What’s new in emergency care? Dr Sally McCarthy Medical Director ECI

ECI Emergency Care Symposium Friday 8 November 2013

Stakeholder survey 2013

Rural metropolitan split (responses compared to presentations)

63% 60% 64%

30% 34% 36%

7% 6%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2013 2012 2012/13 patient volume

Unknown

Rural

Met

ED delineation level (responses compared to presentations)

0.4% 3% 3% 9%

15% 9%

15%

12% 22%

12%

21% 23% 21%

14%

19%

36% 30%

25%

7% 6%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

2013 2012 2012/13 patientvolume

Unknown

6

5

4

3

2

1

What are the ‘top’ challenges for your Emergency Department today? 39%

29% 27%

26% 23%

20% 18%

16% 13% 13%

12% 10% 10%

9% 9%

7% 6% 6% 6%

Access blockIncreased demand for services

Inefficient hospital systems/poor…Introduction of NEAT

Lack of staffOvercrowding

Lack of senior cliniciansTransfer of patients

Mental healthHealth bureaucracy

Ageing populationLack of resources

Recruitment and retentionLack of education / professional…Patient and public expectations

Waiting timesVariations in care

OthereMR

Top challenges – comparison of 2013 to previous

Top challenges – Metro and Rural

Top challenges – emergency service role delineation

How much do you know about the NSW ECI (2012 compared to previous)?

6% 14%

34%

7%

12%

21%

38%

36%

33% 40%

31%

10% 10% 7% 2%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2013 2012 2011

A lot

A fair amount

Not very much

Heard of butknow nothing atall

41%

40%

39%

37%

31%

22%

33%

37%

37%

34%

25%

17%

Standardised reporting of information accessibleto the whole of the hospital

Patient focus

Strong and visible leadership

Quality improvement focus on care

Use of diagnostic and project managementmethodology

Support structures for sites and executives

2013

2012

% of respondents

Implementation of NEAT – activities that were evident

Implementation of NEAT – activities that were evident by staff group 49%

45%

40%

47%

33%

30%

33%

31%

33%

25%

28%

13%

Standardised reporting of information accessible to the whole of the hospital

Patient focus

Strong and visible leadership

Quality improvement focus on care

Use of diagnostic and project management methodology

Support structures for sites and executivesNursing Medical

% of respondents

Implementation of NEAT/WOHP – initiatives introduced

37%

29%

25%

16%

14%

13%

13%

12%

8%

ED right to admit policy implementation

ED navigator role

Team-based ED care

Length Of Stay outlier management

Patient journey boards

Diagnostic mapping

Overcensus on wards

Ward reconfiguration

Weekend discharge management

% of respondents

Where do staff go for information about emergency care

51%

50%

41%

40%

33%

33%

6%

5%

37%

48%

38%

31%

23%

20%

6%

7%

84%

50%

29%

14%

17%

11%

0%

Emergency Care Institute (ECI)

NSW Ministry of Health

College or ProfessionalAssociation

Clinical Excellence Commission(CEC)

Agency for Clinical Innovation(ACI)

Health Education and TrainingInstitute (HETI)

Interstate emergency networks(e.g. Victoria)

Bureau of Health Information(BHI)

2013

2012

2011

% of respondents

What’s happened in 2013?

Education • ECI skills workshops: Orange, Albury • ECI moodle site: dental, NDEC suite, radiology, EZI IO,

procedures • The Best from the Best

Review and change • PECC review implementation in early stages • Surgery for children: referral arrangements; designated

hospitals. Await release. • Advance Planning for Quality Care at End of Life

Framework, NSW Health released: implementation has commenced

Whole of Hospital Program Activity at 23 sites

Work in progress Firstnet remediation program All the committee work

15%

35%

46%

48%

51%

51%

73%

0% 20% 40% 60% 80%

Other

Needing to log out…

Volume of other…

Poor/no wireless…

Slow…

Lack of…

Blocking…

Percentage of respondents

Gap assessment Q20 Barriers to internet access

ECI Survey of Internet Use in Emergency Departments 2013

Research • Evidence into practice research prizes ACEM and CENA 2032 annual

congress

• ECI presentations and posters at CENA, ACEM, RCC and other conferences

Projects Roll out of ACE project completed (*ECI symposium innovation

presentation 2011)

Implementation of ACEM quality framework: 23/ 24 sites • Appropriate test ordering • Morbidity and mortality review • Many other projects Commencing advocacy to support QSO position retention

Nurse Delegated Emergency Care

• Based on “The Walcha Model”

• Framework offering standardised, delegated care by nurses for low risk / low acuity, unscheduled care, patients

• Delineated and robust patient inclusion and exclusion criteria

• Episodic care by accredited RNs through: • Nursing Management Guidelines • Standing Orders • Documentation templates • Discharge and follow-up procedures

• Scheduled follow-up with GP

• Follow-up phone call from RN within 24 hours of presentation

Nurse Management Guidelines •Burns (minor) •Ear ache •Eye problems •Foreign bodies •Head injuries •Insect bites •Limb injuries •Pain (any cause) •Rash •Respiratory type illness •Tick bite •Urinary Symptoms •Vomiting and diarrhoea •Wounds •Marine Creatures

July August September October June Nov - Dec

Steering Committee formed

NDEC Suite Review & Site Expression

of Interest received

NDEC Suite finalised. First tranche sites

notified

First tranche site implementation

commences

NDEC commences at implementation sites

NDEC suite further reviewed

& finalised

Look out for… Workforce literature review and directions

document

Will this change your practice? Limm EL et al. Ann Emerg Med. 2013 Nov;62(5):521-5. doi: 10.1016/j.annemergmed.2013.02.022.

Epub 2013 Apr 23.

Half of all peripheral intravenous lines in an Australian

tertiary emergency department are unused: pain with no gain?

STUDY OBJECTIVE: Our study aims to determine the incidence of unused peripheral intravenous cannulas inserted in the

emergency department (ED). METHODS: A retrospective cohort study using a structured electronic medical record review was performed in a

640-bed tertiary care hospital in Melbourne, Australia. RESULTS: Fifty percent of peripheral intravenous cannulas inserted in the ED were unused. Forty-three percent

of patients admitted to the hospital with unused peripheral intravenous cannulas in the ED continued to have them unused 72 hours later.

Will this change your practice? First do no harm: In fact, first do nothing, at least not a cannula Diana Egerton-Warburton1,2, Sue Ieraci3 Article first published online: 1 AUG 2013 DOI: 10.1111/1742-6723.12109 Emergency Medicine Australasia

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