Shorter Stays in the ED forum 26 and 27 March, 2012

Opening and overview of national picture Mike Ardagh

Welcome

Programme – Day 1 Opening and overview Sessions 1.CDHB – CREST/Preload 2.NMDHB – data analysis 3.MCDHB – MAPU 4.ADHB – process improvement from decision to admit 5.CCDHB – creating momentum 6.BOP – Ops centre set up and operation Wrap up then drinks/nibbles (about 4.30)

Programme – Day 2 9am start Panel – challenges and promising initiatives Bob Lloyd 1.The science of improvement 2.The quality measurement journey 3.Building capacity and capability Close – about 4pm.

The top ten challenges facing NZ DHBs in their target work Ardagh, Tonkin and Possenniskie. NZMJ 14 October 2011, Vol 124 No 1344; ISSN Access to hospital beds 2.Access to diagnostics (particularly CT and US) 3.Inpatient registrar delays 4.Increased patient presentations 5.ED too small/poor layout 6.ED staff deficiencies 7.Discharge delays on the wards 8.Clinical staff not engaging in change 9.Cant get elderly inpatients into aged care facilities 10.Nights and weekends more difficult

Special beds statement-ed-obervation-and- inpatient/?section=9088&contentType=451& tab=822 Creation of ED observation units and inpatient assessment units so that patients with a particular need, for example further observation or treatment by ED staff to achieve discharge or work up by inpatient teams, have that need fulfilled in a space well suited to that purpose. Hospital Operations PlanningDedicated and sophisticated daily hospital operations planning to enhance the use of the human and physical resource, and to improve patient flow between the ED and inpatient wards. Discharge planningGood discharge planning, beginning early with multidisciplinary input and as a particular focus of daily activities to reduce unnecessary patient waits and free hospital capacity. Access to imagingGuidelines and pathways for accessing imaging and a responsive service for the provision of both images and expert interpretation. Responsive acute servicesSeparation of acute and elective medical roster conflicts so that inpatient specialties provide a responsive acute service. Pathways for acute patientsPathways or agreements so that patients with common and relatively straightforward presentations, for example fractured neck of femur, can be transferred to the ward promptly rather than having to wait in the ED for an inpatient registrar assessment. Acute demand mitigationAnalysis of the drivers of increased demand for acute services and interventions to mitigate this demand. Enhanced ED layoutLayout of EDs to enhance function, including streaming of patients and good command and control. Enhanced ED senior staffingA greater senior staff presence to enhance decision making and overview of department activities. Engagement of staffEngagement of all staff by marketing changes with an appropriate whole of system and patient focused emphasis. Promising initiatives

The panel The panellists »Vanessa Thornton »Mike Hunter »Tim Parke »Paul Watson Questions 1.What are the top challenges? 2.What are the promising initiatives? (What do we need to do?)

How are we doing so far?

How are we really doing?

What about NZ?

Are we kicking people out just before 6 hours?

Are more people re-presenting to ED? (within 24 hours)

Are we admitting more patients?

Are we admitting less worthy patients? ( reducing average IP LOS)

Are more people dying?

Soft data A better winter last year –Problems, but a more responsive system Significant interest in EDs lot Dedicated DHB activity to relieve ED overcrowding New conversations Unexpected advocates Control

So We are doing well against the target We are probably doing well against more meaningful measures All the signals are positive, (although the data isnt great) Lets keep doing it

But Its getting harder –Demand is increasing –The easy things have been done

Thats why were here

Programme – Day 1 Opening and overview Sessions 1.CDHB – CREST/Preload 2.NMDHB – data analysis 3.MCDHB – MAPU 4.ADHB – process improvement from decision to admit 5.CCDHB – creating momentum 6.BOP – Ops centre set up and operation Wrap up then drinks/nibbles (about 4.30)