Emergency Services Delivery in a Networked Environment

1
Emergency Services Deliveryin a Networked
Environment

• Dr Paul Gaudry
• Director Emergency Services Stream
• Western Sydney Area Health Service
• Sydney Australia

2
Western SydneyArea Health Service

• Primary secondary health care for 690,000
  people
• Tertiary health care for 1.7 million
• 33 over-seas born, 26 born in non-English
  speaking countries
• 1.1 Aboriginal or Torres Strait Islander people

3
Facilities staffWestern Sydney Area Health
Service

• Westmead Hospital (tertiary referral hospital 747
  beds)
• Cumberland Hospital (mental health hospital 252
  beds)
• Auburn, Blacktown and Mt Druitt Hospitals (total
  of 568 beds)
• St Josephs and Lottie Stewart Hospitals (aged
  care rehabilitation hospitals total of 212 beds)

4
Facilities staffWestern Sydney Area Health
Service

• Institute of Clinical Pathology and Medical
  Research
• Millennium Institute
• Community health centres (mental health,
  community allied health)
• 10,227 staff (8278 paid FTE)
• (Childrens Hospital at Westmead)
• (Division of General Practice)

5
Past achievements Western Sydney Area Health
Service

• New South Wales Trauma Plan
• Western Sydney rescue Angioplasty
• Western Integrated Network
• Evolution of the Stream Structure

6
Organisational ChartWestern Sydney Area Health
Service
7
Clinical OperationsWestern Sydney Area Health
Service
8
Emergency ServicesWestern Sydney Area Health
Service
9
Emergency ServicesWestern Sydney Area Health
Service

• OUTLINE
• Emergency Services Activity
• Planning Process for Future Direction
• Vision for Emergency Services
• Key Outcome Areas
• Key Outcomes and their Relationships
• Emergency Services Plan 2002-2005

10
Australasian Triage ScaleAustralasian College
for Emergency Medicine

• This patient should wait for medical assessment
  and treatment no longer than .
• ATS 1 immediate
• ATS 2 10 minutes
• ATS 3 30 minutes
• ATS 4 60 minutes
• ATS 5 120 minutes

11
Activity by ATS 1 to 5
12
Activity by ATS 1 and 2
13
Subsequent Admission by ATS 1 to 5
14
(No Transcript)
15
Vision for Emergency Services Western Sydney
Area Health Service

• OUR PURPOSE
• We are committed to providing quality emergency
  care by professional and skilled staff
• dimensions of quality
• safety, effectiveness, appropriateness
• efficiency, access, consumer participation

16
Vision for Emergency Services Western Sydney
Area Health Service

• OUR IDENTITY
• We will be recognized as providing to our
  community quality emergency care based on
  evidence based practice and research as a part
  of the continuum of care

17
Vision for Emergency Services Western Sydney
Area Health Service

• OUR VALUES
• We value the needs of our patients, customers,
  staff and care partners and the expertise,
  commitment and dedication of our staff

18
Key Outcome Areas Emergency Services

• Role clarity and network structure
• Staff development and retention
• Clinical systems
• Care partners
• Consumer participation
• Emergency services episode funding
• Information technology

19
Role clarity and network structure Emergency
Services

• Accountabilities
• Clinical and management leadership
• Service planning and implementation
• Operational coordination
• Quality improvement
• Human resource management
• Financial management

20
Staff development and retention Emergency
Services

• Maintenance of professional standards and staff
  development as the basis for staff recruitment
  and retention
• Patients and customers - quality emergency care
  based on evidence based practice and research
• Care partners - multidisciplinary and health
  services research

21
Clinical systems Emergency Services

• Patient flow and access block
• Trends, extent, root cause analysis
• Effects on safety and quality
• Effects on costs (ED and hospital)
• System-change (hospital demand, ambulance access,
  ED patient flow, hospital bed supply, inpatient
  flow, ambulatory care systems)

22
Clinical systems Emergency Services

• Work-practices
• demand management - observational medicine,
  buffer beds, post-acute community care, inpatient
  referral
• packaging - admission to treat not
  admission for diagnosis
• support - practice guidelines, clinical pathology
  and imaging, IT

23
How do you see usLike this
24
How do you see usOr like this
25
Care partnersWe want to be seen like this
26
Care partners Emergency Services

• Continuum of care
• Hand-over - responsibility for emergency care
  decision-making prior to discharge or inpatient
  referral
• Chronic disease and continuing care - integrated
  and comprehensive approaches using practice
  guidelines
• Clinicians and managers - across clinical streams
  and facilities

27
Consumer participationPerceptions may be like
this
28
Consumer participation Emergency Services

• Demand management
• Front door - marketed and managed
• Emergency - prudent person definition
• Triage - care is prioritized
• Left without being seen - quality waste
• Human focus - patients and staff
• Education - conflict resolution, aggression and
  violence management

29
Emergency services episode funding Emergency
Services

• Efficiency
• Cost modelling 01-02 to 03-04
• Cost/weighted attendance
• Cost breakdown
• salary and wages
• goods and services
• Total 350/weighted attendance

30
Information technology Emergency Services

• Knowledge and discovery
• Triage and tracking
• Care documentation
• Documentation templates
• Clinical protocol constructor
• Medication administration record
• Clinical pathology and imaging

31
(No Transcript)
32
(No Transcript)
33
?