Right Patient Right Bed examined ways to minimise clinical risk where there are delays in transferring patients from Kempsey District Hospital to Port Macquarie Base Hospital.
Aim
By February 2020, 100 % of all Kempsey District Hospital patients requiring transfer to Port Macquarie Base Hospital for specialist (or higher level) care will be transferred within the clinical appropriate time frame, as risk assessed by a senior medical officer.
Benefits
- All patients requiring transfer for higher level and/or specialist care are risk-assessed by medical officer, once the decision has been made to transfer the patient to Port Macquarie Base Hospital. This supports improved efficiencies and patient care.
- This project will offer a standardised tool, called the Clinical Risk Rating Tool, to communicate risks and facilitate safe and timely transfers. This helps to minimise error and improve overall standards of patient care.
Background
- There has been an identified clinical risk in relation to transferring patients from Kempsey District Hospital to Port Macquarie Base Hospital. The reason being, Port Macquarie Base Hospital regularly has an occupancy of greater than 100 percent which leads to patient flow issues and delays for patients requiring transfer. There are documented delays which show an increasing number of patients waiting greater than 12 to 24 hours.
- Common presentations experiencing delay include fractured neck of femur, stroke, abdominal pain, gastrointestinal bleeding, unwell renal dialysis patients and patients requiring review by a cardiologist.
- Kempsey District Hospital has approximately three to four transfers per day requiring transfer for higher level and/or specialist care at Port Macquarie Base Hospital.
Implementation
- The establishment of a risk rating tool to communicate and document risks as determined by a senior medical officer in all patients requiring transfer from Kempsey District Hospital to Port Macquarie Base Hospital.
- The relaunch of network daily patient flow meetings from January 2020 onwards.
- Increased written and verbal communication when bed manager and nursing staff organise a patient transfer, as of December 2019. This ensures risk is communicated both in verbal conversation and via documentation on the patient flow portal. There will be further actions as the project continues that involve ways to minimise risk surrounding transport delays, as determined by senior medical officers.
Status
Implementation – The initiative is ready for implementation, is currently being implemented, piloted or tested.
Aspects of this project have been implemented. The clinical risk rating tool will be ready for implementation when business rules surrounding processes of escalation when the delay becomes 24 hours are established and agreed upon.
Dates
The project began in September 2019 and changes started to come into effect from December 2019, which continued into January 2020. The major changes occurred March 2020, alongside the roll out of the Clinical Risk Rating Tool.
Implementation sites
- For communication in relation to clinical risk handover: Kempsey District Hospital ED and nursing administration.
- For network patient flow meetings: Kempsey District Hospital and Port Macquarie Base Hospital.
- Once the risk rating tool is launched it will involve nursing staff and medical officers throughout both sites.
Partnerships
This project involved Port Macquarie Base Hospital, the referral hospital in the Hastings Macleay Clinical Network.
Evaluation
Process measures
- the number of patients with delays greater than 12 and 24 hours awaiting transfer to Port Macquarie Base Hospital related to bed availability.
- The percentage of patients who did not receive a detailed handover via the Patient Flow Portal.
Balancing measures
- Time taken to receive surgery, for patients presenting neck of femur injuries or damage.
Once the clinical risk rating tool is rolled out, these results will be measured against the aim statement.
Lessons learnt
Challenges included:
- difficulties in working with team members off site
- co-ordination of meetings and competing demands.
Once the clinical risk rating tool was established and ready to be rolled out as agreed, there were changes in agreements from the Base Hospital stakeholders which caused delay in the launch requiring renegotiation of business rules.
Contact
Katie-Marie Croad
Acting DDON/Emergency Department NUM
Kempsey District Hospital
Phone: 02 6562 0219
KatieMarie.Croad@health.nsw.gov.au
