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Improving Queanbeyan Health Service Admitted National Emergency Access Target

Queanbeyan District Hospital
Project Added:
20 August 2015
Last updated:
25 August 2015

Improving Queanbeyan Health Service admitted National Emergency Access Target

Summary

At Queanbeyan Health Service (QHS) 74% of patients admitted to an emergency department (ED) bed stay longer than four hours. In 2014 Admitted National Emergency Access Target (NEAT) performance in QHS was 36%. This project implements solutions to improve patient flow and improve NEAT by 20% in 2015.

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

Aim

Improve admitted NEAT in QHS by 20% in 2015.

Benefits

  • Improving patients experience. A 20% improvement in admitted patient flow will improve patient experience and satisfaction with the service.
  • Improving health of population. Having skilled triage staff rostered will ensure early detection, timely assessment, and treatment of critically ill patients to prevent adverse ED outcomes.
  • Reducing per capita costs of health care. Meeting length of stay targets in the ED will improve performance and cost efficiency.

Project status

Project started: 5 August 2014.

Project status: Implementation - the initiatives are currently being implemented.

Background

Queanbeyan Health Service’s case for change is to align with the following key performance indicators.

  • The Australian National Health Care Agreement to achieve the national benchmark set for timely access to emergency treatment by 2016.
  • NSW Health performance framework that requires adherence to the principles outlined in The Australian National Health Care Agreement for achieving NEAT.
  • NSW Health performance framework in the context of national funding reform i.e. activity based funding guidelines.
  • Southern NSW Local Health District strategic plan set key performance targets by aggressively pursuing process redesign with the goal of eliminating non value added steps improving the effectiveness.

QHS moved from a block funded to an activity based funding model in July 2013 requiring the ED to look at strategies to manage within the new budgetary framework.

Hospitals across Australia are working towards a NEAT of 90% by 2015.

Whole of Hospital statistical data indicate the following.

  • There were 17,439 Queanbeyan hospital ED presentations in 2013 and a similar number for 2014 although the average length of stay is increasing.
  • Emergency department admitted NEAT performance is 36% where patients are either admitted to hospital or discharged home within four hours.

Analysis of the Whole of Hospital Admitted NEAT performance identified that annually, 1951 triage category 2 and 3 patients remain in the department more than four hours.

A recent root cause analysis following an adverse event identified a system failure in the early detection, timely assessment, and treatment of a critically ill patient with sepsis. Studies demonstrate that overcrowding and long transition times can be key factors in increasing the risk of adverse events in the ED.

There are 10 complaints relating to ED wait times from 1 July 2013 to 30 June 2014.

Implementation

Solutions implemented

  • New rostering practices ensure there are experienced clinicians on all shifts who carry clinical lead and patient flow responsibilities
  • Fast track model of care implemented between 2 pm and 6 pm. Decision based on historical high volume presentations of low acuity patients during this time.
  • Emergency department escalation pathway implemented to ensure long wait patients, > 4 hours, are flagged to supervisor.
  • Protocols for ED bed management implemented.
  • Local protocol developed to inform direct admission to the ward where appropriate.

Solutions to be implemented

  • Nurse initiated x-rays, five staff enrolled in course due for completion August 2015.
  • Medication protocols developed and roll out of education to ED staff in August 2015.
  • Pathology traffic light ordering system developed to be implemented in September 2015. Interim process has been implemented for the nurse to use a verbal order from medical officer for x-rays, medication, and pathology.

Implementation site

Queanbeyan Health Service, Southern NSW Local Health District.

Partnership

ACI Centre for Healthcare Redesign.

Evaluation

This project will be evaluated using:

  • Whole of Health data reports
  • Southern NSW Local Health District ED performance data
  • patient complaints
  • IIMS and critical incidents
  • questionnaires
  • patient and staff experience trackers
  • patient and staff interviews
  • tag along.

A number of factors have affected the implementation of this project, including the following.

  • Inconsistent clinical leadership in ED inhibited change acceptance but nurse unit manager employed June 2015 and medical director in July 2015.
  • Delayed decision to admit continues due to ad hoc adherence to revised local protocol. There is an expectation of improvement with new leadership team.
  • Increasing demand for Queanbeyan Hospital to accept transfers from ACT for step down and sub-acute care, plus increased surgical activity in 2014/15, is impacting on bed availability for ED patients requiring admission.
  • Length of stay in the ED 2014/15 has improved overall (18%) for acute presentations but timely patient flow to inpatient unit remains a challenge.

Admitted NEAT graph Jul 2014 - April 2015, less than 20% since Jan 2015

Graph of triage 2 ATS scores, 2014 and 2015, shows consistently higher scores in 2015 and most months meeting 80% target

Lessons learnt

  • Strong leadership is imperative to a successful project.
  • Navigating the transition of the project and accommodating resource changes, such as ED senior management.
  • Managing a project in an unpredictable environment generally takes much longer than expected and roadblocks are almost certain to occur.
  • Never give up.

Further reading

  • Emergency Care Institute. 2014. National Emergency Access Target.
  • The College of Emergency Medicine. 2008. The Way Ahead 2008-2012: Strategy and guidance for Emergency Medicine in the United Kingdom and the Republic of Ireland.
  • Forero R, Hillman K, McCarthy S, Fatovich D, Joseph A, Richardson DW. Access block and Emergency Department Overcrowding. Emergency Medicine Australasia 2010; 22: 119-135.
  • NSW Health. 2014. 7. Admitted vs non admitted National Emergency Access Target (NEAT). YouTube.

Contact

Pauline Murtagh
Quality Coordinator
Queanbeyan Health Service
Southern NSW Local Health District
Phone: 02 6128 9850
Pauline.Murtagh@gsahs.health.nsw.gov.au

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