Stephen Kelly RANP Emergency

Increased patient numbers in category 2 and 3 that

waited a protracted period of time to see medical staff.

Need to think differently to decrease the patient

experience time (Pet)

External Pressures from the Special Delivery Unit (SDU)

to decrease lengths of stay in the Emergency

Department.

Research from Emergency Medicine programme to utilise

senior decision makers to expedite the patent journey.

The overarching aim of the Emergency Medicine Programme (EMP) is to improve the safety and quality of care and reduce waiting times for patients in Emergency Departments (EDs) throughout the country.

Patients should receive the same high standard of treatment irrespective of when or where they seek emergency care and they should not experience excessive waiting times in EDs. The safety and quality of patient care must be the primary focus of the Programme. The timeliness of care is an important component of quality and research has demonstrated that prolonged ED waits are associated with poorer outcomes for patients.

Patient satisfaction surveys have identified prolonged waiting times as a major reason for patient dissatisfaction with ED services. Many patients, their families and ED staff members have expressed concerns regarding the delays endured by patients in EDs.

Introduce national Key Performance Indicators (KPIs) for clinical quality and process efficiency;

Agree national process measures and standard ED data sets;

Implement the 6-hour standard for ED attendances so that 95% of patients are admitted or discharged within six hours of attending an ED;

Improve the efficiency of ED processes including triage, assessment, patient streaming etc.;

Implement national clinical guidelines for the top 20 emergency conditions and associated clinical KPIs;

Roll-out the development of, and optimise the work of, Clinical Decision Units;

Disseminate existing good practice, identified through regional workshops;

0

1

2

3

4

5

6

7

8

9

ED DC

PET

Target

< 6 hrs

ED DC PET 8 7.1 6.2 6.1 7 6.2 6 6.4 6.4 8.2 6.8 5.1 5.9 5.01 5.8 5.7 5.9

Target < 6 hrs 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6

11th

Sept

18th

Sept

25th

Sept

2nd

Oct

9th

Oct

16th

Oct

23rd

Oct

30th

Oct

6th

Nov

13th

Nov

20th

Nov

27th

Nov

4th

Dec

11th

Dec

18th

Dec

25th

Dec

1st

Jan

Weekly PET Trend for ED Discharges

0

1

2

3

4

5

hours

time to HCP time to analgesia

R.A.T.

No R.A.T

Shortness of Breath Chest pain Soft tissue Abscesses including pilonidal and peri-anal abscess and

hemorrhoids. Abdominal Pain/Flank Pain. Head Injury with or without Loss of Consciousness. Possible Deep Vein Thrombosis (DVT), possible pulmonary embolus. Trauma RTA - Removal of patients from c spine precautions utilizing the

Canadian c Spine rule Traumatic and a traumatic back pain A Possible Fractured Neck of Femur/pelvic fracture Ear nose and throat. Needle stick injuries Diabetic Emergencies (DKA and HHS) AKI

Patient under 14 years of age.

Patients that do not fall within the inclusion criteria

Currently we have 3 WTE Registered Advanced Nurse Practitioners

1 Advanced Nurse Practitioner Candidate

Advertisement for one Clinical Nurse specialist in the role

Pat

Patient/Client is registered under the care of a Consultant in Emergency

Medicine, Beaumont Hospital

Triage Nurse: Attendee’s clinical urgency is assessed according to the

Manchester Triage Scale 1-5

Injuries/illness

Manchester Triage Scale1-5

Consultant

in

Emergency

Medicine

Specialist

Registrar/

Registrar

RANP

service

SHO/ED

Intern

Patient assessed and managed according to clinical priority

Discharged from care and/or referral to other healthcare provider as

appropriate

Discharged home with/without referral

Admitted to hospital or transfer to other hospital

Self discharged

Self Ambulance GP Other

Hospital

Pathway to RANP Service

Patient

GP Referral

Self referral Ambulance

Emergency

Department

Registration

Assessed by the

triage Nurse

Patient suitable for RANP

Emergency

Assessed by the RANP Emergency

Pathway from the RANP s

Patient suitable for

RANP (Emergency)

Assessment, History and

Examination

Possible Tests:

Bloods

X-ray,

ultrasound

Plan

Treatment

Plan to Discharge

Refer to Senior / Specialist Doctor

Review

Treatment plan

with test

results

Follow up:

GP

PHN

OPD

Psychiatric liaison team

Community intervention team

Phsyio/OT/falls clinic

Alcohol liaison nurse

COPD outreach

MAX FAX St James

Emergency Medicine

Orthopaedic

Ear, Nose and Throat

Eye

Surgical Team

Medical Team

Psychiatry

Neurology/ Neurosurgery

Total of 1693 patients seen.

43% of these patients were admitted/discharged within two hours.

A further 38% had PETs of between 2-4 hours.

Overall, 93% of patients were seen within the national target of 6 hours.

82 % of patients were discharged and 18% were referred for admission.