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30 March 2007 - Auckland

Rapid Cardiac Assessment Unit Presenter: Damian Miners Hospital: Prince of Wales Hospital Key contact person for this project Roger Huntington Nurse Unit Manager, Cardiology Unit 3 North Prince of Wales Hospital Roger.Huntington@SESIAHS.HEALTH.NSW.GOV.AU (02) 9382 0206. 30 March 2007 - Auckland.

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30 March 2007 - Auckland

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  1. Rapid Cardiac Assessment UnitPresenter: Damian Miners Hospital: Prince of Wales HospitalKey contact person for this project Roger HuntingtonNurse Unit Manager, Cardiology Unit 3 NorthPrince of Wales HospitalRoger.Huntington@SESIAHS.HEALTH.NSW.GOV.AU(02) 9382 0206 30 March 2007 - Auckland

  2. KEY PROBLEM • Access block in Emergency Department identified Cardiology patients as one of the highest users of this service, along with Aged Care & Respiratory patients. • Access to cardiac beds limited by number of outlier patients in cardiology unit • June 06 average LOS in ED for ACS patient was 6.3 hours • June 06 access for ACS patients was 79%

  3. AIM OF THIS PROJECT • Provide a twenty four hour short stay unit • Expediting timely access for low to intermediate risk patients with chest pain to the cardiology unit. • Reduce length of stay in hospital for low to intermediate risk chest pain patients • Improve patient outcomes by prioritizing clinical assessment and provision of seven day stress testing. • Funding costed through clinical redesign of services

  4. AIM OF THIS PROJECT Project KPI’s • Improved cardiac access from ED - target 80% • Number of patients admitted to RCAU • % of patients exceeding 23hrs LOS in RCAU • Representation rates RCAU into ED within 48 hours • % patients requiring admission from RCAU • % patients requiring stress test within 24hrs of admission to RCAU • Patient & staff satisfaction

  5. KEY CHANGES IMPLEMENTED • Cardiology statewide NSW DoH initiative • Executive support • Opened 4 bedded Rapid Cardiac Assessment Unit (RCAU) in June 2006 • A clinical pathway was developed and implemented in the emergency department on admission • Criteria expanded to include patients with new onset Atrial fibrillation, investigation of syncope, short term cardiac monitoring and heart failure patients • This initiative required the medical team to prioritise clinical review and treatment of these patients to maintain 24 hour service • The opening of the RCAU required an additional 1 RN (1FTE). This also afforded senior nursing staff the opportunity to extend clinical and assessment skills working in an autonomous environment • Bed management required a generic cardiac population

  6. OUTCOMES SO FAR Av 6.3 hours Feb 2007 - average ED LOS 4.5hours

  7. OUTCOMES SO FAR • RCAU LOS <23 hours • Aim to reduce ED LOS to < 3 hours

  8. OUTCOMES SO FAR RCAU 4 beds – short stay flows Flexible bed practice – other cardiology patients utilising RCAU beds.

  9. PROJECT EVALUATION • What would you recommend to other organisations? • Require adequate bed base to accommodate RCAU • Strong stakeholder communication and collaborative relationships esp. around ED physicians • Executive support essential • 3:2:1 target • Must be protocol driven but requires a level of flexibility between - coronary care - Thoracic Unit - RCAU

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