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The Very Long Corridor

Mid North Coast Local Health District
Project Added:
8 August 2016
Last updated:
19 August 2016

The Very Long Corridor

Summary

Mid North Coast Local Health District (MNCLHD) developed a clinical guideline that allows stable patients with specific diagnoses to have a direct bed-to-bed transfer from Kempsey District Hospital (KDH) to Port Macquarie Base Hospital (PMBH), with contingency plans for situations that may negatively impact the patient.

View a poster from the Centre for Healthcare Redesign graduation, August 2016.

The Very Long Corridor poster

Aim

To ensure 85% of clinically stable patients who present to KDH emergency department (ED) with a neck of femur fracture, sub-acute bowel obstruction, biliary colic, cholestasis or diverticulitis and require transfer to PMBH, are provided with a direct ward admission.

Benefits

  • Provides seamless transfers of patients within MNCLHD hospitals.
  • Eliminates the need for a second ED stay, which can delay treatment and reduce access for other patients.
  • Reduces the risk of duplicate investigations across multiple hospitals.
  • Provides patients with safe, seamless and appropriate care, with the right investigations.
  • Improves the quality of care provided to patients and reduces the risk of harm.
  • Reduces the cost of healthcare per capita.
  • Improves patient and staff satisfaction.

Background

In 2009, The Long Corridor (TLC) project was established to address issues in relation to the timely transfer of deteriorating patients between KDH and PMBH. Since then, critical patients have been transferred in a timely manner and no incidents in relation to the transfer of deteriorating patients have occurred.

During the TLC project, it was identified that stable patients with specific diagnoses (including neck of femur fracture, sub-acute bowel obstruction, biliary colic, cholestasis and diverticulitis) also experience lengthy delays during their transfer to PMBH. Historically, these patients were assessed, completed investigations and treated with pain control at KDH. Once they were transferred to PMBH ED, they went through this process again and waited for orthopaedic or surgical review before being transferred to an appropriate inpatient bed.

The TLC project found that the episode of care for these patients was almost double that of other patients presenting to the ED, increasing the risk of exposure to preventable complications such as pressure injuries and communicable diseases, as well as an increased risk of errors during the handover process. It also resulted in low patient, carer and staff satisfaction, as well as increased delays for other patients presenting to the ED.

The duplication of investigations also led to an increase in costs and resources, including overtime costs for medical officers. Staff at PMBH ED were also frustrated with the unnecessary ED stay required for stable patients. A lack of cohesion between clinicians at both sites and entrenched practices (based on resources available at the time) were also identified, which may have contributed to delays in bed allocations and an increased length of stay.

It was anticipated that a collaborative project across both hospitals would solve these challenges, with the aim of reducing transfer delays, eliminating duplicate investigations and improving the quality of care provided to the patient.

Implementation

  • The project team included:
    • a consumer representative
    • two visiting medical officers
    • representatives from the patient transport service, NSW Ambulance, acute pain service, surgical and orthopaedic departments, and EDs at both sites
    • steering committee members and project sponsors.
  • A vigorous Blitz brainstorming session was held with all stakeholders, to generate ideas to solve the problem.
  • A clinical guideline was developed to provide best practice information to staff on direct transfers between KDH ED and PMBH. The guideline includes algorithms for the transfer and admission of appropriate patients, as well as contingency plans should situations arise that may negatively impact the patient.

Project status

  • Implementation - the initiative is ready for implementation or is currently being implemented, piloted or tested.

Key dates

  • August 2015 - September 2016

Implementation sites

  • Kempsey District Hospital, MNCLHD
  • Port Macquarie Base Hospital, MNCLHD

Partnerships

Evaluation

  • The guideline will be trialled through a series of weekly Plan, Do, Study, Act (PDSA) cycles in September 2016, where all patients in the identified cohort will be reviewed. Where the patient is not transferred to a ward bed, audits will be undertaken to review the reason why this occurred. Where the patient is transferred to a ward bed, the patient’s condition and outcome will be reviewed.
  • An audit of patient records, patient tag-alongs, patient stories and staff stories will be conducted in September 2016. Measures will include:
    • time from decision of transfer at KDH, to arrival in ward bed at PMBH
    • number and type of duplicated results
    • costs associated with registrar call backs during patient admission
    • clinical condition of the patient and any associated deterioration
    • patient satisfaction
    • staff satisfaction.
  • The redevelopment of both sites has also enhanced services and contributed to the success of the project.

Lessons learnt

  • Regular communication with appropriate feedback loops and clarity on the definitions used in the project is vital to its success.
  • It is important to identify all key stakeholders and ensure their voices are heard.
  • When the project stalled, the team relied on support from the project sponsor to keep the project on track.
  • Ownership of the project must lie with those who are impacted, to ensure it is implemented and sustained in the organisation.
  • It is important to review existing policies and procedures and use them where appropriate, to reduce duplication and save time and effort.

Further reading

  • Nurse Manager Patient Transport Services, Mid North Coast Local Health District. Clinical Practice Guideline: Transporting Stable, Monitored Patients Using Hospital Transport Service. Hastings Macleay Clinical Network; June 2015.
  • Quality Improvement Coordinator, Port Macquarie Base Hospital Nurse Escort. Clinical Procedure: Transfer Inter-Facility – Pain Relief for Patients. Hastings Macleay Clinical Network; August 2014.
  • Program Lead, Whole of Hospital, Port Macquarie Base Hospital. Clinical Procedure: Direct Admissions for KDH ED to PMBH Inpatient Bed. Hastings Macleay Clinical Network; November 2015.

Contact

Louise Harper
Clinical Leadership Program Coordinator
Mid North Coast Local Health District
Phone: 02 6588 2859
louise.harper@ncahs.health.nsw.gov.au

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