Redesigning Care in the Paediatric Emergency Department CYWHS, SA Presented by Ms Heather Gray Chief Executive : CYWHS 25 th November 2005

Patient First A vision for improving the health of children, youth and women in South Australia

The Project Streams –Paediatric Emergency Services –Normal Vaginal Births –After Hours Hospital Care –Booking Process for Children’s Surgery

Paediatric Emergency Department Project Team Mission Statement “ Within 6 months, all patients presenting to the Paediatric Emergency Department will be assessed, treated and discharged (either home or to another ward) within 4 hours of their presentation” Acknowledgement to the PED Patient First Project and Guidance Teams

Problem worth solving

Triage Level Threshold Benchmark Target PED CYWHS (last 12 months) Average for like Emergency Departments 1seen immediately 100%98 %99% 2seen within 10 mins 80%69%67% 3seen within 30 mins 75%30 %51% 4seen within 60 mins 70%40 %54% 5seen within 120 mins 70% 83 % 81% The Australasian Triage Scale represents an agreed set of national access performance indicators for Emergency Departments. The codes and performance thresholds are demonstrated in the table below:

Project Plan  Appointment of Clinical Project Officer (Nurse Specialist) and Team Leader (Consultant) from PED staff  Empowering all staff to be involved in change: workshops and focus groups formed  Clinical Project Officer facilitates communication and liaison between all staff  CPI methodology

See and Treat Seven days a week 1000 – 2200hrs  Triage nurse identifies See and Treat patients, based on set criteria  Approx 25% of presentations triaged as See and Treat  See and Treat patients seen in order of arrival not priority  Dedicated waiting and treatment area  Dedicated Experienced Medical and Nursing staff  initially commenced with 1.5 nurses and 1 RMO and 1 Registrar, after staff feedback changed to 1 Nurse and 1 Registrar  Experienced staff essential to maximizing potential of See and Treat

Patient Satisfaction Survey results Pre and Post implementation of See and Treat

Overall impact on Paediatric Emergency Department Seven week period late September – Mid November Average patients per day Average wait time 66min 49min Average length of stay3 hr 20min 2hrs 45 min LOS > 4 hrs 19% 14% Did not waits 4% 1% Presentations admitted 25% 24%

Overall impact on Triage data Triage Level Threshold Benchmark Target PED CYWHS Late September – mid November 2004 PED CYWHS Late September – mid November 2005 Average for other like Emergency Departments 1seen immediately 100%96 %10099% 2seen within 10 mins 80%65%75%67% 3seen within 30 mins 75%29 %43%51% 4seen within 60 mins 70%42%68%54% 5seen within 120 mins 70% 90 % 95%81%

Workforce development implications  Effective use of Nurse Specialists in See and Treat (as staffing numbers allow)  Nurse specialists role includes: IV insertion, plaster application, nurse initiated analgesia.  Highlighted need for more Nurse Specialists or Extended Nurse Practioners  Nurse Practitioner role may impact on training opportunities for training doctors  No impact on training of RMO’s noted at this stage

Workforce development implications  Anecdotal increase in staff morale and satisfaction – will be confirmed with staff satisfaction survey  Anecdotal increase in engagement of staff in problem solving and decision making  All achieved in the midst of major redevelopment works

Questions?