MINISTERIAL TASKFORCE ON
EMERGENCY CARE IN NSW
Progress of state-wide Emergency
Department work
and
MTEC funded projects
December 2011
MINISTERIAL TASKFORCE ON EMERGENCY CARE PROJECT UPDATE December 2nd, 2011
ITEM
ACTIONS
PROGRESS
RESPONSIBILITY
ECI progress
Establish the Emergency Care
Institute.
ECI Positions Established within
Agency for Clinical Innovation (ACI)
Funding transferred to ACI
Establish the Emergency Care
Institute.
ECI Director 0.5 position appointed
Manager position appointed
Director ECI commenced will be invited to MTEC now as a guest and formal request for membership
via the Minister.
Project Completed
Transfer of funds for ECI research projects
Daniel Comerford
Project completed
Sarah Hoy
ECI Research
HSPIB
ECI Transfer of Funds to ACI to be
available for projects
ED Equipment
Purchase of equipment for Level 3-6
EDs
Chest Pain
Journey
Collaborative work group established
The minimum standards for chest pain evaluation were mandated for implementation 9 June 2011
involving: ACI Cardiac Network, Rural (PD2011_037). The Policy outlines the minimum standards for the management of
Critical Care Taskforce Critical Care
patients presenting with Chest Pain or other symptoms of myocardial
Taskforce, and Ministerial Taskforce
ischaemia.
for Emergency Care, Clinical Safety,
and Quality and Governance Branch,
The policy was based on “minimum standards” rather than one size fits all (flexible
Health Services Performance
standardisation). All Local Health Districts must have a clinical governance strategy for chest pain
Improvement Branch, Ambulance and
pathway implementation
NAMO.
1. Local Health Districts must report data relating to use of Chest Pain Pathways on relevant
To develop a state wide chest pain
patients at all facilities
pathway to cover the patient journey,
2. All facilities with emergency departments must have a Chest Pain Pathway
minimise risk and improve patient
3. All facilities who currently do not have a Chest Pain Pathway must implement the standard
outcomes for patients presenting to
NSW Health Chest Pain Pathway
and being admitted to hospital with
4. Facilities that have an existing Chest Pain Pathway must ensure that it meets the following
Chest pain.
minimum standards:
• Assigns triage category 2
• Risk stratification
• ECG taken and reviewed
• Biochemistry taken and reviewed (troponin)
• Vital signs taken
• Times must be documented (symptom onset, presentation)
• Aspirin given unless contraindicated
• A Senior Medical Officer is assigned to provide advice and support on chest pain
assessment and management 24/7
• Provides information and advice regarding atypical chest pain
There has been significant uptake of the pathway with many sites adapting the minimum standards
pathway to suit their local environment.
James Dunne
MINISTERIAL TASKFORCE ON EMERGENCY CARE PROJECT UPDATE December 2nd, 2011
ITEM
ACTIONS
PROGRESS
RESPONSIBILITY
Sepsis Project Development of Sepsis Pathway
Development of Sepsis clinical safety
and quality indicators.
This project is now under the jurisdiction of ACI (ECI) and the CEC. Sepsis project is well underway in Margaret Murphy
EDs. 32 /50 participating hospital Emergency Departments (ED) had submitted progress reports to the
Sepsis Project Database. Next phase of this project is rolling it out to the ward areas
Ambulance
CAD
programme
Ambulance to ED transfer of care time
reporting system. Replacement of off
stretcher time.
In line with Recommendation No. 88
from Care Together response
The Ambulance Transfer of Care Reporting System has been developed to match ambulance patients Sally Howard
to ED patients using Ambulance incident number & date
http://tcrs.doh.health.nsw.gov.au/transferofcare
Currently delays with using system for reporting purposes (i.e. Replacement of OST with Transfer of
Care time) due to ability to transfer ED data in the system from CERNER FirstNet sites. Estimated GoLive date for reporting Transfer of Care KPI is March 2012
Telehealth
Presentation to MTEC following
concerns Re progression
Tele-health funded through COAG Capital for ongoing development
4 million over the next 3 years
Urgent Care
Centres
Pilot of UCCs in NSW
5 Pilot sites selected for UCC
implementation
Campbelltown Hospital
Westmead Hospital
Wyong Hospital
Westmead Children’s Hospital
Sydney Children’s Hospital
Nomination requested from MTEC to
sit on the NSW ABF Workgroup.
5 pilot sites open. Interim models at Westmead and Wyong awaiting completion of major capital works. Sarah Hoy
Data collection in progress since July 2011. Evaluation to commence early 2012.
Nursing Representation, position remains available on the workgroup
Representation of Clinicians from MTEC. Work group continuing to meet and work towards a NSW
ABF solution for implementation.
Daniel Comerford
Care Coordination PD to be
distributed and implementation
materials to be finalised and
distributed.
Patient Flow Predictive Tool to be
implemented in participating facilities
across NSW
Bed Board implementation in NSW
Care Coordination Policy Directive (PD2011_015) distributed to the wider health organisations
supporting material printed and distributed, (Reference Manual, Managers Implementation Handbook
and Patient Brochure).
Patient Flow team
ED ABF
Hospital
Access
Performance
Patient Flow
Systems
Patient Flow Portal, Release 1, New BED BOARD live in hospitals across NSW on 8 June 2011.
All Inter-hospital transfer are to be entered into the Bed Board. All LHN’s key personnel have
completed training and are now training other support staff within the LHN’s. NSW Health
Capacity and Demand Tool built for individual hospital implementation now, will be included in Patient
Flow Portal release 2 in 2012.23 Hospitals have implemented the State Build Capacity and Demand
Tool. Commencement of Patient Flow Systems Eduction program.
SWDB
MINISTERIAL TASKFORCE ON EMERGENCY CARE PROJECT UPDATE December 2nd, 2011
ITEM
ACTIONS
PROGRESS
RESPONSIBILITY
Hospital
Access
Performance
EAP Project
15 hospitals across metro and
All fifteen participating Hospitals were invited to attend a GM EAP Workshop on 18 May 2011. A further Daniel Comerford
regional NSW have been reviewed.
workshop held for all NSW Hospital General Managers in October 2011. Key Actions to deliver National
DG to visit all nine metro facilities over Emergency Access Target (NEAT) were developed and recommended.
the next two weeks
Recovery plans to be provided to NSW
Health for review and support in
implementing
GM workshop to be held to assist with
meeting the actions outlined in the
recovery plans
Policy Review
and
Development
ED Awaiting Care Policy review
ED Discharge of Patients at Risk
Care Coordination Policy Directive:
Inter- hospital transfers
Notification of VMO of Admission
Flu Clinics –
ED to Ward checklist
PD 2010_075 published and distributed
PD2011_031 Interhospital Transfer Process for Adults requiring specialist care Policy published 1
June 2011 and distributed
PD 2011_015 Care Co-ordination policy published 7 March and distributed
GL2005_026, Released
Working with Communicable Diseases Branch to update policy following Flu Clinic evaluation.
Care Coordination policy released in March (PD2011_015)
Transfer policy released in May (PD2011_031)
Australian
Open Tender for external partner to
Request to AHMAC to release final report to Health System. Awaiting consideration of report and
Triage process progress with HPPPC approved review recommendations from HPPPC
review
of Australian Triage Process-
HSPIB
IT FirstNet
Daniel Comerford
ED Training for
Emergency
Medicine
Specialty
4 hour target &
audit
AGG Regular updates to MTEC
HSPIB working with AAG to progress ED to Ward checklist. Project on hold, full assessment of
Between the Flag SAGO chart and requirements before progression.
Sarah Hoy
Independent FirstNet review
Report of FirstNet review is with the Minister
Establishment of ED Registrar training Workforce development and innovation, CETI
networks. Complete
Project scope developed
Development of Draft Clinically
Appropriate exceptions to 4 hour target
Feedback on draft of clinically
appropriate exceptions completed.
Draft list revised from NSW
perspective
57 facilities across NSW selected for Audit of Triage Cat 1 Patients
Audit closing on 11/3/2011. 29 facilities submitting data. Interim report being finalised.
Representative of Level 3-6 ED’s from Rural / metro perspectives
Establish frequency of occurrence of clinically appropriate exception criteria by LHN / ED role
delineation / Metro vs. Rural. Report completed. Discussed at the cross jurisdictional meeting. Report
to be published.
Albert Vasquez
MINISTERIAL TASKFORCE ON EMERGENCY CARE PROJECT UPDATE December 2nd, 2011
PROJECT NAME
PROGRESS
RESPONSIBILITY
Clinical Handover in ED
Evaluation report completed with communication strategy for distribution being prepared,
Article submitted for publication to BMJ Quality and Safety Journal. Training DVD for ED
staff currently in development.
Sarah Hoy
Clinical Initiatives Nurse Role Project
An additional print of the CIN resource booklets (with no changes) has been completed
and copies can be ordered from the Better Health Centre.
Resources are also available on line at:
http://www.health.nsw.gov.au/performance/emergency.asp
Lea Kirkwood
A preliminary evaluation was undertaken results are attached.
Ultrasound Training
All program resources now operational (credentialing and pre-course e-learning).
Currently developing regional “hubs” for sustainability of project beyond MTEC funding
Sarah Hoy
ED Communication-(IPSE)
Each hospital has had 5 site visits (50 in total), early Patient Experience Tracker data
indicates a 5.9% improvement across the aggregates scores of four questions related to
`patient care and communication. The four questions are: knowing the name of the
person caring for them, patients knowing the next step in their care, staff providing pain
relief and staff placing items such as call bells and water near by. Overall Care has
improved by 4%
Lee Holmes
Comments on Leader Rounding
The single most important thing I do (General Manager)
Seeing Executives in the Unit shows commitment and we can escalate issues
as appropriate (Registered Nurse)
More cohesive team working across the Department (Consultant)
Comments on Patient Rounding
Complaints are zero (General Manager)
The patients like being asked (Nurse Unit Manager)
Patients feel valued from being asked (Nurse Unit Manager)
Preliminary meetings with Phase 2 hospital teams have been completed. Phase 2
commenced 1st August 2011.
MINISTERIAL TASKFORCE ON EMERGENCY CARE PROJECT UPDATE December 2nd, 2011
PROJECT NAME
PROGRESS
RESPONSIBILITY
Lifepack 15 Level 1-2 EDs
Installing ECG capable defibrillators in rural Level 1 and 2 Emergency Depts
James Dunne
HSPIB has procured 12 lead transmission capable ECG machines for the selected level
1 and 2 rural emergency departments. ASNSW has commenced training paramedics in
NSW on 12 lead ECG acquisition, transmission and thrombolysis administration. This
training will also be offered to doctors and nurses in the selected level 1 and 2
emergency departments.
Status: more than 30 ECG capable defibrillators have been distributed to Level 1 and 2
ED’s
Establishment of Rural ECG Reading Services
Rural ECG reading services are being established to receive ECGs directly from
Paramedics in the field and from doctors and nurses at selected rural emergency
departments.
Status: Several issues have been identified and are being addressed.
The State-wide Cardiology Redesign Steering Committee is currently working with rural
LHD’s to establish these services:





Establishment of robust governance structures to drive the change
Develop of an implementation checklist and toolkit to assist rural LHD’s
Establishment of local working groups to develop reading services
Small working party formed to build on lessons from successful Hunter pilot
Providing an educational forum for nominated LHD staff to address issues
related to establishing the services
Workforce Analysis Tool
81 ED WAT workshops have been completed (87 were initially scheduled) – visits have
now ceased.
The draft reports from the final workshops are being sent to facilities for validation.
The data base build is progressing well and user testing is scheduled for December.
LHD reports are being prepared for the CEs.
A final state report with key findings will be published in 2012.
An external evaluation is proposed for 2012.
Lea Kirkwood
ED Nursing Education Funds
Funding distributed. Project complete
Sarah Hoy
ED Registrar Training
Funding distributed. Project complete
Sarah Hoy
MINISTERIAL TASKFORCE ON EMERGENCY CARE PROJECT UPDATE December 2nd, 2011
PROJECT NAME
PROGRESS
RESPONSIBILITY
Nurse Practitioner Development
Pathways
MTEC have facilitated the formation of a working group to progress this issue. ENP
Survey of MTEC member’s completed, final meeting of Workgroup on March 31st.
Analysis of issues completed with final presentation to MTEC at the May meeting.
NAMO
Advanced Care Planning
Funding for advance care planning project officers ceased 30th June 2010. Health
Services Performance Improvement Branch is providing advice and leadership in
advance care planning with local health networks continuing education, training and
policy implementation within local resources.
Annette Marley

43 NSW Health staff has completed the advance care planning train-the-trainer
program to provide ongoing local education and training. In 2009/10, 4301 members
of the public, NSW Health, Residential Aged Care Facility and General Practice staff
received advance care planning training. A suite of NSW Health advance care
planning resources have been released, including a Model of Care, information
brochures, train-the-trainer package and an educational DVD for advance care
planning in advanced dementia.
 NSW Health Advance Care Planning website for consumers has been updated at
www.health.nsw.gov.au/patient_care/planning. This site provides information and a
link to tools for members of the public to plan ahead.
 The Advance Care Planning website for health professionals has been updated on
Australian Resource Centre for Healthcare Innovations (ARCHI) at
http://www.archi.net.au/e-library/moc/community-moc/acp . The site contains
information, evidence and tools for health professionals to facilitate advance care
planning.
 The Research, Ethics and Public Health Training Branch are responsible for
developing an End of Life Strategic Framework and Implementation Plan. The
Branch has sought initial comments and proposes a more extensive consultation
process with internal and external stakeholders including EDs.
Project funded for further 12 months to July 2012
ED Aged Care assistants
Sarah Hoy
Emergency care for patients living in
aged care facilities
Project funded for further 12 months to July 2012
See & Treat Paediatric Model of Care
Wyong
Partial funding of project for further 12 months
Multidisciplinary Emergency Skills
Training
ED Waiting Room Redesign
Project completed
Sarah Hoy
Electronic kiosk being trialled at POW ED
Sarah Hoy
Sarah Hoy
Sarah Hoy
MINISTERIAL TASKFORCE ON EMERGENCY CARE PROJECT UPDATE December 2nd, 2011
PROJECT NAME
PROGRESS
Emergency Monitoring Measures:
Review of ED KPI’s
Part One
Agreed measures for Reporting April 2011:
ED Length of Stay for: admitted (Hospital and Short stay units) and non- admitted
patients
Did Not Waits
Unplanned Representations to ED within 48hrs
Hospital length of stay for top ED admitted DRGs reporting awaiting further data from
DPE
Emergency Quality and Safety
Measures:
Part Two
Emergency Department, Quality and safety measures project scoping document
completed. Agreed measures were:
Time to Pain relief-review links with medication Management Systems.
Time to ECG-review capturing at source with Link to AAG Cerner
Project officer to be recruited
Project initiation to be commence when resources available
Planned commencement March 2011
Project plan drafted.
Project on Hold pending NSW Health Ministry Governance Review
HSPIB, Daniel Comerford
Patient Flow Portal Implementation
Patient Flow Portal, Release 1 undertaken on 8th June 2011, 200 hospitals are now live
on the Portal. Continuing development of the Patient Flow Portal with the build of the
Capacity and Demand Prediction Tool, planned release in April May 2012.
Implementation planning commencing now, training program will be provided to LHD’s.
Further opportunities to develop the Portal flowing detailed feedback from across the
health system.
HSPIB, Daniel Comerford
RESPONSIBILITY
Daniel Comerford
Highlighted Projects are completed