Sarah Hoy

Principal Policy Advisor, Emergency Access

NSW Ministry of Health

February 2013

Emergency Department Models of

Care A Statewide perspective

Why do we need ED Models of Care?

https://www.youtube.com/watch?v=9ll01UNrbR4

This presentation will cover….

The review of Emergency Department Models of Care to

improve patient flow through NSW EDs

The development of statewide principles of models of care

& implementation tools created by NSW clinicians.

The statewide process for reinvigoration of models of care

that were no longer working in our EDs and the

development of new models of care

Plenty of time for questions

The Visionary – Daniel Comerford

Patient Flow is

everyone’s

responsibility

ED Models of Care the NSW context

184 Emergency Departments ED Role Delineation 1-6 2.5M patients annually

How are we going to get things moving and

improve access for patients?

Decision to separate out areas of responsibility

– EDs should focus on ED business

– Hospital executive and hospital staff should focus on

improving access to inpatient beds

ED Models of Care

Patient Flow Systems PATIENTS

But we’ve already done ED Models of Care

haven’t we?

2006

Lots of

questions

“Is there any

more

information?”

Why is your

Fast Track in

a cupboard?

“Is there anyone

whose ED Short

Stay Unit works

we can talk to?”

“What ED

models should

we have in our

new ED?”

Review of NSW ED Models of Care needed

Project Initiation &

Start up Diagnostics

Solution Design

Implementation Implementation

Monitoring Evaluation /

Sustainability

NEAT is coming!

NSW Heath Redesign Methodology used

Project Aims

Defining the high level principles for contemporary ED models

of care

Explore new innovative models

Provide a basis for capital planning of future EDs

Diagnostic Methodology

Survey of ED Clinicians

ED Performance

data

NSW Patient Survey

Literature review

14 site visits to NSW EDs

Key Issues identified in diagnostic

Planning

The aims, objectives, impacts and outcomes of ED models of care have not been

communicated, understood or developed in conjunction with ED staff.

Implementation

When locally developed business rules are not adhered to for all ED models of care, access to

timely, safe and quality emergency care become challenged

Variability

Standardised key features for ED Models of Care do not exist. ED clinicians have a differing

opinion of what they are and hence models look different in hospitals across NSW

Sustainability

There is loss of confidence in ED models of care because of poor implementation and immense

variability, this has resulted in EDs operating without thinking of the principles of models of care

i.e. “A bed is a bed”

Feedback from EDs

Solutions Design

Solutions Design workshops

held at each of the 14

observation sites

We also engaged Local

Health District

Executive &

Operations Managers

The High Level Solutions to the Key Issues

Documented high level principles for

Contemporary Emergency Models of Care in NSW

State- Wide Standardised Implementation tools

• self assessment toolkit

• implementation toolkit

System wide implementation strategy

• LHD Project Officers

• Implementation support provided by NSW

Ministry of Health and Emergency Care Institute

State-Wide Consultation on revised Models of Care

by ED Community and LHD Managers

Solution 1 & 2 - NSW ED Models of Care 2012

Available on

– NSW Health website

http://www0.health.nsw.go

v.au/pubs/2012/ed_model_

of_care_2012.html

– Emergency Care Institute

website

www.ecinsw/models_of_ca

re

Solution 3 - Self

assessment checklists

are available for each

documented model of

care

Self Assessment Summary Report

Solution 4 - Statewide Supported

Implementation

FUNDING

• $1.3M

• Project officer each LHD

TRAINING

• Models of care

• Project/change management

NETWORKING

• Teleconferences

• Sharing resources

We have since added 2 new Models of Care

ED Senior

Assessment &

Streaming MoC

&

Implementation

Toolkit

Aged Care

Emergency

Model

of Care

Our Performance remains challenged!

Period Target Total NEAT % NEAT (Pts admitted to ward/ICU/OT from ED)

NEAT (Patients not admitted to inpatient unit from ED)

1. 1 Jan 2012 – 31 Dec 2012

69% 61.2% 26.5% 71.8%

2. 1 Jan 2013 – 31 Dec 2013

76%

3. 1 Jan 2014 – 31 Dec 2014

83%

4. 1 Jan 2015 – 31 Dec 2015

90%

The Emergency Care Institute is here to help you www.ecinsw.com.au

ED Models of Care & Patient Flow

Utilisation of functioning models of care in ED provides a

planned approach to patient care.

This enables the delivery of better patient outcomes,

reduced waste in the system and elimination of

unnecessary delays for patients.

Thank you Sarah Hoy

NSW Ministry of Health sahoy@doh.health.nsw.gov.au