EMERGENCY CARE CO-ORDINATION TEAMS

(ECCT)

CANTERBURY / WEST COAST AND OTAGO / SOUTHLAND

SOUTH ISLAND DHB CEO MEETING

22 AUGUST 2008

PRESENTATION OVERVIEW

• Background to ECCT’s

• Who we are and what we’ve achieved: - Canterbury / West Coast ECCT

- Otago / Southland ECCT

• Ongoing and Future linkages within DHB’s

OVERVIEW

1999 - release of “Roadside to Bedside” a 24 hour Clinically Integrated Acute Management

System for NZ

joint publication through MoH, ACC, HFA and Council of Medical Colleges in NZ

aimed to ensure the best outcomes for patients involved in trauma, medical and surgical emergencies and

complicated births

KEY AIMS

“people get the right care,

at the right time,

in the right place

from the right person”

ESTABLISHMENT OF ECCT’s

Jointly funded by ACC and MoH (devolved to DHB’s)

KEY ROLES:

• to enhance regional co-ordination of all emergency care providers

• advise regional service providers and funders ACC/MoH/DHB’s)on issues relating to provision, distribution and standard of emergency acute health services

• scope is across continuum from pre-hospital to specialist service delivery

OPERATION OF ECCT

ISSUE / PROBLEM RESEARCH / SOLUTION PROPOSAL

ECCT forum

MINISTRY OF HEALTH and ACC

facilitates, connects and establishes working groups Advice to and

reporting to

Reporting to Advice to, and recommendations between both groups

DHB’s, Ambulance Services, other providers, interested parties

Direct question

INTEGRATED AND EFFECTIVE REGIONAL EMERGENCY CARE SYSTEM

• Implement recommendations of Roadside to Bedside

• Overall systems design

• Integrated communications network

• Common standards and protocols

• Integrated provision of all key system components

• Team approach to development and operation of all system aspects

• Improved information systems to allow sound performance monitoring andcontinuous improvement

AIMS OF ECCT

NATIONALLY

ECCT’S CURRENTLY OPERATIONAL IN:

Otago / SouthlandCanterbury / West Coast Midland (central North Island)

IN RECESS:

Central Region (Lower North / Upper South Island)

UNDER DISCUSSION:

NorthlandAuckland

• CHAIRPERSONS AND CO-ORDINATORS meet bi annually with MoH, ACC and other key parties in Wellington

• COMMUNICATIONS USER GROUPS and regional PRIME committeeshave reporting lines back to ECCT for oversight.

“UNIQUENESS OF ECCT”

• Very wide member representation across all aspects of pre - hospital emergency care: not replicated in the sector

• Unique opportunity to have this combined skill and knowledge base around the table.

• Based on respect and collaboration to see sector working seamlessly

• A solution finding / problem solving and pre-emptive forum for emergency health care issues

SECTOR LINKAGES

EXTERNAL NATIONAL REPRESENTATION

• Air Ambulance Review Group• National Trauma Database• Interhospital Transfer Working Group• PRIME reviews and development• National Framework of Ambulance Delivery, Retrieval and Transfer

DOCUMENT REVIEWS / CONTRIBUTIONS

• Ambulance Services Sector Standards review• Interhospital Transfer review • Ashburton Model of Care (C/W ECCT) • Parliamentary Health Select Committee Review into provision of Ambulance Services in NZ (C/W

ECCT)

LINKED INVOLVEMENT

• Integrated Model of Care for Ashburton Health Services (C/W ECCT) • Improving the Patient Journey Project, Christchurch Hospital (C/W ECCT)• DHBNZ Inter Hospital Air Ambulance group• Acute Demand and Emergency Care Practitioners Project (ED - CDHB)

CANTERBURY WEST COAST

• Inception 2002

• Co-ordinator appointed 2005 (0.5FTE)

• Original contract with St John; moved to CDHB since April 2008 after 6 month recess

• Strong and active ongoing membership from CDHB, SCDHB, WCDHB

• Linkage with NMDHB re boundary issues

• Linkages nationally with other ECCT’s

• Excellent, proactive and positive working relationships between representatives from all facets of Emergency Care in these three DHB’s

• Quarterly all day meetings held in ChCh; other subgroup meetings as required

CANTERBURY WEST COAST MEMBERSHIP

• Hank Bader Clinical Standards Manager, St John• Garth Bateup GM Rural Services and Ashburton Hospital• Serena Bayles Assoc Director NICU, ChCh Womens Hospital• Dr David Bowie Intensivist ICU and Emergency retrievals• Margaret Bunker Secondary Care, Planning and Funding, CDHB• Dr Robyn Carey (CHAIR) Emergency Doctor, ED, Timaru Hospital• Tim Chiswell Emergency Planner, St John• Dr Sandy Dawson Ministry Of Health • Simon Duncan Manager, Garden City Helicopters• Maureen Frankpitt Nurse Manager, Community Primary Health, WCDHB • Alan Goudge Manager, SouthComm, St John• Dr Alistair Humphrey Medical Officer of Health, ChCh Community and Public Health• Eldon Macarthur Planning & Development Manager, St John Communications• Donna McCann Service Leader, Medical and Specialty Services, Timaru Hospital• Graeme McColl Emergency Planning, Ministry of Health• Shane McKerrow Transport Co-ordinator, ChCh Hospital• Dr Roger Mills GP / ED Grey Hospital • Sharon North Clinical Nurse Manager, Wairau Hospital• Michelle Prier Chair Canterbury West Coast College of Midwives• Sandy Richardson Research Nurse, ED, ChCh Hospital• Dona Shiell Programme Manager, Primary Care, ACC• Barbara Smith Nurse Manager, Murchison Hospital• Yvonne Stuart Project Manger, Partnership Health PHO• Dr Martin Than Emergency Physician, ED, ChCh Hospital• Craig Woodham Operations Support, St John• Dr Rex Yule Rural GP and PRIME• Marinda Hawthorne Co-ordinator / Projects

KEY PROJECTS

STEMI FAST TRACK INITIATIVE

• First Ambulance to Cardiology ECG transmission on November 13, 2006.

• Life-threatening cases managed through the expedited coronary angioplasty pathway, with improved door to balloon times and patient outcomes as a result.

• Project exemplifies achievement of different health care providers working together for patient benefit - (ECCT, St John, Christchurch Hospital Cardiology and Emergency Departments and MedXus)

MATERNITY AND AMBULANCE SERVICES SURVEY

Completed in 2006.

• Results published in two arms – Maternity Care Providers Survey and Emergency Ambulance Services Survey

• Results: Key recommendations made for improvement in both sectors, MoH to review maternity ambulance funding, greater linkages and inter-sector understanding and training achieved.

KEY PROJECTS

WEST COAST PRE HOSPITAL THROMBOLYSIS

• Joint project seed funded by ECCT with ongoing costs met by WCDHB

• Training Rural Nurses and Doctors in administration of pre hospital thrombolysis

• Project exemplifies achievement of different health care providers working together for patient benefit - (ECCT, West Coast District Health Board – Rural Nurses and GP’s , PRIME , St John, Christchurch Hospital Cardiology, Dunedin and Dunstan Hospitals)

• Implementation November 2007 (awaiting first patients)

• Considered a New Zealand first for rural nurses services to administer thrombolysis

WEST COAST CARDIAC OUTCOMES SURVEY

• Seed funded by ECCT in conjunction with West Coast DHB

• Aims to retrospectively explore disparities between patient outcomes in a rural isolated setting vs. urban setting

KEY PROJECTS

DEFIBRILLATOR MAPPING• in conjunction with O/S ECCT and SouthComm

• tracking placement of all South Island defibrillators

• SouthComm to map onto Computer Aided despatch using GPS co-ordinates

HELIPAD CHRISTCHURCH HOSPITAL

• Active campaigning by ECCT over several years to resolve lack of suitable helipad at Christchurch Hospital . Work continues on this project

FUTURE PROJECTS

• Information sharing from community through to admission - trial proposed for South Canterbury in conjunction with St John SouthComm and road ambulance services

• West Coast after hours issues especially rural sector

Development of “See and Treat” protocols for Emergency department nurses

GPS “tagging” of key sites within Rural District Councils in conjunction with St John and SouthComm

OTAGO / SOUTHLAND

• Inception 2002

• Co-ordinator appointed 2002. Was full time until 2006. Role in recess for one year due to staffing issues

• Now co-ordinator working 0.4 FTE ECCT/ 0.6 FTE ICU

• Contract held with ODHB based in Dunedin

• Active ongoing membership from ODHB and SDHB

• Linkages nationally with other ECCT’s

• Excellent, proactive and positive working relationships between representatives from all facets of Emergency Care in these two DHB’s

• Quarterly all day meetings held in various locations throughout Otago /Southland and

sub group meetings as required

OTAGO SOUTHLAND MEMBERSHIP

• Pam Adams Coordinator / Registered Nurse, ICU Dunedin Hospital• Ray Anton CEO Clutha Health First, Balclutha Hospital • Dr Matt Born Medical Officer, Dunstan Hospital• Kathryn Brookes Clinical Nurse Manager, ICU, Dunedin Hospital• Pauline Buchanan District Operations Manager, St John Southland• Dr John Chambers Clinical Director, Emergency Department, Dunedin Hospital • Michael Dodds Service Manager, Surgery, Anaesthetics and ICU, Dunedin Hospital• Marg Eckhoff Rural / PRIME Nurse, Otago region• Dr Pat Farry GP, Dunedin• Doug Flett Chief Crewman / Paramedic, Otago Air Emergency Rescue Trust• Robert Gonzales CEO Waitaki Health, Oamaru Hospital • Alan Goudge Manager, SouthComm, St John• Carol Gray ODHB Planning and Funding• Tony Hill Manager, Lakes District Air Rescue Trust, Queenstown• Dr John Holmes Medical Officer of Health, Otago• Dr Mike Hunter Clinical Director, Intensive Care, Dunedin Hospital• Linda Koks Clinical Nurse Manager, ED, Dunedin Hospital • Dr Sampsa Kiuru Emergency Department Consultant, Southland Hospital• Graeme McColl Emergency Planning , MoH• Lloyd Matheson Operations Manager, Southern Lakes Helicopters, Te Anau • Dr Roy Morris Urban GP, Dunedin• Nicki Pealing LMC, Midwifery Department, Otago Hospital• Dr Pete Rodwell Emergency Department Consultant, Oamaru Hospital• Leanne Samuels Director of Nursing, Southland Hospital • Dr Claudia Schneider Clinical Director, Intensive Care, Southland Hospital• Dave Seque Chief Fire Officer, Otago Fire Service• Dona Shiell ACC Programme Manager, Primary Care • Dr Mathew Stokes Rural GP / PRIME, Southland• Doug Third Regional Operations Manager, St John Otago / Southland

KEY PROJECTS

Kiwi CARPA • Standardised treatment Manual for remote and rural nurses / GP’s• Treatment guidelines developed and reviewed by clinicians using the guidelines• Developed on Australian model Central Australian Rural Practitioners Association) • Collaborative project between O/ S ECCT, Southland and West Coast DHB’s, NZ Institute

of Rural Health and ACC• Published and distributed for use throughout rural NZ

DEFIBRILLATOR MAPPING• Sites throughout Otago / Southland mapped with GPS via SouthComm

INTERNAL CHIEF EMERGENCY PHYSICIAN TRAINING COURSE ON MASS CASUALTY INCIDENTS

• Provision of 7th international ITAACS conference 2005

KEY PROJECTS

PRE HOSPITAL FIBRINOLYSIS

• Expansion of existing service throughout Otago to other sites in region• Aim for equity of access for rural AMI patients• Developed extensive teaching programme for GP’s, nurses and paramedics in

conjunction with Dunstan and Dunedin Hospitals

NATIONAL AND REGIONAL TRAUMA DATABASE

• Instrumental in background research, development and scoping of project• Part of ACC review group to assess Australian models• Trial of software as pilot to future project implementation

MEDICAL EMERGENCY TEAMS• Development of scoring system for evaluation of rapidly deteriorating acute patients • Allows escalating response to patients needs

KEY PROJECTS

OBSTETRIC / NEONATAL RETRIEVALS

• determines optimal expertise mix when retrieving woman in labour, impending birth or neonate• very clear and concise, time saving and determines easily which team members to take

GUIDLELINES FOR DEVELOPMENT OF OPTIMAL USE OF HELICOPTERTRANSPORT IN EMERGENCIES

• Draft under discussion with potential for national use

FUTURE and CURRENT PROJECTS • Community First response fully functional in Southland; expansion into remote Otago • Further thrombolysis sites throughout remote rural sites• Southland Hospital - aiming for accreditation for Registrar training• After Hours issues – regional solutions• Digital X Ray transmission issues between Oamaru and Dunedin Hospital • Wanaka / Queenstown / Central Otago issues of huge increase in demand for emergency services

during ski season and increasingly throughout the year.

- Joint ACC/MoH meetings including ECCT held June 2008 plus all stakeholders involved in emergency care in Wanaka / Queenstown region

THE FUTURE

How can ECCT’s be best utilised within DHB’s• Expertise• Existing networks• Individual projects• Linked projects• Lobbying• Liaison

How can DHB’s maximise ECCT’s presence within their organisations?

• ? Link into existing DHB networks ? Which ones• Be consulted in planning future DHB projects / initiatives• Approach ECCT in all aspects of pre hospital emergency healthcare issues