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Sarah Hoy, Principal Policy Advisor Emergency Access, NSW Ministry of Health delivered this presentation at the 6th annual Hospital Bed Management & Patient Flow conference 2013 in Melbourne. For more information on the annual event, please visit the conference website: http://bit.ly/1f3Pp03
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Sarah Hoy
Principal Policy Advisor, Emergency Access
NSW Ministry of Health
February 2013
Emergency Department Models of
Care A Statewide perspective
Why do we need ED Models of Care?
https://www.youtube.com/watch?v=9ll01UNrbR4
This presentation will cover….
The review of Emergency Department Models of Care to
improve patient flow through NSW EDs
The development of statewide principles of models of care
& implementation tools created by NSW clinicians.
The statewide process for reinvigoration of models of care
that were no longer working in our EDs and the
development of new models of care
Plenty of time for questions
The Visionary – Daniel Comerford
Patient Flow is
everyone’s
responsibility
ED Models of Care the NSW context
184 Emergency Departments ED Role Delineation 1-6 2.5M patients annually
How are we going to get things moving and
improve access for patients?
Decision to separate out areas of responsibility
– EDs should focus on ED business
– Hospital executive and hospital staff should focus on
improving access to inpatient beds
ED Models of Care
Patient Flow Systems PATIENTS
But we’ve already done ED Models of Care
haven’t we?
2006
Lots of
questions
“Is there any
more
information?”
Why is your
Fast Track in
a cupboard?
“Is there anyone
whose ED Short
Stay Unit works
we can talk to?”
“What ED
models should
we have in our
new ED?”
Review of NSW ED Models of Care needed
Project Initiation &
Start up Diagnostics
Solution Design
Implementation Implementation
Monitoring Evaluation /
Sustainability
NEAT is coming!
NSW Heath Redesign Methodology used
Project Aims
Defining the high level principles for contemporary ED models
of care
Explore new innovative models
Provide a basis for capital planning of future EDs
Diagnostic Methodology
Survey of ED Clinicians
ED Performance
data
NSW Patient Survey
Literature review
14 site visits to NSW EDs
Key Issues identified in diagnostic
Planning
The aims, objectives, impacts and outcomes of ED models of care have not been
communicated, understood or developed in conjunction with ED staff.
Implementation
When locally developed business rules are not adhered to for all ED models of care, access to
timely, safe and quality emergency care become challenged
Variability
Standardised key features for ED Models of Care do not exist. ED clinicians have a differing
opinion of what they are and hence models look different in hospitals across NSW
Sustainability
There is loss of confidence in ED models of care because of poor implementation and immense
variability, this has resulted in EDs operating without thinking of the principles of models of care
i.e. “A bed is a bed”
Feedback from EDs
Solutions Design
Solutions Design workshops
held at each of the 14
observation sites
We also engaged Local
Health District
Executive &
Operations Managers
The High Level Solutions to the Key Issues
Documented high level principles for
Contemporary Emergency Models of Care in NSW
State- Wide Standardised Implementation tools
• self assessment toolkit
• implementation toolkit
System wide implementation strategy
• LHD Project Officers
• Implementation support provided by NSW
Ministry of Health and Emergency Care Institute
State-Wide Consultation on revised Models of Care
by ED Community and LHD Managers
Solution 1 & 2 - NSW ED Models of Care 2012
Available on
– NSW Health website
http://www0.health.nsw.go
v.au/pubs/2012/ed_model_
of_care_2012.html
– Emergency Care Institute
website
www.ecinsw/models_of_ca
re
Solution 3 - Self
assessment checklists
are available for each
documented model of
care
Self Assessment Summary Report
Solution 4 - Statewide Supported
Implementation
FUNDING
• $1.3M
• Project officer each LHD
TRAINING
• Models of care
• Project/change management
NETWORKING
• Teleconferences
• Sharing resources
We have since added 2 new Models of Care
ED Senior
Assessment &
Streaming MoC
&
Implementation
Toolkit
Aged Care
Emergency
Model
of Care
Our Performance remains challenged!
Period Target Total NEAT % NEAT (Pts admitted to ward/ICU/OT from ED)
NEAT (Patients not admitted to inpatient unit from ED)
1. 1 Jan 2012 – 31 Dec 2012
69% 61.2% 26.5% 71.8%
2. 1 Jan 2013 – 31 Dec 2013
76%
3. 1 Jan 2014 – 31 Dec 2014
83%
4. 1 Jan 2015 – 31 Dec 2015
90%
The Emergency Care Institute is here to help you www.ecinsw.com.au
ED Models of Care & Patient Flow
Utilisation of functioning models of care in ED provides a
planned approach to patient care.
This enables the delivery of better patient outcomes,
reduced waste in the system and elimination of
unnecessary delays for patients.
Thank you Sarah Hoy
NSW Ministry of Health [email protected]