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Teamwork the Mid North Coast Way: From ED to Urgent Care Centre

Wauchope District Memorial Hospital
Project Added:
21 October 2015
Last updated:
4 November 2015

Teamwork the Mid North Coast Way: From ED to Urgent Care Centre

Summary

Wauchope District Memorial Hospital (WDMH) transformed its emergency department (ED) into an Urgent Care Centre (UCC), which is equipped to treat patients with minor illness or injury. Patients that require emergency care for serious or critical conditions are transferred by NSW Ambulance directly to Port Macquarie Base Hospital (PMBH). The successful transition was underpinned by a comprehensive communications strategy made possible by the formation of a dynamic team which included key representatives from health and the community. 

This project was the recipient of the 2015 NSW Health Awards, Collaborative Team and Local Solutions categories. Watch a video on this project:

Aim

To reduce adverse clinical incidents and wait times for patients presenting to WDMH ED and improve the recruitment and retention of nursing staff and medical officers.

Benefits

  • Allows low-acuity and low-volume EDs to meet the needs of people with minor injury or illness in an efficient, convenient and timely manner.
  • Increases access to existing diagnostic services, with reduced wait times for care.
  • Educates consumers about the need to call 000 or attend another facility for serious conditions.
  • Increases patient safety due to the stability and retention of nurses and medical staff, with clarity on the roles of nursing, medical and ambulance staff.
  • Increases access to clinical care for critically ill patients in a more timely manner, through collaboration with nearby facilities.

Project status

Key dates

  • Start: March 2014
  • Finish: January 2015 

Status

  • Sustained - The initiative has been implemented and is sustained in standard business.

Background

A review of low-volume EDs in Mid North Coast Local Health District (MNCLHD) was undertaken in 2011 and revised in 2012. The review identified that the Level 2 ED at WDMH had a significant increase in adverse clinical incidents, a crisis in recruitment and retention of appropriately-trained nursing staff and a substantial change to medical officer coverage.

It was found that 8% of all patients presenting to WDMH ED required transfer to PMBH. This created delays in diagnosis, treatment and care. It also reduced the ability of WDMH ED to deliver a quality service and increased the risk of adverse events.

To overcome these challenges, telehealth technology was trialled at WDMH. A camera was placed in the ED that transmitted high-definition images to PMBH, which enabled off-site medical review and treatment at times when WDMH had no onsite medical officer. Despite some success, the technology was not well supported and staff reported frustration and a lack of confidence. More often than not, nursing staff were instructed to ‘send the patient to Port Macquarie’.

Following high-level deliberations, it was determined that the site could no longer support a full emergency service and a UCC was better suited to the needs of the community and the capabilities of the facility and its workforce.

A UCC model of care delivers ambulatory medical care outside of a hospital ED without appointment. It allows the facility to treat patients with minor illness or injury and offers easy access to radiology and pathology services to assist diagnosis and treatment. The aim is to treat each patient within a 60-minute timeframe. This model particularly suited the service requirements of the Wauchope community, which was predominantly low acuity and low volume.

Implementation

  • MNCLHD brought together a diverse team to work on improving patient care and staff safety at WDMH and communicating the change to the local community. The team included clinical experts such as the Director of Emergency Services, critical care nurse consultants and NSW Ambulance staff, as well as a local board member, executive officers, network management, hospital staff, volunteers and the MNCLHD media unit. 
  • All stakeholders were informed, involved and consulted throughout the 12-month transition process. A series of community information sessions were held in Wauchope and in three outlying communities, which were attended by all team members.
  • This transition process targeted the entire community and all staff. Regular information was provided to the community via media outlets, to ensure people were aware of the change and understood the reasoning and implications. The emotional connection to this rural health facility by the local community was considered in every step.
  • The UCC operates 10 hours a day, seven days a week, staffed by a medical officer, First Line Emergency Care accredited registered nurse, emergency nurse and receptionist. It is supported by radiology, allied health and pathology collection services, which operate seven day a week during business hours. This staffing model has improved the hospital’s ability to support and retain medical staff. 
  • Patients presenting to the UCC are assessed and treated for acute medical conditions (non-emergency) within 60 minutes. Patients are referred back to their general practitioner for follow-up management. In the event patients present with emergency conditions, they are provided with first aid treatment and arrangements are made for transport to PMBH.

Implementation site

  • Wauchope District Memorial Hospital

Partnerships

  • Ambulance NSW
  • The ‘Wise Owls’ group comprising representatives from community organisations including Lions, Rotary, Apex, church groups (Anglican, Uniting and Presbyterian), Chamber of Commerce, Hastings Cooperative and local businesses.

Results

  • Within the first 12 months of operation, there was a total of 4991 presentations with only 2% of patients requiring a transfer to PMBH for higher level review or care.
  • Between March 2014 and January 2015, 58% of patients received treatment within 60 minutes, with an average treatment time of one hour and 13 minutes.
  • The number of incidents reported by nursing staff declined from 23 in the period March 2013 to February 2014, to 14 incidents from March 2014 to February 2015.
  • Nursing, medical and administration staff within the UCC and hospital reported high levels of satisfaction with the change. In early 2014, staff were asked: “Overall, are you satisfied with the transition from ED to UCC?” Of 18 respondents, 33% were satisfied, 28% neutral and 39% dissatisfied. When the same question was asked in March 2015, 75% of the 16 respondents were satisfied, 25% neutral and none were dissatisfied.
  • Patient feedback has been very supportive of the model, as evidenced by unsolicited feedback via the hospital’s compliments, complaints and suggestions processes.
  • There was risk that the community and WDMH staff would view the UCC as a downgraded service and purposefully agitate against it. One year after opening, the UCC is still receiving strong community support, has maintained consistent staffing and delivered safe and clinically appropriate services to more than 6000 patients.
  • The UCC has increased access to higher-level clinical care for critically ill patients in a more timely manner, with NSW Ambulance now bypassing WDMH and travelling directly to PMBH with these patients.

Awards

This project won two MNCLHD 2015 Health Innovation Awards: Collaborative Team and Local Solutions and was the recipient of the Collaborative Team and Local Solutions categories in the 2015 NSW Health Awards.

Lessons learnt

  • The UCC model can efficiently be applied to small rural hospitals where there is a need to offer daily, but not 24-hour, non-emergency access.
  • Proximity to the Level 5 ED at PMBH was an essential feature of the communications strategy, where patients could receive emergency care for serious or critical illness or injury.
  • The successful transition was underpinned by a comprehensive communications strategy and made possible by ensuring key stakeholders were part of the collaborative team.

Further reading

Contact 

Ann Bodill
Executive Officer / Director of Nursing
Wauchope District Memorial Hospital
Mid North Coast Local Health District
Phone: 02 6580 8014
Email: ann.bodill@ncahs.health.nsw.gov.au 

 

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