CLINICAL TASKFORCE UPDATE

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CLINICAL TASKFORCEUPDATE
ACHSE Executive

• Peter Castaldi
• 19 June 2007

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CLINICAL TASKFORCE

• Future Challenge is Chronic Disease
• Prevention - smoking , medications , lifestyle
• Primary Care - pivotal - team work and continuity
• Integration - Clinical Governance - incident
  monitoring - institutional renewal

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CLINICAL TASKFORCE

• Large Hospital
• Emergency Department
• 24 Hour
• 130 180 presentations
• 50 60 admissions (42)
• 30 40 medical includes older multi-system

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CLINICAL TASKFORCE

• Roadblocks
• Queues for tests - CT
• Negotiating specialties / sub-specialties
• Referral to clinics / rooms
• Specialist RMO ratio
• ED 14 for 30 patients
• Ward 4 2-3 for 10 30 patients

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CLINICAL TASKFORCE

• Clinic Referral for those not admitted
• Specialist availability in clinics or rooms
• ED is 24/7 Rooms 9/5
• Post Acute Care effective route

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CLINICAL TASKFORCE

• ED Community
• Post-Acute Care (PAC) for defined conditions
• (pneumonia, cellulitis, DVT, anaemia,
  musculo-skeletal, seizures)
• Camden Campbelltown experience
• NZ experience Pegasus Health (PCO)
• 230 GPs acute admissions project
• Community alternatives to hospital care
• Effective with decline in ED attendance and acute
  admissions

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CLINICAL TASKFORCE

• Collaboration required
• Community - GP
• CAPAC (Community Acute / Post-Acute Care)
• ED clinicians

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CLINICAL TASKFORCE

• Information Exchange
• Access from outside
• Feedback
• The ideal is one record

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CLINICAL TASKFORCE

• Undifferentiated Symptom Complex(breathless,
  chest pain, fever, delirium)
• No General Physicians
• Referral to specialist which?
• Consultation process may be protracted

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CLINICAL TASKFORCE

• Physician Taskforce
• Develop care pathways
• Provide access to assessment
  acute early follow-up
• Define acceptance / responsibility
• Establish acute care location

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CLINICAL TASKFORCE

• Resistance to Change
• 'We are not paid to ponder'
• "Nurses are trained to follow guidelines, we are
  trained to break them"
• Brand et al, Engineering a safe landing......
• Int Med J 37 , 295 , 2007

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CLINICAL TASKFORCE

• Leadership
• From whence?
• Coordinate, attract, inveigle, coerce
• Lead from within
• Bottom-up reform works - eg St Vs , JHH
• "Commitment and not compliance"

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CLINICAL TASKFORCE

• Leadership
• From AHS collaboration between GPs, ED
  Clinicians, Physician Specialists
• From NSW Health eg. Clinical Redesign improving
  access to assessment, treatment follow-up
• From Physicians availability, prompt
  discussion, appropriate consultation referral,
  engagement of craft groups