Transcript No Slide Title

The Introduction of Teams and Streams
Emergency Department
Royal Hobart Hospital
Introduction
Aim
Emergency Department (ED) overcrowding and
issues related to flow into, through and out of the
ED are not new to EDs. EDs have reached a crisis
point as emergency staff are challenged in caring
for unwell patients in a timely manner. The focus of
ED overcrowding has remained on EDs, and many
departments have implemented a range of
strategies to overcome this. It is well documented
that access block leads to ED overcrowding
resulting an increased in-hospital mortality,
increased inpatient length of stay, delays in
definitive emergency therapy and patient
dissatisfaction.
In 2012 the Royal Hobart Hospital (RHH) ED
introduced a system of Team Based Care and
Streaming of patients into Admission and
Discharge Streams to improve patient outcomes
and patient flow through the ED.
The National Health Reform Agreement – National
Partnership Agreement on Improving Public
Hospital Services was developed to improve public
patient access to EDs and elective surgery by
improving capacity and efficiency in public
hospitals. The National Emergency Access Targets
(NEAT) were introduced with 90% of all patients
presenting to the Emergency Department to be
admitted to hospital or discharged home within 4
hours of their presentation by 2015. The
benchmark targets are to be implemented over the
next four years (see table below).
Average NEAT benchmark targets for Tasmania
1 JAN 2012 TO 31 Dec 2012 (Period 1)
72%
1 JAN 2013 TO 31 Dec 2013 (Period 1)
78%
1 JAN 2014 TO 31 Dec 2014 (Period 1)
84%
1 JAN 2015 TO 31 Dec 2015 (Period 1)
90%
The Introduction of a new model of care
(Teams and Streams) is an ED strategy to
improve the delivery of patient care in a safe
efficient and timely fashion. This assists the ED
to achieve the NEAT.
Patient Presentations
Staff Survey
Over the past 5 years the RHH has seen an
increase in the number of patients presenting
for treatment.
Whilst being able to analyse the effects on
patient flow and waiting times statistically, it is
also important to evaluate the other
components of In order to gain the ED staff
perspective a staff survey was undertaken in
August/September 2012.
Total number of RHH ED patient presentations
The Introduction of a Team and Stream Model
provides consistency in care, early decision
making for disposition with a team-based
approach.
Objectives
1. Improve the coordination and timeliness of
patient care in ED
2. Improve the care planning and coordination
of patients in ED
3. Improve the patient experience and
satisfaction
4. Increase the percentage of patients leaving
the ED in 4 hours
Streaming
The Streaming of patients into likely admission
and likely discharge by the triage nurse has
been found to be a strategy of variable benefit.
Admission and discharge streaming is easily
measured and quality controlled as the
Streaming preference is entered onto the
Emergency Department Information System at
triage.
Time to Patient Treatment
The triage nurse provides a brief clinical
assessment that determines the urgency of
treatment and the time and sequence in
which patients should be seen. The
introduction of Streaming and Teaming has
resulted in an increasing the initiation of
treatment within the recommended time.
Percentage of presentations seen within time, by
triage, by year
Teaming
Team assignment is based on a geographical
areas within the ED. Each Team consists of
medical and nursing staff with a Team Leader
in each Team. This improves communication
and coordination of patient care providing the
patient with a consist approach to their care.
The care of patients presenting to ED is shared
with an ED multi disciplinary team, with a
coordinated approach to the patients physical,
social and psychological issues being
provided.
Next Steps
This has resulted in less patients
leaving the ED before seeing a doctor
It is envisaged over the next 12 months that
the implementation of hospital wide changes
will ultimately enhance the delivery of safe and
efficient patient centered care and further work
to achieve National Emergency Access
Targets.
Acknowledgements
RHH ED staff
Safety and Quality Unit RHH
Geographical ED Map of Streaming and Teaming Areas
for their participation and valuable contribution