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Streaming at John Hunter Hospital Emergency Department

Streaming at John Hunter Hospital Emergency Department. Michael Di Rienzo Director Acute Operations Hunter New England Health Email: Michael.Dirienzo@hnehealth.nsw.gov.au Phone: 0249214932 Mob: 0408441905. The Problem. Increasing number of presentations and Admissions 57,000 p.a.

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Streaming at John Hunter Hospital Emergency Department

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  1. Streaming at John Hunter Hospital Emergency Department Michael Di Rienzo Director Acute Operations Hunter New England Health Email: Michael.Dirienzo@hnehealth.nsw.gov.au Phone: 0249214932 Mob: 0408441905

  2. The Problem • Increasing number of presentations and Admissions 57,000 p.a. • Aging Population • Need to increase ED capacity • Not meeting Triage 3 and 4 Targets • Increased complexity front of house and lack of accountability • Emergency Assessment Teams, Clinical Initiatives Nurse, Triage RNx2, Ambulance Release Nurse • Task overloadED coordinators and staff specialists

  3. What did we do? • Changed Patient Flows within ED • Introduction of Patient management teams: Team A, B and EE • Defined roles and responsibility of staff • Gave people specific jobs and rules • Streaming patients according to acuity/complexity matrix from arrival • Introduction of Emergency Express

  4. Complexity/Acuity Matrix

  5. Emergency Express • Emergency Express lane – system designed to reduce waits “queue bust” and improve the patients experience. • Increasing throughput into Emergency Express by introduction of Advanced Practice Nurse and senior medical staff allocated to area (Low Acuity/High Decision making) • Paediatric presentation over the age of 3 months that are low acuity and low complexity can go to EE • KPI’s • Increase EE throughput to at least 50 patients per day • 90% patients seen and discharged within 90 minutes of treatment • Did not wait rate <2%

  6. Achieved • More collaborative environment, enhancing the relationship between: • junior and senior staff • medical and nursing staff • Enhanced guidance, support and education for junior staff • Staff rotate between each team and are exposed to all areas • Improved utilisation of senior staff • Decreased time wasted looking for doctor/nurses responsible for a given patient • Within a team, everyone has to work efficiently. Its more difficult to “hide”

  7. Improved Performance

  8. Feedback • Team A • It’s the place to work (Resus, High Acuity, Low turnover of patients) • Team B • Everyone is now exposed to the Paeds area • Most SRMO’s like the new experience of being “in charge” of an area in the ED • More defined work area with better vision of patients • Team EE • More interesting cases in EE • Junior doctors exposed to procedures • Patient flow in EE and type of presentations is now more appealing • Senior doctors like to be able to go back to EE and appreciate the fact that a junior doctor is also there (teaching, supervision etc)

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