ED Stream WorkshopTMH ED MOC

August 2013

ED Stream Workshop

1

TMH ED Models of Care (MOC)

• Triage

• Clinical Initiatives Nurse (CIN)

• Senior Assessment Streaming (SAS)

• Early Treatment Zone (ETZ)

• Consults (Fast Track)

• Paediatrics

• Resuscitation

• Acute Care

• Sub-acute Care

2

TMH Consult MOC

TMH ED Consult area has been running for the past 7 years

It was built into the new department in 2010 and is now embedded into our daily

processes

Has evolved in hours of operation and processes over this time

Open between 0800-2400hrs 7 Days/week

Staffed by one nurse and one doctor

Situated at “front of house” very separate from the acute/sub-acute area

3

MAP

4

Physical space

• Floor space – 10m x 15m (150m2)

• Staff work station (2 computers)

• 1 x plaster room

• 1 x Procedure room (bed)

• 3 x Chairs

• Slit lamp

• Interview room

5

6

7

Differences between your Model and the definition in the “Emergency Department Models of Care July 2012”

• Recent work completed aligning Consults with the ED MOC 2012 Document as part of the SAS Project

• Consult MOC consistent with ECI definitions and key principles of “Fast Track”

• Minor Differences are;– No Nurse Practitioner– No dedicated allied health support (physio)

8

Clinical operation

Guideline Business rulesOperational flow chartNursing expectations In process of building competencies for

nursing staff

9

The old!

• Previous inclusion/exclusion criteria

10

The New!

The New!

Resource Required for TMH ED Consults

NursingRegistered Nurse 2.94FTEMedicalSRMO or Registrar 2.94FTE

TrainingPre-requisite – experience in Acute / sub acute (knowledge of department and hospital processes)One hour orientation (Data entry and clinical governance/operation)Preferable or working toward competency in;

-Mobility aids and assessment-Tissue adhesive application-Soft tissue injury management/ splinting- NIX & NIA- IVC & venepuncture

13

Benefits of the Model

• Allows for the waiting room queue to be separated into complex

and single system injury management

• Easy identification of those who are “sick” in the waiting room

• Reduces non-acute patients using acute MOC, improving patient

safety.

• Reduces the waiting times to treatment for everyone

• Providing care that is standardised and targeted to specific

conditions and injuries

14

Challenges

• Nursing Staff (broad skill set)

• Medical staff (not always a senior decision maker)

• Compliance with guideline

• Doctor to patient ratio

• Blockages

• Bottlenecks – Paediatric Emergency just opened!

• Not open during the night

• Reception duties

15

Identify how it supports KPIs and NEAT

• Maitland's only hope!

• 43% of our patients are able to be seen in consults increasing likelihood

of meeting NEAT by bringing up % of discharged and admitted patients

within 4 hours.

• Category 4 and 5’s streamed to consults are generally seen by a doctor

within triage KPI’s.

16

Evaluation – Not so good!

• Recently evaluated against fast track MOC and revised.

• Waiting time for treatment by triage category

• Collect data on total time in ED – aim for all consult patients within 2 hours

• White board will soon reflect patient time in department through colour/codes –

monitoring system to track those that are nearing or over the 2 hours

• Admitted patients from fast track – need to capture data and identify patient group

• National Emergency Access Target (4-hour target).

• Patient incidents and complaints

• Staff feedback

17