Best Practice in Emergency Departments &
Intensive Care Settings
Legal, governance and patient care issues: delivering quality healthcare
in a challenging environment:
20-21 February 2012, Rendezvous Hotel, Auckland
Draft Agenda Updated: 12/02/2016 23:28:55
DAY 1: 20 February 2012
8.30
Registration and coffee
9.00
Opening remarks from the Chair
Best practice and challenges when managing acute demand
9.10
Setting the scene: An overview of the current ED and ICU challenges
We start with a discussion about the current issues facing those working in ED and
ICU settings and their patients. With patients presenting with ever more complex
medical conditions, how will these units keep up with the increasing community
demand for healthcare and be responsive rather than reactive.
 Addressing an increasingly ageing, urban and ethnically diverse population
 Expected workforce shortages and unsustainable spending on health
Dr Tim Parke, Clinical Director, Adult Emergency Department, Auckland DHB
9.50
Meeting the targets while maintaining the quality of outcomes in the ED
The Government’s health targets are looking favourable operationally but what have
been the benefits of the 6 hours targets for staff and patients?
 How the different DHBs have been meeting their target
 Have reduced waiting times seen a measurable improvement in quality of care?
 Meeting the targets within existing resources and the effect of seasonal variation
Professor Mike Ardagh, Professor of Emergency Medicine, University of Otago
10.30
Morning tea
10.50
Meeting increasing demand for the ICU
Demographic and health trends are expected to see the demand for ICU treatment
double over the next 20 years. With an already stretched workforce and resources,
how is anticipated future growth in demand going to be managed and what are the
other pressures on intensive care departments?
 Clinical governance in the ICU
 The increase in demands from surgery
 Pressure to move people out of ICU before they are ready
Dr Janet Liang, Clinical Director, Intensive Care Unit, Waitemata DHB
11.30
Access block and its effect on the ED targets and the ICU
This session examines access block and the effect a lack of beds is having on the
ability of hospitals to meet the ‘Shorter Stays in ED’ target and length of stay in the
ICU. We ask what effect treatment delay is having on patients requiring critical care.
Dr Peter Jones, Director of Emergency Research, Auckland DHB
12.10
Helping families make the best decision
In this session we look at how health professionals can help families overcome some
of the difficulties associated with making critical decisions about loved ones which
can be stressful for both families and staff.
 Breaking bad news and who should be delivering it
 Managing the family dynamic
 Communicating the options and their consequences
 The cultural issues to be considered in end of life decisions
Karlin Austin, Practice Supervisor, Adult Social Work Trauma Team, Emergency
Care, Auckland DHB
12.50
Lunch
1.40
Hospitals after hours: Improving ED and ICU outcomes
Research has shown that patient outcomes are worse for those presenting at night
times and during the weekend. We examine how Canterbury DHB has improved
patient handover and patient care at times when there less staff are available.
John Crozier and Jane Goodwin, Clinical Team Coordinators, Christchurch
Hospital
2.20
Case Study: Why patient flow is not just about the ED and ICU
Having spent many billions round the world on expanding ED and ICU capacity, the
smartest money in healthcare is now being spent at the back door and before the
front door of hospitals. This session will look at why this makes such a difference, and
how Canterbury’s whole-system approach of the ‘Improving the Patient Journey’, the
Canterbury Initiative and other related programmes have yielded dividends in patient
flow, clinician engagement and systems thinking at all levels in the DHB.
Brian Dolan, Director of Service Improvement, Canterbury DHB
3.00
Afternoon tea
3.15
Case Study: Examining the primary care and ED interface and the need for
more accessible primary care
This session will examine the reasons why more patients are presenting at the ED at
Middlemore Hospital and how three Auckland DHBs are attempting to make
attendance at A&M clinics easier for the more vulnerable groups in society.
 Cost, convenience and access: the blocks to primary care
 The further plans by primary care to lower the barriers to primary care
experienced by some patients
 Is a 15-minute consultation suitable for all patients?
Dr Vanessa Thornton, Clinical Head, Emergency Care, Counties Manukau DHB
Dr Ian Scott, Chair, Afterhours Alliance Taskforce; Chair, Auckland PHO
4.05
Panel Discussion: Is primary care coming to the ED?
We look at the bundle of care now expected to be provided in ED, alongside the care
required for the immediate reasons for attendance. Is this adding to the workload of
the ED and making the targets harder to achieve?
 The extra resources required for extra screening
 The expected effect of integrated family health centres on the bundle of care
Dr Vanessa Thornton, Clinical Head, Emergency Care, Counties Manukau DHB
Dr Ian Scott, Chair, Afterhours Alliance Taskforce; Chair, Auckland PHO
Alex Boersma, Service Manager, Emergency Care, Counties Manukau DHB
5.00
End of day one & networking drinks
DAY 2: 21 February 2012
9.00
Welcome back from the Chair
Dr Ross Freebairn, Vice President, College of Intensive Care
Workforce planning
9.05
Dealing with the shortage of ICU specialists in New Zealand
New Zealand and Australia have a unique system with a primary lead specialist
responsible for patient care in the ICU. This session examines how the system
developed and what is being done to address the shortage of intensive care staff.
 The historical reasons for the shortage of intensivists
 Would NZ be better adapting the model used in other regions
 Addressing competency issues and a shrinking workforce
 The impact of less specialised and/or unregulated staff working in the traditionally
closed environment of the ICU
Dr Ross Freebairn, Medical Director Intensive Care Services, Clinical Director,
Acute Services, Hawke's Bay Hospital
9.50
Case Study: Getting the staffing mix right in the ED and ICU: Best practice
This presentation will cover processes and tools developed to assist the Bay of Plenty
ED better match their demand and capacity. By using intelligent information in the
form of capacity and demand indicators they can better match staffing to patients in
the moment and over time.
 An agreed set of indicators for variance
 Triggers for action at ED and operations level
 Standard Operating Responses with accountabilities for action
 A multi-disciplinary approach
Rhonda McKelvie, CCDM Programme Consultant, Bay of Plenty DHB
10.30
Morning tea
10.50
Expanding the role of nurse practitioners
The nurse practitioner and nurse specialist workforce is growing with nurses being
given more autonomy in the ICU and ED. What opportunities are available to nurse
practitioners in acute care and what more can be done to increase these?
 What are the gaps in the service nurse practitioners are aiming to fill?
 Developing a independent and autonomous role
 Autonomous practice and clinical error
Michael Geraghty, Nurse Practitioner, Adult Emergency Care, Auckland DHB
Adverse events
11.35
Learning from adverse events - managing information safely
Mistakes are an opportunity to learn but how can this be achieved safely? Concerns
about patient privacy and staff vulnerability are barriers to the review of adverse
events. This session will consider how to manage information collected in quality
improvement processes. When can and must information about an adverse incident
be disclosed and how can it be managed in a way that facilitates review while
minimising the risk of inappropriate or unforeseen disclosure?
 Engaging staff in review processes
 Interviewing staff
 Protected Quality Assurance Activities
 Disclosure to patients and families
 Disseminating learnings to staff
 Providing feedback to third party providers such as GP or ambulance staff
 Use of information in other legal processes such as HDC or Coroners Court
 Media requests
Peter Le Cren, Legal Counsel, Auckland DHB
12.15
Lunch
1.05
Treatment for mental health patients in acute care settings
We examine the options available when dealing with patients with mental health and
addiction issues. With the intense environment of the ICU and ED being an area of
focus for immediate health concerns, what effect is the wait for admittance elsewhere
having on staff and the patients?
 Options available when dealing with mental health patients
 Are the new health targets improving access for mental health patients?
 Understanding the Mental Health (Compulsory Assessment and Treatment)
Amendment Act
Representatives from Department of Liaison Psychiatry, Auckland DHB
Legal challenges
1.50
When to say when: Managing patients' demands for treatment, withdrawal of
treatment, and dealing with difficult patients
All patients are entitled to care and treatment that meets their clinical needs, but there
are times when the risks of medical intervention outweigh the benefits. Depending on
the patient's level of capacity, difficult decisions regarding provision of treatment can
be overlaid by ethical and legal considerations in relation to consent. What are the
legal implications for withdrawing treatment, with and without patient consent? What
legal issues arise when patients demand, refuse to accept, or place conditions on,
treatment?
 Demands for treatment by competent patients
 End of life decisions for the young
 Treatment vs care
Penny Andrews, Senior Associate, Buddle Findlay;
Catherine Miller, Senior Solicitor, Buddle Findlay
2.35
Advance directives in the ICU and ED: Supporting the patient’s wishes
Individual autonomy is a key ethical principle that underpins the provision of health
care in New Zealand. Advance directives are an important mechanism by which a
patient can make a choice about possible treatment in the future.
 The legal standing of advance directives
 Establishing the validity of advance directives
 Respecting the patient’s wishes when families and/or clinicians disagree
 Advance refusals vs advance requests for treatment
 Strengthening the right to express wishes about future treatment
Amy de Joux, Senior Solicitor, Buddle Findlay;
Iris Reuvecamp, Senior Associate, Buddle Findlay
3.15
Afternoon tea
3.30
The rights and responsibilities of child patients in critical care situations
There are a number of special concerns when dealing with minors in intensive care
and ED settings, with children lacking the maturity to understand the effects of
treatments. What are the legal obligations that exist to protect minors?
 Patient confidentiality and the information that can be given to parents and
caregivers
 Dealing with separated parents
 The State’s obligation to provide care
Maria Kazmierow, Family law barrister and mediator
4.15
Closing remarks from the Chair and end of conference
Full day Workshop: 22 February 2012
The art of managing patient flow
9.00am – 5pm
Solving the issues of flow in an Emergency Department requires a whole-of-health system
approach. This workshop will provide insight into the tools and concepts that enable a
complex health system to create flow. Participants will have the opportunity to practice these
new skills and will leave the workshop having a better understanding of the key design
elements to redesigning patient flow.
In this all-day workshop you will explore how health can learn about the art of designing
business processes to enable flow from manufacturing and service businesses. Participants
will be asked to redevelop a fictitious pharmaceutical business using techniques and ideas
borrowed from industries such as auto-manufacturing, logistics and telecommunications.
Participants will apply their learning using simulation exercises which replicate a complex
manufacturing environment. The group will explore the impact of these ideas on our health
system, and look at how these ideas can be incorporated into daily health operations.
Key areas of learning will involve:
 Queuing theory (understanding and managing variation in patient demand),
 The importance of single piece flow vs batch processing patients,
 The foundation principles of Lean Thinking and Constraint Theory
 An overview of production planning principles applied to health; and
 The art of managing change in complex systems
Your workshop facilitators
Richard Hamilton, Business Development Manager, Canterbury DHB
Richards’s primary focus for the DHB is process redesign built around value streams,
implementing the use of production planning methods in conjunction with Lean Thinking
management principles.
Richard has over 20 years’ experience in production planning and management for logistics
and service industries. Richard has specialised in working with service industries which can’t
cap demand, such as Postal Authorities, Health Services, and Call Centres.
The key focus of Richard’s work is on identifying opportunities to improve process flows, and
focusing on what information and tools frontline staff need to maintain a regular rate of work.
‘Improving the Patient Journey’ is a significant strategic programme focused on delivering
these attributes within the Canterbury District Health Board.
Brian Dolan, Director of Service Improvement, Canterbury DHB; Director, Dolan & Holt
Consultancy Ltd, UK
Brian’s role includes work on the ‘Improving the Patient Journey’ programme incorporating
Collabor8 (lean thinking and leadership course) and the ward-based ‘Making Time for Caring’
projects. In the UK, he works with organisations undertaking leadership development,
improvement in patient flow and systems reform. He did his psychiatric nurse training in
Ireland and his general nurse training at St Mary's Hospital, Paddington and worked in a
number of London A&E departments.
Brian recently ran the ‘Lean thinking and Leadership’ workshops for the Nursing and
Midwifery Office of New South Wales Health, Australia. He has published over 100 papers in
a range of nursing, medical and paramedic journals and is the co-editor of an international
best-selling book on emergency nursing, the third edition of which will be published in 2012.
He is currently writing up a doctoral dissertation at Oxford University into the consultation
skills of emergency nurse practitioners.