Redesigning Care in the Paediatric Emergency

Department CYWHS, SA

Presented by Ms Heather GrayChief Executive : CYWHS

25th November 2005

Patient First

A vision for improving the health of children, youth and women in

South Australia

The Project Streams

– Paediatric Emergency Services– Normal Vaginal Births– After Hours Hospital Care– Booking Process for Children’s

Surgery

Paediatric Emergency Department Project Team Mission Statement

“Within 6 months, all patients presenting to the Paediatric Emergency

Department will be assessed, treated and discharged (either home or to

another ward) within 4 hours of their presentation”

Acknowledgement to the PED Patient First Project and Guidance Teams

Problem worth solving

Fiscal Years July 2002 - June 2004

Percentage Of PED Presentations By Month Where PED Length Of Stay > 4 Hours

0%

5%

10%

15%

20%

25%

Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun

Per

cent

age

Of P

ED

Pre

sen

tatio

ns

2002 2003 2004

Total PED presentations (as per criteria) : 109850

Average Presentations Per Month: 3051

Problem worth solving

Triage Level

Threshold

BenchmarkTarget

PED CYWHS(last 12 months)

Average for like Emergency

Departments

1 seen immediately100% 98 % 99%

2 seen within 10 mins80% 69% 67%

3 seen within 30 mins75% 30 % 51%

4 seen within 60 mins70% 40 % 54%

5 seen within 120 mins

70%83 %

81%

The Australasian Triage Scale represents an agreed set of national access performance indicators for Emergency Departments. The codes and performance thresholds are demonstrated in the table below:

Project Plan

Appointment of Clinical Project Officer (Nurse Specialist) and Team Leader (Consultant) from PED staff

Empowering all staff to be involved in change: workshops and focus groups formed

Clinical Project Officer facilitates communication and liaison between all staff

CPI methodology

See and Treat Seven days a week 1000 – 2200hrs

Triage nurse identifies See and Treat patients, based on set criteria Approx 25% of presentations triaged as See and Treat See and Treat patients seen in order of arrival not priority

Dedicated waiting and treatment area Dedicated Experienced Medical and Nursing

staff initially commenced with 1.5 nurses and 1 RMO and 1

Registrar, after staff feedback changed to 1 Nurse and 1 Registrar

Experienced staff essential to maximizing potential of See and Treat

Patient Satisfaction Survey results Pre and Post implementation of See and Treat

Waiting time to see Doctor

5%11%

36% 34%

14%

0% 2%

14%

29%

55%

0%

20%

40%

60%

VERYPOOR

POOR FAIR GOOD VERYGOOD

Per

cen

tag

e

"Pre See & Treat" "Post See & Treat"

Patient Satisfaction Survey results Pre and Post implementation of See and Treat

Care your child received while in PED

1% 3%

17%

39% 40%

0% 0%5%

21%

74%

0%

20%

40%

60%

80%

VERYPOOR

POOR FAIR GOOD VERYGOOD

Per

cen

tag

e

"Pre See & Treat" "Post See & Treat"

Overall impact on Paediatric Emergency Department

Seven week period late September – Mid November

2004 2005

Average patients per day 109 111

Average wait time 66min 49min

Average length of stay 3 hr 20min 2hrs 45 min

LOS > 4 hrs 19% 14%

Did not waits 4% 1%

Presentations admitted 25% 24%

Overall impact on Triage data

Triage Level

ThresholdBenchmark

Target

PED CYWHS Late

September – mid

November2004

PED CYWHSLate

September – mid

November2005

Average for other like Emergency Departments

1 seen immediately 100% 96 % 100 99%

2 seen within 10 mins 80% 65% 75% 67%

3 seen within 30 mins 75% 29 % 43% 51%

4 seen within 60 mins 70% 42% 68% 54%

5 seen within 120 mins

70%90 %

95% 81%

Workforce development implications

Effective use of Nurse Specialists in See and Treat (as staffing numbers allow) Nurse specialists role includes: IV insertion, plaster application,

nurse initiated analgesia.

Highlighted need for more Nurse Specialists or Extended Nurse Practioners

Nurse Practitioner role may impact on training opportunities for training doctors

No impact on training of RMO’s noted at this stage

Workforce development implications

Anecdotal increase in staff morale and satisfaction – will be confirmed with staff satisfaction survey

Anecdotal increase in engagement of staff in problem solving and decision making

All achieved in the midst of major redevelopment works

Questions?