Emergency Services Delivery in a Networked Environment

1. Emergency Services Deliveryin a Networked Environment Dr Paul Gaudry Director Emergency Services Stream Western Sydney Area Health Service Sydney Australia

2. Western SydneyArea Health Service • Primary & secondary health care for 690,000 people • Tertiary health care for 1.7 million • 33% over-seas born, 26% born in non-English speaking countries • 1.1% Aboriginal or Torres Strait Islander people

3. Facilities & staffWestern Sydney Area Health Service • Westmead Hospital (tertiary referral hospital 747 beds) • Cumberland Hospital (mental health hospital 252 beds) • Auburn, Blacktown and Mt Druitt Hospitals (total of 568 beds) • St Josephs and Lottie Stewart Hospitals (aged care & rehabilitation hospitals total of 212 beds)

4. Facilities & staffWestern Sydney Area Health Service • Institute of Clinical Pathology and Medical Research • Millennium Institute • Community health centres (mental health, community allied health) • 10,227 staff (8278 paid FTE) • (Childrens Hospital at Westmead) • (Division of General Practice)

5. Past achievementsWestern Sydney Area Health Service • New South Wales Trauma Plan • Western Sydney rescue Angioplasty • Western Integrated Network • Evolution of the Stream Structure

6. Organisational ChartWestern Sydney Area Health Service

7. Clinical OperationsWestern Sydney Area Health Service

8. Emergency ServicesWestern Sydney Area Health Service

9. Emergency ServicesWestern Sydney Area Health Service OUTLINE • Emergency Services Activity • Planning Process for Future Direction • Vision for Emergency Services • Key Outcome Areas • Key Outcomes and their Relationships • Emergency Services Plan 2002-2005

10. Australasian Triage ScaleAustralasian College for Emergency Medicine “This patient should wait for medical assessment and treatment no longer than ….” ATS 1 immediate ATS 2 10 minutes ATS 3 30 minutes ATS 4 60 minutes ATS 5 120 minutes

11. % Activity by ATS 1 to 5

12. % Activity by ATS 1 and 2

13. % Subsequent Admission by ATS 1 to 5

15. Vision for Emergency Services Western Sydney Area Health Service OUR PURPOSE We are committed to providing quality emergency care by professional and skilled staff dimensions of quality safety, effectiveness, appropriateness efficiency, access, consumer participation

16. Vision for Emergency Services Western Sydney Area Health Service OUR IDENTITY We will be recognized as providing to our community quality emergency care based on evidence based practice and research; as a part of the continuum of care

17. Vision for Emergency Services Western Sydney Area Health Service OUR VALUES We value the needs of our patients, customers, staff and care partners; and the expertise, commitment and dedication of our staff

18. Key Outcome AreasEmergency Services • Role clarity and network structure • Staff development and retention • Clinical systems • Care partners • Consumer participation • Emergency services episode funding • Information technology

19. Role clarity and network structureEmergency Services Accountabilities • Clinical and management leadership • Service planning and implementation • Operational coordination • Quality improvement • Human resource management • Financial management

20. Staff development and retentionEmergency Services Maintenance of professional standards and staff development as the basis for staff recruitment and retention • Patients and customers - quality emergency care based on evidence based practice and research • Care partners - multidisciplinary and health services research

21. Clinical systemsEmergency Services Patient flow and access block • Trends, extent, root cause analysis • Effects on safety and quality • Effects on costs (ED and hospital) • System-change (hospital demand, ambulance access, ED patient flow, hospital bed supply, inpatient flow, ambulatory care systems)

22. Clinical systemsEmergency Services Work-practices • demand management - observational medicine, buffer beds, post-acute community care, inpatient referral • packaging - “admission to treat” not “admission for diagnosis” • support - practice guidelines, clinical pathology and imaging, IT

23. How do you see usLike this

24. How do you see usOr like this

25. Care partnersWe want to be seen like this

26. Care partnersEmergency Services Continuum of care • Hand-over - responsibility for emergency care decision-making prior to discharge or inpatient referral • Chronic disease and continuing care - integrated and comprehensive approaches using practice guidelines • Clinicians and managers - across clinical streams and facilities

27. Consumer participationPerceptions may be like this

28. Consumer participationEmergency Services Demand management • Front door - marketed and managed • Emergency - prudent person definition • Triage - care is prioritized • Left without being seen - quality waste • Human focus - patients and staff • Education - conflict resolution, aggression and violence management

29. Emergency services episode fundingEmergency Services Efficiency • Cost modelling 01-02 to 03-04 • Cost/weighted attendance • Cost breakdown • salary and wages • goods and services • Total $350/weighted attendance

30. Information technologyEmergency Services Knowledge and discovery • Triage and tracking • Care documentation • Documentation templates • Clinical protocol constructor • Medication administration record • Clinical pathology and imaging

32. Real Time Data Triage & Assessment Fast Track and Early Response Standing Orders Clinical Guidelines

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