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Allied Health Nelson Hospital Emergency Department. Strategy & Governance. The strategy was to: Support National Health Targets of reducing length of stay Provide ‘Better Sooner More Convenient’ service delivery Enhance clinical intervention
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Strategy & Governance • The strategy was to: • Support National Health Targets of reducing length of stay • Provide ‘Better Sooner More Convenient’ service delivery • Enhance clinical intervention • Provide integration across DHB and primary care services • Reduce inappropriate hospital admissions • Reduce frequent presenters to ED • Optimise patient’s journey • Facilitate access to community support services • Assess physical, mobility, rehabilitation, support, and psychosocial needs of patients • A Steering Group was established between AH, medical & nursing teams to ensure a robust quality & safety governance framework
Physiotherapy Services in ED • Inclusion Criteria for Primary Intervention: • Triage 4 and 5 Primarily musculoskeletal injuries • Falls 2 Exclusion Criteria for Primary Intervention: • Red Flags • Significant mechanism of action/head injury • Open wounds • Children under five years • Major deformities • Confusion or agitated state/altered level of consciousness • Recent seizure activity • Observations triggering EWS
Patient JourneyPhysiotherapy Primary Referral • 14 year old female rolls L ankle during netball, unable to weight bear, presents to ED with swelling and 8/10 pain score • Ankle assessment, Ottawa rules applied, XRAY requested • No bony injury - Treatment as per musculoskeletal injury • Follow up into Primary Health Primary Consultation - No Doctor intervention Frees up medical/nursing staff - patient on optimal pathway
Patient JourneyPhysiotherapy Secondary Referral • 73 year old woman fell, presented to ED via ambulance • Medical review – XRAY NAD • Physiotherapy referral - acute pain at intervals on movement, discussion with Dr, CT ordered, # pelvis • Patient keen to go home, successful mobilization with aids • Follow up community team, # clinic Assisted with diagnosis, prevented admission, optimal patient pathway
Patient JourneySocial Work Referral • Referral received from ED SMO overnight • Mother had overdosed came in with 15 yr • Concerns • Action Social Worker in ED meant: - Concerns of staff followed up thoroughly - Timely liaison with MCT and CYF - Provides holistic care, considers family and environment
Multiple Presenters Project • Management Plans: • Best interest for patients • Time saving, therefore cost saving • Free beds for true emergencies • Redirect to GP • Social Worker’s Contribution: • Liaison with Community re plan • Central person to link concerned professionals • Update Management Plan details when changes happen
Added Value • Safety and Risk • Preventing admissions & Frequent Flyers • Effective use of staffing resources • Takes pressure off medical team – concentrate on triage 1, 2, 3 patients • Support for young doctors, second opinion, assessment and management • Bridging gaps in service delivery across the: • Age continuum • Community / Health sector • Community liaison • Falls for over 65 year olds • Improve patient satisfaction • GP Enrolments
Nursing Perspective • Team approach provides timely and safe patient care for patients in ED. • Early allied health assessment and interventions provide better outcomes. • Nursing staff now able to concentrate on nursing role.
What did the Data Say during the pilot?30th April – 1st October 2012 (22 weeks) • Total Patients 749 Physiotherapy 429 patients with 45 follow ups Social Work 320 patients with 287 follow ups • Total Contacts 1081 • Represents approx 7% of ED presentations over the 22 weeks • 56% female and 44% male • 2.8% patients lived out of NM Area • 9.2% identifying as Maori
Consumer, Staff and Stakeholder Feedback (Time of Pilot) • Consumer, Staff and Stakeholder Questionnaire and interviews held post the pilot • Consumer’s feedback - 27/ 31 rated 5 extremely valuable • How were they helpful? • Provided information, treatment, practical support, follow up advice • Supportive and Professional service • Provided explanations , friendly • Good to talk to someone, empathetic • Follow up call to advise on community services/activities • Staff Questionnaires: • Social Work: 42/42 rated extremely helpful • Physiotherapy: 39/42 rated extremely helpful
Stakeholder Feedback Impact on services • Social worker improved communication across the hospital & community • Prepares background work, support and communication if patient admitted to the wards, flow through to ward MDT meetings • Admissions to hospital avoided as additional interventions put in place • Families more supported • Positive linkages to private providers • Increase follow up for urgent outpatients and community services in PT area and decrease referral rate in OT • Reduction in hospital based acute AH staff being called to ED • Early identification rehab clients i.e. stroke • Increase use of short term equipment loans • Improved communication / linkages to PHO and appropriate services
Project Financials Return on investments: • Admission avoidance • An estimated 3 per week (supported by whole Clinical Team and backed by Stakeholders) during initial Pilot. • Primary Contact Physiotherapy • Additional cost benefits – Falls, multiple variables
Current Quality Improvements and Future Directions Strategic • Continual integration and coordination of clinical teams across service boundaries ( Referrals to the Community Care Coordination Centre) • Electronic records , Shared Care view, EDAGG system • Continue to focus on the - Falls Prevention, Child and Family Concerns • Part of the wider approach to acute demand management and Alliance Work streams • Current case to extend to Wairau Hospital ED Consumer Focused • Care plans put in place to ensure consistency of care if re-present to ED • Commence discharge planning on admission • OPJ and consumer engagement in self management Workforce • Inter-disciplinary Team Model • Enhancements : Plastering , basic wound support – base on task competencies, nurse and AH initiated X rays
THANK YOU Questions?