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Beat it! Every patient, every time

Project Added:
6 August 2015
Last updated:
21 August 2015

Beat It! Every patient, every time

Summary

The Beat It! (Beat the Mental Health National Emergency Access Target [NEAT]) project used clinical redesign methodology to identify barriers to the timely and efficient assessment, treatment, admission or discharge of mental health consumers presenting to Wyong Hospital emergency department (ED).  Solutions were developed to address the root causes of delays to reduce lengthy waiting times and enhance the consumer experience. Improved communication and collaboration between the divisions and teams will also enhance staff and consumer satisfaction.

Download a poster from the Centre for Healthcare Redesign graduation, August 2015.

poster

Aim

To improve the experience for people with mental health concerns or symptoms presenting to Wyong Hospital ED by reducing waiting times and treatment delays.

Benefits 

  • Improved patient experience by reducing waiting times and treatment delays.
  • Improved patient care through early initiation and streamlining assessment and treatment.
  • Improved collaboration and communication between mental health and the ED.
  • Improvement in NEAT performance (now Emergency Treatment Performance ETP).
  • Increased efficiency through reduction of unnecessary duplication in assessments.

Project Status

Start date: August 2014

Project status: Implementation - the initiatives are currently being implemented, piloted and tested.

Background

Consumers presenting to the emergency department at Wyong Hospital with a primary mental health diagnosis have faced delays in assessment and treatment. Of the 1432 mental health presentations in 2013, only 47% met the NEAT for admission, transfer or discharge within four hours. Of the 396 admissions from the ED in this period, 69% waited longer than four hours to be admitted.

With the Wyong population forecasted to expand by nearly 18% by 2021, it was essential to address barriers to treatment for this important patient group.

For the mental health consumer, emergency departments present a high stimulus environment that may increase anxiety and contribute to mental distress. Prolonged waiting times can lead to frustration with increased risk of symptom exacerbation, aggression and the risk the consumer may leave without completing assessment and treatment.

Implementation

Twelve solutions were prioritized based on their ability to impact the root causes of delays, the ability to influence outcomes and ease of implementation. Solutions include expanded scope of practice for mental health nurses in the ED, clinical initiative nurse pathways for mental health consumers, dedicated FirstNet monitors and electronic patient journey boards and changes to policy and practice. Implementation of the solutions is being staged over 12 months in order to monitor the effectiveness of each solution.

  • Second monitors and electronic patient journey boards have been installed.
  • FirstNet standing operating practices have been developed and published.
  • Staggered shift times are under negotiation.
  • 'Nurse treat only' and admission to Psychiatric Emergency Care Centre (PECC) standing operating practices have been drafted. Collaborative education sessions between mental health and ED are under development. A dedicated ED staff specialist position has been assigned on each shift as a direct contact point to encourage regular communication and to enhance collaboration between mental health and ED medical officers.

Implementation sites

Initially Wyong Hospital emergency department followed by Gosford Hospital emergency department. 

Two identified solutions are now being developed as statewide processes including medical assessments in the ED and streamlining of clinical assessment documentation. 

Partnerships

  • NSW Health Whole of Health Program
  • Agency for Clinical Innovation, Centre for Healthcare Redesign Program 

Evaluation 

Monthly performance and weekly snap shot reports of key performance indicators including overall NEAT performance, admitted and non-admitted ETP, did not waits and presentations by hour of day are being monitored. Ongoing consumer and carer interviews are being conducted to evaluate overall satisfaction.

The project is demonstrating gradual improvement in performance with current ETP average of 70% and non-admitted ETP average of 80%.

Access to mental health inpatient beds continues to impact on the length of stay in ED and alternate avenues for acute response in the community is being addressed in another clinical redesign project.

Lessons learnt

  • Clear and concise communication is paramount to project success.
  • Maintain consumer experience as focus.
  • Collaboration and ownership by stakeholders is essential.
  • Cascading sponsorship required to translate and reinforce the importance of the changes.
  • Ensure robust and accurate data is available to support and monitor performance.

Further reading

  • Australian Bureau of Statistics. 2009. National Survey of Mental Health and Wellbeing: Summary Results, 4326.0, 2007. ABS: Canberra
  • Brown V, Knott J, Dakis J, Fielding J, Lyle D, Daniel C, Bruce M, Virtue E. 2011. ‘Improving the care of mentally ill patients in a tertiary emergency department; development of a psychiatric assessment and planning unit’. Australasian Psychiatry, 19:4
  • Department of Human Services Victoria. 2005. Mental health presentations to the emergency department. Melbourne: Department of Human Services  
  • .id. 2012. Wyong City population, households and dwellings forecast. Retrieved from http://forecast.id.com.au/wyong/population-households-dwellings [July 2012]
  • J A Projects Pty Ltd. 2012. External Review of Psychiatric Emergency Care Centres in NSW, Final Report to NSW Ministry of Health.
  • Kerrison S, Chapman R. 2007. What general emergency nurses want to know about mental health patients presenting to their emergency department. Accid Emerg Nurs, 15:48-55
  • Potter R, Huckson S. 2006. Victorian emergency department - mental health triage project. Melbourne: National Institute of Clinical Studies
  • Morphet J, Innes K, Munro I, O’Brien A, Gaskin C, Reed F, Kudinoff T. 2012. Managing people with mental health presentations in emergency departments – A service exploration of the issues surrounding responsiveness from a mental health care consumer and carer perspective. Australasian Emergency Nursing Journal, 15, 148-155
  • Lynne Blanchette. [n.d.] Providing more holistic and efficient health care for people with mental health issues in the Wollongong Emergency Department’. Illawarra Shoalhaven Local health District.

Contacts

Ben Roberts
Nursing Unit Manager
Psychiatric Emergency Care Centre /
ED Mental Health Team
Wyong Hospital
Central Coast Local Health District
Phone: 0416193873
Ben.Roberts@health.nsw.gov.au

Anne Louise Elsom
Clinical Nurse Consultant – Mental Health
Wyong Hospital
Central Coast Local Health District
Phone: 02 4320 5378
Anne.Elsom@health.nsw.gov.au

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