emergency care co-ordination teams overdue for attention

EMERGENCY CARE CO-ORDINATION TEAMS

Overdue for Attention

General Practitioners Liaison Group

12 August 2010

-Canterbury West Coast ECCT -Southern Region ECCT

PRESENTED BY

Dr Robyn Carey Chair Canterbury/West Coast

Gill Thomson Co-ordinator Canterbury/West Coast


Why are we here?

• Minimal knowledge /understanding by many DHBs of the existence/role of ECCTs

• Some DHBs reneging on their responsibilities

• Roadside to Bedside cannot work without robust and effective ECCTs


National Situation

• ECCT’S CURRENTLY OPERATIONAL– Southern Region (Otago /Southland)– Canterbury / West Coast – Midland Region North Island) Each region required to have a co-ordinating body (ECCT) as defined in Service Specification jointly agreed between MOH, ACC and DHBNZ

• DEFUNCT / NEVER OPERATIONAL – Central Region (Lower North / Upper South Island)– Northern Region

• NATIONAL CHAIRS & CO-ORDINATORS GROUP – meet six-monthly with MoH, ACC


Team of Multiple and Diverse Players

• Primary care providers• Other emergency

services• Ambulance and

transport operators• Communications

centres• Telecommunications

providers

• DHB funding and planning

• DHB provider arms (multiple)

• Funding agencies• Clinical groupings,

professional societies

• Community groups and public opinion


Task of ECCT• To act as a clinical network group

across all pre-hospital and in-hospital emergency services, including emergency planning

• Implement recommendations of Roadside to Bedside using a Systems Approach


Roadside to Bedside (1999)

• Outlines 24 hr clinically integrated acute management system for NZ– Policy document of MOH

• endorsed by HFA, ACC, Council of Medical Colleges

• Best outcomes for patients involved in trauma, medical emergencies and complicated births

– “It is essential that people get the right care , at the right time, in the right place from the right person.”


FUNDING AND ADMINISTRATION

• ACC • MOH• Administration• Annual Plan


How can your ECCT help you?

• Identifying issues

• Taking a Systems overview

• Oiling the wheels*

• Sharing best practice nationally


Improvements achieved Canterbury/West Coast Region

STEMI FAST TRACK INITIATIVE

• First Ambulance to Cardiology ECG transmission on November 13, 2006.

• Life-threatening cases managed through the expedited coronary angioplasty pathway, with improved door to balloon times and patient outcomes as a result.

• Project exemplifies achievement of different health care providers working together for patient benefit - (ECCT, St John, Christchurch Hospital Cardiology and Emergency Departments and MedXus)

WEST COAST PRE HOSPITAL THROMBOLYSIS

• Joint project seed funded by ECCT with ongoing costs met by WCDHB

• Training Rural Nurses and Doctors in administration of pre hospital thrombolysis

• Project exemplifies achievement of different health care providers working together for patient benefit - (ECCT, West Coast District Health Board – Rural Nurses and GP’s , PRIME , St John, Christchurch Hospital Cardiology, Dunedin and Dunstan Hospitals)

• Implementation November 2007

• Considered a New Zealand first for rural nurses services to administer thrombolysis


Improvements achieved Southern Region

• Emergency Ambulance Survey• Data collection undertaken over a 3 month period from Dec 3rd, 2008 to March 3 rd, 2009 to

gather evidence surrounding the provision of ambulance response, and perceived delays in response times.

• The purpose of the survey was to collect reliable data, as previously all information was anecdotal.

• The aim was to then work closely with any stakeholder if necessary, and to attempt to find a solution to problems identified.

• Annual Skifields meetings in Queenstown and Wanaka

• Funded and organised by NASO each year to support the Skifields staff and doctors in the efficient use of the ambulance service during the busy ski season.

• Doctors working on the fields coming from overseas• ECCT is very much to the fore as part of the Emergency Care team in ensuring an integrated

service.


BARRIERS TO GOOD OUTCOMES

• Silo mentality

• Perverse /unintended outcomes from funding mechanisms

• Failing to address key clinical issues


BIG ISSUES

• After Hours Care• Emergency Department congestion• Ambulance services shortfall• Place of Aeromedical transport • Trauma systems and NTDBase• Training for acute care• Training for rural and provincial practice• Early identification of the unstable patient

within our hospitals


How can you help your ECCT?

• Understand and value it• Use it • Send a representative with authority• Recruit/encourage key clinicians• Encourage a strong and independent

chair• Re-commit to Roadside to Bedside• Assist other regions to establish


Thank you - Questions?

emergency care co-ordination teams overdue for attention

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