ED Stream Workshop Acute MOC – Manning August 2013 ED Stream Workshop 1

Models of Care at MRRH 1.Triage and registration –First point of contact for all presenters to ED –Ambulance also enter via single triage point. –Contiguous with clerical for ease of registrations. –Streaming to Waiting room, Fast Track or a bed. –Have a ambulance holding bay which can be staffed. –Ability to implement BEAUT process. 2

Models of Care at MRRH 2.Brief Emergency Assessment and Urgent Treatment –Developed along the lines of the ‘Early ED Senior Assessment and Streaming’. –Operates during peak periods –Employs streaming –Has a designated Early Treatment Zone –Rapid review by SMO with documented Mx plan and Rx 3

Models of Care at MRRH 3.Fast Track –Nurse Practitioner led –Commenced November Resuscitation –WIP Trauma Response at MRRH ED –Tiered approach, recognises local constraints. 4

Fast Track Model at MRRH In response to DNWs, long LOS, Pt complaints. Non-complex pts able to be discharged in <2hrs. Dedicated area with direct access to the waiting room. Collaborate with CAPACs to Fast Track appropriate patients. Benefits demonstrated in improved KPIs. 5

How are we different? Main difference: Nurse Practitioner led service Have specific inclusion and exclusion criteria Dedicated area connected to waiting room. Patients streamed direct from triage. Works collaboratively with physio, CAPACs. Successful! 6

Resource Required for Fast Track Model Staffing: Endorsed Nurse Practitioner – FTE 1.0. Nurse Practitioner Candidate for FTE 1.4 for 2012/2013. Training:Master of Nursing (Nurse Practitioner). Space:Dedicated Consultation room. Well stocked. 7

Monitoring and Evaluation Data clearly show positive impact. Data pre & post Fast Track. 12 months of data used for pre & post. 8

KPI: Improvement in LOS 9 Patients who stayed a minimum of 480 minutes. Compares 2009 & 2012/13

KPI: Improvement in LOS 10 Patients who stayed a minimum of 360 minutes. Compares 2009 & 2012/13

KPI: Improvements in Did Not Waits 11 Patients who did not wait to be seen. Compares 2009 & 2012/13

Evidence of Success Improved KPIs since implementation. Contributes to our excellent NEAT results. NEAT target result of 78% YTD for all pts. NEAT result of 86% for non-admitted pts. Sustainability – operating since