After Hours Care Models

The Royal Children’s Hospital

Dr Jye Gard

Chief Resident Medical Officer, Junior Medical Staff Training & Support

After Hours Medical Lead, Short Stay Unit, General Medicine

Paediatric Clinical Teaching Fellow, University of Melbourne

Contents

1. RCH after hours

2. Our JMS

3. Deciding to change

4. Changes and how

5. What we learnt

Royal Children’s Hospital (RCH)

RCH After Hours

RCH After Hours

On floor 8:30am – 5:30pm After hours

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Our JMS

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Our JMS

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Our JMS

Changes to RCH After Hours

Changes to RCH After Hours• Nurse Hospital Manager

• Most senior person in the hospital after hours

• Operational decision maker: patient flow, code gray

responder, bed management, staffing allocations

• Clinical Nurse Consultant

• Senior nurse – ED nurse practitioner

• Can review unwell patients, transfer, proceduralist (site

IV, administer nitrous, venepuncture), assist JMS with

procedures, reviews

• Medical Lead

• Acute care trainee to coordinate workflow, provide

support, proactively identify and communicate risk,

develop anticipatory care plans

Changes to RCH After Hours

1. Know your team:

• 2100 multidisciplinary handover

• 0100 multidisciplinary huddle

2. Communication:

• 24/7 use of electronic task board

3. Additional staffing:

• New Medical lead and Clinical Nurse Consultant roles

• Change in Social Worker hours in ED

• Extended Cardiology and Oncology resident hours

• Additional evening General Medicine registrar

Outcomes so far

• Identification of patient of concern after hours a

(plan in place)

• Staff medical satisfaction and sense of team work

after hours

• Discharges after hours

• Time to admission from 1800 – 0800 and number

of General medicine admissions handed over to the

night team

• Cardiac and Oncology JMO overtime

• Unplanned admissions to PICU after hours

• MET calls after hours

Outcomes so far

Outcomes so far

Outcomes so far

Outcomes so far

Lessons learnt

Lessons learnt

• Difficulty navigating new roles

• Role vs. responsibility vs. expectations

• Integration within organisation

• Development of the after hours ‘team’

• Tensions with pre-existing teams

Lessons learnt

1 The most effective tools were not

costly or particularly onerous

• Multidisciplinary handover and huddle

• Improved visibility of workloads

2 Workshop issues with all craft groups,

this includes the JMS

3 Models need to be tailored & creative

Acknowledgements

• Paula Howard, RCH, Improvement Manager, Strategy and

Improvement

• Margot Nash, Director of Junior Medical Staff Training and

Support Unit, RCH

• Ed Oakley, Chief of Critical Care, RCH

• Bernadette O’Connor, Director of Allied Health, RCH

• Sheri Waldron, Director of Operations & Chief of Information

Nurse, RCH

• Tal Galdish, Intensive Care Unit Consultant, RCH

• Tom Connell, Director of General Medicine, RCH

• Georgina Tiller, General Medicine Fellow, RCH

Questions?

Outcomes so far

After Hours Care

Contents

1. RCH after hours

2. Our JMS

3. Deciding to change

4. Changes and how

5. What we learnt