Acknowledgements Mr Tim Free Director Clinical Operations CCLHD

Steering Committee & Project Team

Emergency Department Clinicians

Mental Health Clinicians

Lynne Blanchette ISLHD

Conclusion Working collaboratively with the Emergency Department (ED) has highlighted the complexities and barriers to timely and efficient care of mental health consumers in this environment. The Beat It! project is demonstrating gradual improvement in performance with current ETP average of 70% and non-admitted ETP average of 80%. Solutions are being implemented across both Wyong and Gosford Hospitals. Engagement with the Whole of Health program has led to solutions being rolled out state wide including streamlining of current assessment documentation and clinical guidelines for physical assessment of mental health consumers in emergency departments.

Objectives By December 2015, people presenting to Wyong Hospital Emergency Department with a primary mental health diagnosis will be discharged, admitted or transferred from the Emergency Department within 4 hours, thereby improving the Emergency Treatment Performance (ETP) (formerly known as NEAT) from 47% in 2013 to 81%.

Case for change Mental Health consumers presenting to the Emergency Department at Wyong Hospital have in the past faced delays in assessment and treatment. During 2013, only 47% of these consumers met the National Emergency Access Target (NEAT) of being admitted, discharged or transferred within 4 hours. Of those consumers requiring admission from the ED, 69% waited longer than 4 hours.

For the mental health consumer, Emergency Departments present a high stimulus environment that may increase arousal and anxiety and contribute to mental distress. Prolonged waiting times can lead to frustration, increased risk of symptom exacerbation, aggression and the risk of consumers leaving without completed treatment.

Diagnostics Over 200 issues were identified through:

Process Mapping

Patient & Carer Experience Trackers (PETs)

Patient interviews

Staff Interviews

Brainstorming

Data analysis

Compliments & Complaints

Planning and implementing solutions Implementation of solutions are being staged in order to

monitor effectiveness of each solution

Streamlined assessment & documentation procedures

Expanded Scope of Practice for ED mental health nurses allowing admission to PECC and discharge of low risk consumers

Dedicated FirstNet monitor & electronic patient journey boards for quick view of referrals and bed status

Clinical Initiatives Nurse pathways for mental health consumers

Staggered shift times to meet peak demand periods

Video Conference assessments

Physical Review and Assessment pathway

ED Staff Specialist allocated for mental health

Structured combined education and orientation

Assessment clinics

Results Since commencing the project we have seen a gradual improvement in mental health ETP performance

Mental Health consumers who do not require admission are being assessed, treated and discharged within 4 hours with non-admitted ETP achieving target of 81%

Consumers leaving ED without being seen has reduced despite presentation rates remaining constant

Quick Wins Standard Operating Practices for FirstNet referral, notes & discharge have been developed and published to standardise practice and improve KPI reporting

Dedicated FirstNet monitor & electronic patient journey boards have been installed to provide quick access to ED referrals and inpatient bed status

Beat It! every patient, every time Mental Health Emergency Treatment Performance 81% within 4 hours

Anne Louise Elsom Clinical Nurse Consultant Ben Roberts Nursing Unit Manager

Goal To improve the experience for people with mental health issues presenting to Wyong Hospital Emergency Department by reducing waiting times and treatment delays.

Method

Sustaining change Weekly Dashboard reports on KPI - displayed

Monthly Performance Report on related KPIs

Fortnightly FirstNet data report

Structured Clinical Handover and Case Reviews to ensure safe and consistent practice.

Policy & Procedures amended

Ongoing education, orientation & training

Leadership and modelling by sponsors

Solution ownership by teams

Staff recognition awards

Contact Anne Louise Elsom Anne.Elsom@health.nsw.gov.au

Ben Roberts Ben.Roberts@health.nsw.gov.au

Project Initiation Diagnostics Solution Design Implementation

Planning Implementation Evaluation

Sustainability

Steering Committee & Project Team established Communication Plan

Process Mapping Patient & Carer Experience Trackers Patient & Staff Interviews

Brainstorming Benchmarking Literature Review Prioritisation

Develop plan Ensure sponsorship Circulate for comment

Staged implementation Patient Journey Boards Expanded Scope of Practice

Weekly Dashboard Report Monthly Performance Report Structured Clinical Handover & Reviews

0%

20%

40%

60%

80%

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0

5

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25

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Length of MH Ax Psych RegDelay

Physical Ax FirstnetProcesses

Admitted NEAT Triage

Impa

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T

MH NEAT Delay Root Causes

50%

55%

60%

65%

70%

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80%

85%

90% Mental Health Non-Admitted ETP

Process Measure 1 - MH Non-Admitted ETP Data

Process Measure 1 - MH Non-Admitted ETP Target

50%

60%

70%

80%

90%

May

-13

Jun-

13

Jul-1

3

Aug

-13

Sep

-13

Oct

-13

Nov

-13

Dec

-13

Jan-

14

Feb-

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Mar

-14

Apr

-14

May

-14

Jun-

14

Jul-1

4

Aug

-14

Sep

-14

Oct

-14

Nov

-14

Dec

-14

Jan-

15

Feb-

15

Mar

-15

Apr

-15

May

-15

Jun-

15

Jul-1

5

Aug

-15

Mental Health ETP

Data Target

81%

01234567

Num

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s

Did Not Waits

Data

Target0

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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24

Mental Health Presentations to ED by Hour of Day Hourly Totals

Jun-15

May-15

Apr-15

Mar-15

Feb-15

“The second monitor makes it easier to navigate between

systems” “My daughter was

seen quickly and the staff were caring and

professional”

Slide Number 1