beat it! every patient, every time - agency for clinical innovation_cclhd.pdfbeat it! every patient,...
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Acknowledgements Mr Tim Free Director Clinical Operations CCLHD
Steering Committee & Project Team
Emergency Department Clinicians
Mental Health Clinicians
Lynne Blanchette ISLHD
Conclusion Working collaboratively with the Emergency Department (ED) has highlighted the complexities and barriers to timely and efficient care of mental health consumers in this environment. The Beat It! project is demonstrating gradual improvement in performance with current ETP average of 70% and non-admitted ETP average of 80%. Solutions are being implemented across both Wyong and Gosford Hospitals. Engagement with the Whole of Health program has led to solutions being rolled out state wide including streamlining of current assessment documentation and clinical guidelines for physical assessment of mental health consumers in emergency departments.
Objectives By December 2015, people presenting to Wyong Hospital Emergency Department with a primary mental health diagnosis will be discharged, admitted or transferred from the Emergency Department within 4 hours, thereby improving the Emergency Treatment Performance (ETP) (formerly known as NEAT) from 47% in 2013 to 81%.
Case for change Mental Health consumers presenting to the Emergency Department at Wyong Hospital have in the past faced delays in assessment and treatment. During 2013, only 47% of these consumers met the National Emergency Access Target (NEAT) of being admitted, discharged or transferred within 4 hours. Of those consumers requiring admission from the ED, 69% waited longer than 4 hours.
For the mental health consumer, Emergency Departments present a high stimulus environment that may increase arousal and anxiety and contribute to mental distress. Prolonged waiting times can lead to frustration, increased risk of symptom exacerbation, aggression and the risk of consumers leaving without completed treatment.
Diagnostics Over 200 issues were identified through:
Process Mapping
Patient & Carer Experience Trackers (PETs)
Patient interviews
Staff Interviews
Brainstorming
Data analysis
Compliments & Complaints
Planning and implementing solutions Implementation of solutions are being staged in order to
monitor effectiveness of each solution
Streamlined assessment & documentation procedures
Expanded Scope of Practice for ED mental health nurses allowing admission to PECC and discharge of low risk consumers
Dedicated FirstNet monitor & electronic patient journey boards for quick view of referrals and bed status
Clinical Initiatives Nurse pathways for mental health consumers
Staggered shift times to meet peak demand periods
Video Conference assessments
Physical Review and Assessment pathway
ED Staff Specialist allocated for mental health
Structured combined education and orientation
Assessment clinics
Results Since commencing the project we have seen a gradual improvement in mental health ETP performance
Mental Health consumers who do not require admission are being assessed, treated and discharged within 4 hours with non-admitted ETP achieving target of 81%
Consumers leaving ED without being seen has reduced despite presentation rates remaining constant
Quick Wins Standard Operating Practices for FirstNet referral, notes & discharge have been developed and published to standardise practice and improve KPI reporting
Dedicated FirstNet monitor & electronic patient journey boards have been installed to provide quick access to ED referrals and inpatient bed status
Beat It! every patient, every time Mental Health Emergency Treatment Performance 81% within 4 hours
Anne Louise Elsom Clinical Nurse Consultant Ben Roberts Nursing Unit Manager
Goal To improve the experience for people with mental health issues presenting to Wyong Hospital Emergency Department by reducing waiting times and treatment delays.
Method
Sustaining change Weekly Dashboard reports on KPI - displayed
Monthly Performance Report on related KPIs
Fortnightly FirstNet data report
Structured Clinical Handover and Case Reviews to ensure safe and consistent practice.
Policy & Procedures amended
Ongoing education, orientation & training
Leadership and modelling by sponsors
Solution ownership by teams
Staff recognition awards
Contact Anne Louise Elsom [email protected]
Ben Roberts [email protected]
Project Initiation Diagnostics Solution Design Implementation
Planning Implementation Evaluation
Sustainability
Steering Committee & Project Team established Communication Plan
Process Mapping Patient & Carer Experience Trackers Patient & Staff Interviews
Brainstorming Benchmarking Literature Review Prioritisation
Develop plan Ensure sponsorship Circulate for comment
Staged implementation Patient Journey Boards Expanded Scope of Practice
Weekly Dashboard Report Monthly Performance Report Structured Clinical Handover & Reviews
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20%
40%
60%
80%
100%
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5
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Length of MH Ax Psych RegDelay
Physical Ax FirstnetProcesses
Admitted NEAT Triage
Impa
ct o
n N
EA
T
MH NEAT Delay Root Causes
50%
55%
60%
65%
70%
75%
80%
85%
90% Mental Health Non-Admitted ETP
Process Measure 1 - MH Non-Admitted ETP Data
Process Measure 1 - MH Non-Admitted ETP Target
50%
60%
70%
80%
90%
May
-13
Jun-
13
Jul-1
3
Aug
-13
Sep
-13
Oct
-13
Nov
-13
Dec
-13
Jan-
14
Feb-
14
Mar
-14
Apr
-14
May
-14
Jun-
14
Jul-1
4
Aug
-14
Sep
-14
Oct
-14
Nov
-14
Dec
-14
Jan-
15
Feb-
15
Mar
-15
Apr
-15
May
-15
Jun-
15
Jul-1
5
Aug
-15
Mental Health ETP
Data Target
81%
01234567
Num
ber o
f pat
ient
s
Did Not Waits
Data
Target0
50100150200250
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24
Mental Health Presentations to ED by Hour of Day Hourly Totals
Jun-15
May-15
Apr-15
Mar-15
Feb-15
“The second monitor makes it easier to navigate between
systems” “My daughter was
seen quickly and the staff were caring and
professional”
Slide Number 1