ETP - Top tips
Although NEAT is no longer an instituted program, many of the strategies and resources developed to support it are still relevant to ETP.
In 2011 NSW Ministry of Health ran an Emergency Access Target workshop designed to understand the key issues and actions to achieve NEAT.
The key actions were grouped into the following themes:
- Community and Ambulatory Care based alternatives
- DIscharge Planning
- Emergency Department
- Governance and Quality
- Inpatient Care / Care Coordination
In addition to these, the following top tips have been pulled together to provide some key areas to focus on. The list is by no means exhaustive but highlights some key ways that have been found to assist:
- Quality of care should be the driver of change with time as one component. Don’t work to achieve the target, work to improve the patient’s whole experience.
- At all times patient safety is paramount.
- The ETP target should be part of a larger quality improvement program.
- Ensure staff are aware of the performance against what is being measured.
- Involve patients.
- The target is a whole hospital initiative, not an Emergency Department (ED) one. It is vital that the whole health care system is considered and any changes result in a whole system improvement and not just a change within one unit, and that such changes are sustainable.
- Patient flow is crucial. For example, it was found in the UK that the greatest variability in the system is with elective admissions not emergency admissions.
- Elective and emergency work needs to be planned together, with equal priority. Only by careful planning can delays in exiting the ED be controlled.
- Accurate system data is vital, to understand patterns of arrival, discharge, when and why waits occur and to reduce system variability. The data support team need access to ALL data eg ED, hospital occupancy, elective waiting lists and outcome data.
- Identify an executive leadership sponsor as senior engagement is essential from the whole system.
- Form committees and working parties that reflect whole of hospital ownership of the target i.e. executive, surgery, patient flow, medicine, radiology, pathology ED. Whole system engagement is required and organisational barriers must be minimized.
- First meetings should:
- Review current performance of hospital/s with respect to ETP
- Identify challenging areas in the hospital, the ED and other units e.g. access to surgical consult, diagnostics in ED, access to ICU/high dependency beds, access to beds for ICU discharges, access to imaging within the hospital, quantity and location of unit outlier patients, in-hospital/discharge planning and options for out of hospital care i.e. OPD, Hospital in the Home, enhanced outreach to residential care facilities models of care
- Determine what information is required to support identification and monitoring of challenges
- A diagnostic phase is essential to identify the challenges. Risks attached to changes in workflows and clinical care delivery need to be considered in relation to the unique aspects of each hospital.
- Achievable solutions identified need to be implemented with identified resources and support from hospital executive.
- Admitted patients from ED may be smaller numbers than those discharged but creating available beds within the hospital within a timely manner is where the greatest challenge lies, to enable improved access to new ED patients.
- Patient transfers need to be reviewed and streamlined with both the referring and receiving hospitals agreeing process and communication.
- The role that an MAU, SAU, CDU or CAU can play should be explored to determine if appropriate for the facility as these models can make a huge difference.