kirsty cummin and michelle lambert - act health - australia's first nurse led walk-in centre
TRANSCRIPT
7th Annual Emergency Department Management
Conference
16th -17th July 2015
Michelle Lambert – Clinical Nurse Consultant
Kirsty Cummin – Advanced Practice Nurse
HISTORY, VISION &
MODEL OF CARE
Walk-in Centre: HistoryYour health – our priority, ready for the future
Increase in health care demand over next 10-15 years, needs an
increase in health services(1)
10 year redevelopment of health infrastructure, one of the
initiatives -Walk -in Centre (1)
ED demand is known to be rising in almost all first world countries including those
with a strong primary care network. Many of these countries are experimenting with
innovative methods to reduce demand on emergency services. Minor illness and
injury make a large proportion of these presentations (2)
Australia’s first public, nurse-led Walk-in Centre opened
to the public 18 May 2010 located at Canberra Hospital
in the ACT
Provide high quality, rapid access to health care for the
management of minor illnesses and injuries for the ACT
Community
Walk-in Centre: Vision
Walk-in CentresNorth Side – Belconnen Health Centre
South Side – Tuggeranong Health Centre
Canberra Image: https://en.wikipedia.org/wiki/File:Canberra_Map_Districts-MJC.png
01/07/2014
26/06/2014
Aims
1. Improve public health care access in the ACT;
2. Address projected demand for health care services;
3. Add value to the health journey - health promotion and
information; and
4. Relieve pressure on the public hospital system. (3)
Complements existing primary health care
services
Community
Pharmacy
healthdirectWalk-in Centre
General
Practice
ACT
Ambulance
Service
Emergency
Department
Minor illness or injury Life threatening emergency(3)
PrinciplesInnovative
use of technology
Population Health
approach
Safe and high Quality
Patient Centred
Collaboration
(3)
Model of Care - Governance
1. Decision making algorithms
2. Training – orientation and final assessment OSCE
3. Supervision – peer review, GP mentoring and support
4. Incident monitoring and risk management
Model of Care - Clinical Governance (3)
Clinical Advisory Group
DON Rehabilitation Aged &
Community Care (chair)
ADON WIC
DON Division of Critical Care
TCH GP advisor
Community Care Representative
Physiotherapy
Pharmacist
WiC Nurse Practitioner
WiC Advanced Practice Nurse
Consumer Representative
ACT Ambulance Service
ACT Medicare Local Rep - (PHN)
Rehabilitation Aged and Community
Care Executive
CHHS Executive
WiC Management Group
WiC ADON
CNC
Pharmacist
Nurse Practitioner
Staffing Model
Shifts are staggered across the day 0730am – 10 pm seven
days/week
The Walk-in Centres staffed by
1. Nurse Practitioners
2. Advanced Practice Nurses
3. Administrative Staff
Clinical Scope of Practice
Exclusions:
• Children under 2 years
• Ongoing care
• Chronic conditions
• Referrals to specialists
• General health checks
• Workers Compensation
Claims
Free, one-off treatment for minor illnesses and injuries:
Inclusions:
• Cuts and bruises
• Minor infections
• Strains/Sprains & Simple
Fracture
• Skin complaints
• Coughs and colds
• Gastroenteritis
Information Technology
The Walk-in Centre uses Decision Making Algorithm Software:
1. Triage Algorithms
2. Systematic assessment and treatment tabs
3. Medication Standing Orders
4. Clinical Treatment Protocols
Event summary’s are sent to the GP after each visit with
consent
EVALUATION
Evaluation
External review 2011: conducted by Australian Primary Health
Care Research Institute (APHCRI)(4)
Review highlighted:
• Safe, effective service that is supported and valued by the
Community
• Confirmed the positive impact of the WiC for patients and
Practitioners
Areas of Potential Improvement/Impact:
• Model of care
• Protocols & Clinical decision support software
• Potential impact on CH Emergency Department for CAT
4 & 5 presentations
• Relationship with the Emergency Department
• Education (Professional Development)
Recommendations from the Evaluation
(4)
Consumer FeedbackOver 313 written letters of compliment and 40 of complaints, received since opening
Developed using Wordle
WHAT DOES THE DATA TELL US?
1795320290 21414 22208
FY 10-11 FY 11-12 FY 12-13 FY 13-14
Presentation to WiC whilst located at Canberra Hospital by
Financial Year
0
500
1000
1500
2000
2500
3000
3500
4000
JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN
No
. o
f P
resen
tati
on
s
Month of the Year
No. of Presentations to WiC Financial Year 14/15
Tugg 14/15
Belc 14/15
14/15
*Invalidated data
Total Presentations for 2014/2105 = 32980
0
1000
2000
3000
4000
5000
6000
Mon Tue Wed Thu Fri Sat Sun
No
. o
f p
resen
tati
on
s
Day of the Week
Presenting Day - Financial Year 14/15
Both
Tuggeranong
Belconnen
*Invalidated Data
0
200
400
600
800
1000
1200
1400
1600
1800
2000
07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22
No
. o
f P
resen
tati
on
s
Time of day (24 hr clock)
Presentations versus Time of DayFinancial Year 14/15
Tuggeranong Belconnen
*Invalidated Data
0
100
200
300
400
500
600
1 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52 55 58 61 64 67 70 73 76 79 82 85 88 91 94 97
No
. O
f p
resen
tati
on
s
Age in years
Demographics: Female (Pink), Male (Grey) andAge for FY 14/15 *Invalidated Data
URTI -AllWounds
-ALLWound
DressingOtherMSK
GastroOther -
Skin Ear Wax
Other -Resp
Other -ENT
Other -GIT
PP 8078 3172 1769 1457 1387 1066 1060 702 679 524
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
No
. o
f P
resen
tati
on
sTop 10 Presentations to WiC - FY 14/15
(combined common presentations)
*Invalidated Data
72%
8.30%
12.68%
5.62%1.10%
0.18%
Treatment Outcomes – FY 14/15 *Invalidated Data
Treated in WiC
Interim Plan and GPReferralRedirection to GP
Redirection to ED
DNW or left beforetreatmentOther Redirection
URTI-ALL
Wounds-ALL
Wounddressin
g
Gastro -V&D
EarWax
Other-MSK
Other -Skin
Sutureremoval
AnkleSprain
OtitisMedia
PP 7046 2661 1615 1174 1024 754 553 476 442 410
0
1000
2000
3000
4000
5000
6000
7000
8000
No
. o
f P
resen
tati
on
sTop 10 Presentations Treated in WiC - FY14/15
(combined common presentations) *Invalidated Data
Wounds- All
OtherMSK
ChestPain
Other -Eye
Acuteabdopain
Other -resp
Headinjury
NotwithinScope
Other -GIT
Other -Cardiac
PP 304 140 116 115 109 65 64 50 47 46
0
50
100
150
200
250
300
350
No
. o
f P
resen
tati
on
sTop 10 Redirections to ED - FY 14/15
(combining common presentations) *Invalidated Data
OtherMSK
Other -Skin
Other -Resp
NotwithinScope
WoundInfection
Other -GIT
Other -ENT
URTI-AllWounds
-All
Acuteabdopain
PP 317 307 280 187 183 179 171 155 153 127
0
50
100
150
200
250
300
350
No
. O
f P
resen
tati
on
sTop 10 Redirections to GP - FY 14/15
(combined common presentations) *Invalidated Data
WiC Presentations 149
Tuggeranong 81/Belconnen 68
Camera image: Commons.wikimedia.org
3.3%
29/06/2015
Treated in WiC, 112
Redirect to GP, 10
Redirect to ED, 5
Interim Plan & GP,
20
WiC definitively treated 75% and set up
treatment plans for a further 13% of pts
ACT Health Business Intelligence Unit and Finance Group
WiC Client Original Inclination –June 2015
47%
GP
16%
ED
16%
STAY
HOME
When asked: If the Walk-in Centre was not available, where would you
have gone instead today?
51% response rate (1453 respondents) for the month of June 2015
LESSONS LEARNT, EVOLUTION AND
THE FUTURE
Lessons and Evolution
• The WiC MOC has safely and effectively been implemented
• The WiC has successfully evolved into a valued community
service that has improved access to public health
• High staff and consumer satisfaction
Challenges and the Future
• Expansion of scope for clinicians and the service
• Enhancing collaborative partnerships with health providers
• Research and Education
• Recruitment and retention of staff
• Ongoing performance monitoring
• Growing the service
REFERENCES1. ACT Health, “your health –our priority, READY FOR THE FUTURE” (2008) accessed from
www.health.act.gov.au
2. Mason, S., Mountain, G., Turner, J., Mubashir, A., Revue, E. and Weber, E.J., (2014).
Innovations to reduce demand and crowding in emergency care; a review study.
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 22(55)
3. ACT Health, (2104) Walk-Centres: Operational Model of Care, May 2014
4. Parker, R., Forrest, L., Desborough, J., McRae, I and Boyland, T., (2011). Independent
evaluation of the nurse-led ACT Health Walk-in Centre.
https://au.search.yahoo.com/search?ei=utf-
8&fr=aaplw&p=Independent+evaluation+of+the+nurse-led+ACT+Health+Walk-in+Centre
QUESTIONS?
THANK YOU TO ACT HEALTH, ACT HEALTH BIU, FINANCE GROUP AND THE
DIVISION OF REHABILITATION, AGED AND COMMUNITY CARE (RACC)