specialist advice (and someone who knows your context)
• Mentoring
It’s a Journey!
Contact Slide
Didier PalmerDirector, Royal Darwin Hospital Emergency [email protected]
Sam DennyACEM National Program Manager [email protected]
