by allan ajami (ed num /change manager) · by allan ajami (ed num /change manager) ... botany bay...
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By Allan Ajami (ED NUM /Change Manager)
The St George Experience
Top tips
Lessons learned
NSW Gov't has spent billions over the last 5 years and set to spend billions in the coming years on Health infrastructure. Currently there are 50 projects in progress worth $4.7 billion Several facilities recently redeveloped- RNS, Liverpool, Port Macquarie, Wagga, Orange…. Several others in planning or delivery phase : Sutherland, Gosford, Wyong, Wollongong, Blacktown, Westmead, St George Once in a 10-20 year opportunity
2011 pre announcement of funding for a new ED
Serve a population base of
over 200,000
Large CALD community 33% Aged population (25 %
>70y)
Paediatrics:25 % of presentations
Admit rate of 35%
St George Emergency Department: MADMEN
Airport Botany Bay
Bondi Beach
St George Emergency Department: MADMEN
o Level One Trauma centre
o 2011: 62,500 presentations
o Within top four busiest EDs in NSW
o ED treatment space = 40
o Current bed base 650 beds o 6% increase in Presentations,
St George Emergency Department: 2011
Discharged home:
65% within 4hrs
DTA: 43% within 4hrs
Variation: 1 and 12 hrs
Average time to ED doctor: 74 mins Variation: 1min – 5hrs
Pathology: Average: 1 hour Variation: 20 mins-3hrs
Admitted LOS in ED (EAP): 64% within 8 hrs Variation: 1hr – 36 hrs
Register Assessment Diagnostics
Disposition Decision
Transfer to Ward Discharge Triage
Radiology: 55% within 1 hr Variation: 26mins – 6 hrs
Admitted LOS in ED (NEAT): 17% within 4 hrs Variation: 1hr – 36 hrs
National Emergency Access Target-(NEAT)
90% of ED presentations need to be out of the ED with in 4 hrs.
Staged over 4 years. 69% 2012 76% 2013 83% 2014 90% 2015
mm…..4 Hours
Hmmm…..4 Hours
St George Emergency Department: Future State Vision St George Emergency Department: Ideal Pt journey
Immediately
Lab 30-60 min
Point of care Testing
Within 3 hours
Within Benchmark,
ideally within 30 mins
Radiology 80% within 1 hour
100% within 2 hours
Within 4 hours
Register
Assessment Diagnostics
Disposition Decision
Transfer to Ward/ Ward
Care
Discharge Hospital
Triage
2011 funding for new ED
Allowed us to look at long term solutions
Not only around process and people but also around technology and layout
Improve design and capacity of the unit- WHS,IC, storage,training facilities,privacy,computers
Implement new MoC- SAS/ETZ/FT Improve utilisation of EDSSU Improve Radiology TAT
Enhance Triage MoC Expand Acute model and remove
Subacute model Enhance coordination-Emergency
Journey Coordinator Enhance communication Enhance workforce
2012 2013 2014 2015
Phase 1 Phase 2 Phase 3
Move into new ED October 2014) ED Redevelopment
4 Hr Rule ED Flow Co-
ordinator Triage Cat 2
2011
NEAT Target: 69% 76% 83% 90%
Point of Care testing
JMO eMR entry
Pre-Lead
Reduce work place variations in senior staff practice Intern
Assignment
Admit Phone Individual phones Reduce
overheads
Streamline ED Forms STOP
Reducing the frequency and volume of interruptions
Decrease non-specialists tasks being done
eMR efficiency
JMO Assignment
Dual Med Reg cover
Dual Surg Reg cover
ED Pt Flow Coordinator
ED Clinical Notes documentation
ED workforce review PA, ED techs
Surgical Assessment Unit MAU after hours admission
criteria
Dual ED SS cover 7 days ED SS cover P3
Team Structure P2 Team Structure P3
Day Shift Roles Evening Shift Roles
Phase 4.....
LEAD
Solutions Prioritised and timed Solutions timeline: The ED Vision
Team effort- Working parties established to refine solutions for each individual area.
They each developed implementation plans consisting of
solutions
Implementation time line – quick wins
Risks and issues - mitigation strategies
Communication plans
Trials, review , evaluate
Change Management plan/register Identify all changes and their impact Utilise AIM Engage Stakeholders (internal/external) Manage resistance
Scenario testing
Equipment
Training orientation ED staff and key stakeholders
Open days staff - community
Go live day
Redevelopment is really an Opportunity to reflect on what we do and look for ways to do it better!
“By failing to prepare, you are preparing to fail". Benjamin Franklin
Designing and Building a new ED is really only 25% of the solution.
In order to improve patient care and performance you need to design a efficient system and develop a highly skilled and cohesive team
The design then really takes care of it self!
ECI ACEM MoH Site visits Literature review International models Staff Suggestions Pt Voice
5% +5%+ 5% - 10% increase in presentations =5% improvement overall
• Use Redesign methodology to
• Identify issues across the patient journey
• Design solutions
• Implement the best solutions
• Ensure we analyse problems before developing solutions by utilising data analysis, project & change management
• Proven to deliver long-term sustainable changes
Project Initiation &
Start-up
Diagnostics
Solution Design
Implementation Planning Implementation
Checkpoints Implementation
Planning
Evaluation Sustainability Knowledge
Sharing
Diagnostics
Process: process flow, policies, procedures & protocols
People: Involvement, roles & responsibilities, reporting lines & capability
Technology: changes to systems & reports or introduction of new technology
Facilities: Physical layout of the building
Collaboration is key- don’t forget external stakeholders
Get passionate- engage people on an emotional level. Lead them from fear/ anxiety to anticipation and excitement.
AHFG are guidelines! If you have good rationale stick to your guns!
ICT - look at new innovative technologies that will assist practice into the future, paperlite, task management and ensure you future proof for new ways of practice
Future proof as much as possible – flexibility in design for new models/growth
Better integration of Support services, eg Radiology/Pathology
Questions?