Redesigning Care in the Paediatric Emergency Department CYWHS, SA

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Redesigning Care in the Paediatric Emergency
Department CYWHS, SA

• Presented by Ms Heather Gray
• Chief Executive CYWHS
• 25th November 2005

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Patient First

• A vision for improving the health of children,
  youth and women in South Australia

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The Project Streams

• Paediatric Emergency Services
• Normal Vaginal Births
• After Hours Hospital Care
• Booking Process for Childrens Surgery

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Paediatric Emergency Department Project Team
Mission Statement

• Within 6 months, all patients presenting to the
  Paediatric Emergency Department will be assessed,
  treated and discharged (either home or to another
  ward) within 4 hours of their presentation
• Acknowledgement to the PED Patient First Project
  and Guidance Teams

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Problem worth solving
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Problem worth solving

• The Australasian Triage Scale represents an
  agreed set of national access performance
  indicators for Emergency Departments. The codes
  and performance thresholds are demonstrated in
  the table below

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Project Plan

• Appointment of Clinical Project Officer (Nurse
  Specialist) and Team Leader (Consultant) from PED
  staff
• Empowering all staff to be involved in change
  workshops and focus groups formed
• Clinical Project Officer facilitates
  communication and liaison between all staff
• CPI methodology

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See and Treat Seven days a week 1000 2200hrs

• Triage nurse identifies See and Treat patients,
  based on set criteria
• Approx 25 of presentations triaged as See and
  Treat
• See and Treat patients seen in order of arrival
  not priority
• Dedicated waiting and treatment area
• Dedicated Experienced Medical and Nursing staff
• initially commenced with 1.5 nurses and 1 RMO and
  1 Registrar, after staff feedback changed to 1
  Nurse and 1 Registrar
• Experienced staff essential to maximizing
  potential of See and Treat

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Patient Satisfaction Survey results Pre and
Post implementation of See and Treat
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Patient Satisfaction Survey results Pre and Post
implementation of See and Treat
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Overall impact on Paediatric Emergency Department
Seven week period late
September Mid November
2004 2005 Average patients per day
109 111 Average wait time
66min 49min Average length of stay 3 hr
20min 2hrs 45 min LOS gt 4 hrs
19 14 Did not waits 4
1 Presentations admitted
25 24
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Overall impact on Triage data
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Workforce development implications

• Effective use of Nurse Specialists in See and
  Treat (as staffing numbers allow)
• Nurse specialists role includes IV insertion,
  plaster application, nurse initiated analgesia.
• Highlighted need for more Nurse Specialists or
  Extended Nurse Practioners
• Nurse Practitioner role may impact on training
  opportunities for training doctors
• No impact on training of RMOs noted at this
  stage

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Workforce development implications

• Anecdotal increase in staff morale and
  satisfaction will be confirmed with staff
  satisfaction survey
• Anecdotal increase in engagement of staff in
  problem solving and decision making
• All achieved in the midst of major redevelopment
  works

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• Questions?