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Julie Oliver, Carmel Larkin and Lisa McBurnie - Caloundra Emergency Dept - Improving Patient Flow & NEAT Compliance
Julie Oliver, Carmel Larkin and Lisa McBurnie - Caloundra Emergency Dept - Improving Patient Flow & NEAT Compliance
Julie Oliver, Carmel Larkin and Lisa McBurnie - Caloundra Emergency Dept - Improving Patient Flow & NEAT Compliance
Julie Oliver, Carmel Larkin and Lisa McBurnie - Caloundra Emergency Dept - Improving Patient Flow & NEAT Compliance
Julie Oliver, Carmel Larkin and Lisa McBurnie - Caloundra Emergency Dept - Improving Patient Flow & NEAT Compliance
Julie Oliver, Carmel Larkin and Lisa McBurnie - Caloundra Emergency Dept - Improving Patient Flow & NEAT Compliance
Julie Oliver, Carmel Larkin and Lisa McBurnie - Caloundra Emergency Dept - Improving Patient Flow & NEAT Compliance
Julie Oliver, Carmel Larkin and Lisa McBurnie - Caloundra Emergency Dept - Improving Patient Flow & NEAT Compliance
Julie Oliver, Carmel Larkin and Lisa McBurnie - Caloundra Emergency Dept - Improving Patient Flow & NEAT Compliance
Julie Oliver, Carmel Larkin and Lisa McBurnie - Caloundra Emergency Dept - Improving Patient Flow & NEAT Compliance
Julie Oliver, Carmel Larkin and Lisa McBurnie - Caloundra Emergency Dept - Improving Patient Flow & NEAT Compliance
Julie Oliver, Carmel Larkin and Lisa McBurnie - Caloundra Emergency Dept - Improving Patient Flow & NEAT Compliance
Julie Oliver, Carmel Larkin and Lisa McBurnie - Caloundra Emergency Dept - Improving Patient Flow & NEAT Compliance
Julie Oliver, Carmel Larkin and Lisa McBurnie - Caloundra Emergency Dept - Improving Patient Flow & NEAT Compliance
Julie Oliver, Carmel Larkin and Lisa McBurnie - Caloundra Emergency Dept - Improving Patient Flow & NEAT Compliance
Julie Oliver, Carmel Larkin and Lisa McBurnie - Caloundra Emergency Dept - Improving Patient Flow & NEAT Compliance
Julie Oliver, Carmel Larkin and Lisa McBurnie - Caloundra Emergency Dept - Improving Patient Flow & NEAT Compliance
Julie Oliver, Carmel Larkin and Lisa McBurnie - Caloundra Emergency Dept - Improving Patient Flow & NEAT Compliance
Julie Oliver, Carmel Larkin and Lisa McBurnie - Caloundra Emergency Dept - Improving Patient Flow & NEAT Compliance
Julie Oliver, Carmel Larkin and Lisa McBurnie - Caloundra Emergency Dept - Improving Patient Flow & NEAT Compliance
Julie Oliver, Carmel Larkin and Lisa McBurnie - Caloundra Emergency Dept - Improving Patient Flow & NEAT Compliance
Julie Oliver, Carmel Larkin and Lisa McBurnie - Caloundra Emergency Dept - Improving Patient Flow & NEAT Compliance
Julie Oliver, Carmel Larkin and Lisa McBurnie - Caloundra Emergency Dept - Improving Patient Flow & NEAT Compliance
Julie Oliver, Carmel Larkin and Lisa McBurnie - Caloundra Emergency Dept - Improving Patient Flow & NEAT Compliance
Julie Oliver, Carmel Larkin and Lisa McBurnie - Caloundra Emergency Dept - Improving Patient Flow & NEAT Compliance
Julie Oliver, Carmel Larkin and Lisa McBurnie - Caloundra Emergency Dept - Improving Patient Flow & NEAT Compliance
Julie Oliver, Carmel Larkin and Lisa McBurnie - Caloundra Emergency Dept - Improving Patient Flow & NEAT Compliance
Julie Oliver, Carmel Larkin and Lisa McBurnie - Caloundra Emergency Dept - Improving Patient Flow & NEAT Compliance
Julie Oliver, Carmel Larkin and Lisa McBurnie - Caloundra Emergency Dept - Improving Patient Flow & NEAT Compliance
Julie Oliver, Carmel Larkin and Lisa McBurnie - Caloundra Emergency Dept - Improving Patient Flow & NEAT Compliance
Julie Oliver, Carmel Larkin and Lisa McBurnie - Caloundra Emergency Dept - Improving Patient Flow & NEAT Compliance
Julie Oliver, Carmel Larkin and Lisa McBurnie - Caloundra Emergency Dept - Improving Patient Flow & NEAT Compliance
Julie Oliver, Carmel Larkin and Lisa McBurnie - Caloundra Emergency Dept - Improving Patient Flow & NEAT Compliance
Julie Oliver, Carmel Larkin and Lisa McBurnie - Caloundra Emergency Dept - Improving Patient Flow & NEAT Compliance
Julie Oliver, Carmel Larkin and Lisa McBurnie - Caloundra Emergency Dept - Improving Patient Flow & NEAT Compliance
Julie Oliver, Carmel Larkin and Lisa McBurnie - Caloundra Emergency Dept - Improving Patient Flow & NEAT Compliance
Julie Oliver, Carmel Larkin and Lisa McBurnie - Caloundra Emergency Dept - Improving Patient Flow & NEAT Compliance
Julie Oliver, Carmel Larkin and Lisa McBurnie - Caloundra Emergency Dept - Improving Patient Flow & NEAT Compliance
Julie Oliver, Carmel Larkin and Lisa McBurnie - Caloundra Emergency Dept - Improving Patient Flow & NEAT Compliance
Julie Oliver, Carmel Larkin and Lisa McBurnie - Caloundra Emergency Dept - Improving Patient Flow & NEAT Compliance
Julie Oliver, Carmel Larkin and Lisa McBurnie - Caloundra Emergency Dept - Improving Patient Flow & NEAT Compliance
Julie Oliver, Carmel Larkin and Lisa McBurnie - Caloundra Emergency Dept - Improving Patient Flow & NEAT Compliance
Julie Oliver, Carmel Larkin and Lisa McBurnie - Caloundra Emergency Dept - Improving Patient Flow & NEAT Compliance
Julie Oliver, Carmel Larkin and Lisa McBurnie - Caloundra Emergency Dept - Improving Patient Flow & NEAT Compliance
Julie Oliver, Carmel Larkin and Lisa McBurnie - Caloundra Emergency Dept - Improving Patient Flow & NEAT Compliance
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Julie Oliver, Carmel Larkin and Lisa McBurnie - Caloundra Emergency Dept - Improving Patient Flow & NEAT Compliance

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Julie Oliver, Carmel Larkin and Lisa McBurnie delivered the presentation at the 2014 Emergency Department Management Conference. …

Julie Oliver, Carmel Larkin and Lisa McBurnie delivered the presentation at the 2014 Emergency Department Management Conference.

The 2014 Emergency Department Management Conference explored areas such as how to improve access to care, clinical redesign, NEAT compliance, patient flow, point of care testing, geriatric care, and enhance the performance of Emergency Department.

For more information about the event, please visit: http://bit.ly/edmanagement14

Published in: Health & Medicine
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  • 1. Caloundra Emergency Department Redevelopment and NEAT Presented by Julie Oliver, Carmel Larkin and Lisa McBurnie SCHHS Caloundra Emergency Department 2014
  • 2. Clinical Nurse Group • Carmel Larkin Chris Murray • Lisa McBurnie Elizabeth Brown • Julie Keane Jackie Shapland • Zane Lay Kim Rylatt • Donna Powell Alana Williams • Rachelle Ryan Joanna Sparks • Lynette Howell Tracey Coulton
  • 3. Sunshine Coast • Sunshine Coast Hospital and Health Service (SCHHS) is located in south east Queensland and extends through the coastal and hinterland areas from Caloundra in the south to Gympie in the north.
  • 4. • 2013: Estimated residential population - 316 858 (source: ABS census, 2011) • Projected population of 516 250 by 2031- 62.9% increase (source ABS, census. 2011) •16% of Sunshine Coast population is over 65 years, compared with 14% Australia wide (source: ABS census. 2011) • South and West Caloundra is Sunshine Coasts largest growth area Sunshine Coast
  • 5. • Size – 6 acute bays, 2 Resus, 2 Consultation rooms, 8 Short Stay • Presentations 24 894 • Capability: no Surgical, HDU/ICU, Paediatric, Oncology or Acute Medical Services. • No Pathology or CT onsite. • 24 bed sub-acute medical ward. • Inter-hospital transfer rate 12% 2011: Caloundra Emergency
  • 6. • >16000 people going to Brisbane each year • Unable to offer burns, spinal, major trauma, neurosurgery, neurovascular, interventional cardiology, radiation oncology • Bed block, ramping, extreme capacity • Consumer push for new hospital 2011: SCCHS Consumer demand
  • 7. • Size 750 bed by 2021 • Emergency Department - 87 bays comprising 5 Resus, 42 acute and sub-acute bays, 20 SSU, 8 paed, 12 Fast track 2016: Sunshine Coast University Public Hospital
  • 8.
  • 9. • Predicted presentations by 2016: 31000 • Caloundra DEM growth rates were predicted at 5% • 2011- 2012: 25,000 - 4% • 2012 – 2013: 26,500 - 6% • 2013 -2014: 30,000-14% - build it and they will come The interim
  • 10. • Redevelop Caloundra Emergency • Size- 29 bays- 12 Acute Bays, 2 Resus, 7 Fast Track and the existing 8 SSU • No increase in CHS facility- still 24 sub acute medical beds The short term plan
  • 11. Now what • Expectation that KPI’s would be meet during redevelopment – business as usual • Neat became a reality during redevelopment • Expectation that new models of care would be explored • What happens to Caloundra ED post 2016?
  • 12. Carmel Larkin Models of care: Introduction of NEAT nurse
  • 13. What we were used to • Two point triage (separate doors) • Triage nurse: walk in • Team Leader: QAS • Short Stay Unit (half commissioned) • Allocated bays per RN • Resuscitation Nurse (resus bay just off acute bays) • Float nurse
  • 14. Planning: How to function during development • Shut Queensland Ambulance door • Lost our “ramp” • Visitor access • Keep patient flow moving safely
  • 15. Post redevelopment geography • One point triage • Separated resuscitation room • Fast Track area • Acute bays with higher acuity • Short Stay Unit
  • 16. Opportunity to review our nursing models • Multiple sessions with staff • Clinical Nurse planning days • Looked at other departments models of care, e.g. Gold Coast • Referenced new department’s map
  • 17. Issues with previous model • Coverage during breaks • Workloads variable between bays • Patients allocated depending on RN skill • Team Leader being caught up Triaging • Some unallocated areas: consult rooms • “Overflow” patient’s being allocated to resus – resus bay off acute bays • Effectiveness of Float Nurse
  • 18. First thing: review float nurse • No clear role definition or skill set for float nurse • Person dependant • Impacted by team nursing model • Shift time 0930 - 1800 and 1800 – 0230 • Staff confused of float nurse’s role
  • 19. New role: Neat Nurse • Hours came from float nurse • Role description designed with NEAT in mind • Some other districts introducing →WA (navigator) • Trial commenced January 2013
  • 20. Job Description NEAT: key elements Flow out: • Q –Health / Private • EDIS completion • CN level • Assist with packaging, final once over • Change hours to cover busiest transfer time 0600- 2200
  • 21. Challenges • Team leader / NEAT cross over • Lack of understanding of role • Clinical Role vs non clinical role • Double communication: especially medical
  • 22. Challenges • Backfill sick leave or not backfilled • Two tired system to orientate to team leader • CN role, depleted CN pool availability for clinical shifts
  • 23. Where are we today? • NEAT role is still in existence • CN / senior level one model, succession planning • Medical and nursing understanding role • Team leader now has now clinical overview / resource into patients
  • 24. Lisa McBurnie Introduction of Endorsed Enrolled Nurses (EEN)
  • 25. Redevelopment and Geography created change •The Short Stay Unit (SSU) during the redevelopment became quite separated from ED. •8 bed 24/7 SSU Introduction of ENs to ED
  • 26. Redevelopment and Geography created change •We needed a cost effective model of care and sustainable workforce while continuing to deliver high quality ED nursing care. •Short Stay Unit: RN/EN model Introduction of ENs to ED
  • 27. Idea of ENs in ED is Born…Now What? • Bring on board the Practice Development Team • Develop understanding of EN scope of practice Introduction of ENs to ED
  • 28. Idea of ENs in ED is Born…Now What? • 3 months of in-services/education and discussions with ED staff • Development of EN Professional Development Framework Introduction of ENs to ED
  • 29. EN P.D.F. ??insert Framework Introduction of ENs to ED
  • 30. Introduction of ENs to ED Interview & Employment • 5 permanent ENs with varying experience – none had ED backgrounds
  • 31. Introduction of ENs to ED EN Education Framework • In conjunction with the Practice Development Team courses, workshops and packages needed to be agreed on…
  • 32. Introduction of ENs to ED EN Education Framework • What did we agree on to be most beneficial? • Deteriorating Patient Workshop • Respiratory Assessment Workshop • Intravenous Cannulation package
  • 33. Introduction of ENs to ED Facilitation ENs into SSU • Clinical Nurse (CN) of SSU & EN facilitator • Patient assessment and documentation
  • 34. Introduction of ENs to ED Facilitation ENs into SSU • Scenario Day –Clinical Bedside Handover, Rounding, RED Flags…
  • 35. EN Extended Scope of Practice • 6 weeks in the Acute bays area with Clinical Coach • Practice Development Team – development of IV medication/antibiotic package Introduction of ENs to ED
  • 36. Assessment & Review of Program 12 months on… • Assessment – Clinical Assessment Tools • Staff survey Introduction of ENs to ED
  • 37. Assessment & Review of Program 12 months on… • Reflective practice • Submited report to Department of Emergency Medicine Council Introduction of ENs to ED
  • 38. Results & Future of ENs in ED • EN dependant – interview selection criteria refinement • Overall a success…cost effective model – (Comparison of EN vs RN: RN = $114,896 EN = $81,114) • sustainable workforce, continued high quality ED nursing care Introduction of ENs to ED
  • 39. Results & Future of ENs in ED • Royal College of Nursing – EN Emergency Nursing Course • Emergency ENAP Introduction of ENs to ED
  • 40. The end • Questions ? Introduction of ENs to ED

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