PENINSULA HEALTH

CHEST PAIN STREAMING

Paul Ormrod

Manager Emergency Redesign

Nurse Manager Emergency Short Stay Unit

Frankston Hospital

Peninsula Health

PENINSULA HEALTH

Peninsula Health is the major health care provider serving the metropolitan and rural areas on Victoria’s Mornington Peninsula.

With close to 800 beds Peninsula Health provides a wide range of services from obstetrics to aged care, rehabilitation, emergency and intensive care, oncology, psychiatric services and Hospital in the Home (HITH).

PENINSULA HEALTH

PENINSULA HEALTH

• The region’s population is over 300,000 people

• Seasonal influx of visitors of 100,000. The

• Population is growing at a faster rate than most

other regions

• Predicted growth rate 5.3% higher than

Melbourne

• New freeway expected to increase growth rate

even further

DEMOGRAPHICS OF DEMAND

PENINSULA HEALTH

Frankston Hospital is the major provider of acute secondary

and tertiary hospital services on the Mornington Peninsula.

With 336 beds, it provides general and specialty medical and

surgical services, mental health, maternity, and paediatric

services.

Construction of an additional 90 beds and new Emergency

Department is underway with completion scheduled for 2014

FRANKSTON HOSPITAL

PENINSULA HEALTH

Consistent with the population increase demand on

acute services has also increased over recent years. This

has particularly impacted on the Emergency Department

(ED) at Frankston Hospital.

FRANKSTON HOSPITAL DEMAND

PENINSULA HEALTH

There has been significant growth in ED

presentations to an expected 60,000 this year

PENINSULA HEALTH

0

5,000

10,000

15,000

20,000

25,000

FY 08/09 FY 09/10 FY 10/11 FY 11/12 FY 12/13

Ambulance Victoria Presentations 2008-2009 to 2012-2013

DANDENONG HOSPITAL FRANKSTON HOSPITAL MONASH MEDICAL CENTRE CLAYTON CASEY HOSPITAL

Frankston Hospital Emergency Department receives more patients via Ambulance Service

Victoria than any other hospital in the state

PENINSULA HEALTH

• Length of Stay an Issue across the Board

• Looked at high volume presentations

• Chest Pain identified as potential presentation suitable for streaming of care

National Emergency Access Targets (NEAT)

PENINSULA HEALTH

WHAT WE FOUND

6 Months of data from 2011 showed 1,320 patients presented

with and average LOS for this cohort to be 6hrs and 55 min

80% of these patients were discharged home

Working group established to look at options for this group

(Naomi Winter RN, Sreyus Sreedhar RN, Kishan Ajjampur ED Registrar, Helen Hewitt ED Director)

PENINSULA HEALTH

How could this group be better managed?

• Identify low risk patients early in presentation

• Manage their stay outside the ED

• Develop new pathway for this group

• Decrease waits

PENINSULA HEALTH

OLD PATHWAY FOR THIS GROUP

PENINSULA HEALTH

NEW PATHWAY FOR THIS GROUP

On arrival

moves to

assessment

cubicle

Registration

Moves to

acute

cubicle

Moves to

ESSU

95%

Home

Admit or

Home

PENINSULA HEALTH

Objective of the new

pathway was to identify low

risk chest pain patients and

stream their care early to a

short stay unit managed by

the ED

PENINSULA HEALTH

On arrival

moves to

assessment cubicle

SO HOW DID THIS WORK?

• Key was early assessment

• Hx

• ECG

• Early Decision

ACHIEVED BY

• Dedicated Dr & Nurse (Cat 2)

• Called by Triage

• See, Assess, Send

PENINSULA HEALTH

DID CHANGE ANYTHING?

WE GOT BUSIER & % OF CHEST PAIN PRESENTATIONS INCREASED

PENINSULA HEALTH

50

150

250

350

0

200

400

600

800

Apr

'12

May

'12

Jun

'12

Jul

'12

Aug

'12

Sep

'12

Oct

'12

Nov

'12

Dec '12 Jan

'13

Feb

'13

Mar

'13

No

. o

f p

ati

en

t -

All

pa

tie

nts

No. of admissions to EDS

All transfers to EDS

All transfers to EDS -

previous year

Target population

Target population - previous

year

Potential patients

No

. o

f p

ati

en

ts -

Ta

rge

t p

op

ula

tio

n

90% - 100% occupancy 9 beds

90% - 100% occupancy 8 beds - previous year

41% increasein the number of patients in the target population

being admitted to EDS

SO WHAT DID WE ACHIEVE?

PENINSULA HEALTH

In the previous 12 months April 2012 to April 2013

• 224 patients were streamed directly to EDS

• A further 1,408 went to EDS via an acute ED cubicle

• A further 377 patients presenting with chest pain were

discharged home from the ED

PENINSULA HEALTH

3

4

5

6

7

8

Apr

'12

May

'12

Jun

'12

Jul

'12

Aug

'12

Sep

'12

Oct

'12

Nov

'12

Dec

'12

Jan

'13

Feb

'13

Mar

'13

Ho

urs

Average Length of Stay

All patients

All patients - previous year

Target population

Target population - previous

year

4hr Target

* Target population: Patients presenting with Cat 2&3 chest pain receiving care form emergency physicians

SO DID ANYTHING IMPROVE?

LOS FOR CHEST PAIN GROUP DECREASED

PENINSULA HEALTH

DID WE IDENTIFY PATIENTS APPROPRIATELY?

We expected that less than 5% target of this cohorts of patients would

require admission to an inpatient bed. To date this rate remains below

5%

PENINSULA HEALTH

CHALLENGES

1. Assessment Area (3 cubicles)

The area to be dedicated as an assessment area contained

monitoring equipment.

2. Performing quick assessment

Change of practice to undertake quick assessment and decision

making

3. Standardising work practicesDifferent staff working in different ways

4. Access to EDS beds

EDS bed not available

5. Access block to inpatients

No beds for patients requiring an inpatient bed

PENINSULA HEALTH

STRATEGIES IMPLEMENTED

1. Removed equipment

2. Senior medical staff to undertake this role

3. SOP

4. EDS admission criteria & beds controlled by ED

5. Still working on them

PENINSULA HEALTH

WHERE TO NEXT?

1. Increase in ED Short Stay Beds (15 as June 2013)

2. Working with Mental Health to stream to EDS

3. Identify other presenting groups for streaming

4. A new ED and Short Stay Unit

PENINSULA HEALTH

QUESTIONS?

pormrod@phcn.vic.gov.au