0
PENINSULA HEALTH
CHEST PAIN STREAMING
Paul Ormrod
Manager Emergency Redesign
Nurse Manager Emergency Short Stay Unit
Frank...
PENINSULA HEALTH
Peninsula Health is the major health care provider
serving the metropolitan and rural areas on Victoria’s...
PENINSULA HEALTH
PENINSULA HEALTH
• The region’s population is over 300,000 people
• Seasonal influx of visitors of 100,000. The
• Populati...
PENINSULA HEALTH
Frankston Hospital is the major provider of acute secondary
and tertiary hospital services on the Morning...
PENINSULA HEALTH
Consistent with the population increase demand on
acute services has also increased over recent years. Th...
PENINSULA HEALTH
There has been significant growth in ED
presentations to an expected 60,000 this year
PENINSULA HEALTH
0
5,000
10,000
15,000
20,000
25,000
FY 08/09 FY 09/10 FY 10/11 FY 11/12 FY 12/13
Ambulance Victoria Prese...
PENINSULA HEALTH
• Length of Stay an Issue across the Board
• Looked at high volume presentations
• Chest Pain identified ...
PENINSULA HEALTH
WHAT WE FOUND
6 Months of data from 2011 showed 1,320 patients presented
with and average LOS for this co...
PENINSULA HEALTH
How could this group be better managed?
• Identify low risk patients early in presentation
• Manage their...
PENINSULA HEALTH
OLD PATHWAY FOR THIS GROUP
PENINSULA HEALTH
NEW PATHWAY FOR THIS GROUP
On arrival
moves to
assessment
cubicle
Registration
Moves to
acute
cubicle
Mov...
PENINSULA HEALTH
Objective of the new
pathway was to identify low
risk chest pain patients and
stream their care early to ...
PENINSULA HEALTH
On arrival
moves to
assessment cubicle
SO HOW DID THIS WORK?
• Key was early assessment
• Hx
• ECG
• Earl...
PENINSULA HEALTH
DID CHANGE ANYTHING?
WE GOT BUSIER & % OF CHEST PAIN PRESENTATIONS INCREASED
PENINSULA HEALTH
50
150
250
350
0
200
400
600
800
Apr
'12
May
'12
Jun
'12
Jul
'12
Aug
'12
Sep
'12
Oct
'12
Nov
'12
Dec '12 ...
PENINSULA HEALTH
In the previous 12 months April 2012 to April 2013
• 224 patients were streamed directly to EDS
• A furth...
PENINSULA HEALTH
3
4
5
6
7
8
Apr
'12
May
'12
Jun
'12
Jul
'12
Aug
'12
Sep
'12
Oct
'12
Nov
'12
Dec
'12
Jan
'13
Feb
'13
Mar
'...
PENINSULA HEALTH
DID WE IDENTIFY PATIENTS APPROPRIATELY?
We expected that less than 5% target of this cohorts of patients ...
PENINSULA HEALTH
CHALLENGES
1. Assessment Area (3 cubicles)
The area to be dedicated as an assessment area contained
monit...
PENINSULA HEALTH
STRATEGIES IMPLEMENTED
1. Removed equipment
2. Senior medical staff to undertake this role
3. SOP
4. EDS ...
PENINSULA HEALTH
WHERE TO NEXT?
1. Increase in ED Short Stay Beds (15 as June 2013)
2. Working with Mental Health to strea...
PENINSULA HEALTH
QUESTIONS?
pormrod@phcn.vic.gov.au
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Chest Pain Streaming: Can This Strategy Improve Patient Flow In The ED?

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Paul Ormrod, Manager, from the Emergency Department Redesign, Frankston Hospital - Peninsula Health, VIC, delivered this presentation at the 5th annual Emergency Department Management conference. For more information on the annual conference, please visit:
www.healthcareconferences.com.au/edmanagementconference

Published in: Health & Medicine
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Transcript of "Chest Pain Streaming: Can This Strategy Improve Patient Flow In The ED?"

  1. 1. PENINSULA HEALTH CHEST PAIN STREAMING Paul Ormrod Manager Emergency Redesign Nurse Manager Emergency Short Stay Unit Frankston Hospital Peninsula Health
  2. 2. PENINSULA HEALTH Peninsula Health is the major health care provider serving the metropolitan and rural areas on Victoria’s Mornington Peninsula. With close to 800 beds Peninsula Health provides a wide range of services from obstetrics to aged care, rehabilitation, emergency and intensive care, oncology, psychiatric services and Hospital in the Home (HITH).
  3. 3. PENINSULA HEALTH
  4. 4. PENINSULA HEALTH • The region’s population is over 300,000 people • Seasonal influx of visitors of 100,000. The • Population is growing at a faster rate than most other regions • Predicted growth rate 5.3% higher than Melbourne • New freeway expected to increase growth rate even further DEMOGRAPHICS OF DEMAND
  5. 5. PENINSULA HEALTH Frankston Hospital is the major provider of acute secondary and tertiary hospital services on the Mornington Peninsula. With 336 beds, it provides general and specialty medical and surgical services, mental health, maternity, and paediatric services. Construction of an additional 90 beds and new Emergency Department is underway with completion scheduled for 2014 FRANKSTON HOSPITAL
  6. 6. PENINSULA HEALTH Consistent with the population increase demand on acute services has also increased over recent years. This has particularly impacted on the Emergency Department (ED) at Frankston Hospital. FRANKSTON HOSPITAL DEMAND
  7. 7. PENINSULA HEALTH There has been significant growth in ED presentations to an expected 60,000 this year
  8. 8. PENINSULA HEALTH 0 5,000 10,000 15,000 20,000 25,000 FY 08/09 FY 09/10 FY 10/11 FY 11/12 FY 12/13 Ambulance Victoria Presentations 2008-2009 to 2012-2013 DANDENONG HOSPITAL FRANKSTON HOSPITAL MONASH MEDICAL CENTRE CLAYTON CASEY HOSPITAL Frankston Hospital Emergency Department receives more patients via Ambulance Service Victoria than any other hospital in the state
  9. 9. PENINSULA HEALTH • Length of Stay an Issue across the Board • Looked at high volume presentations • Chest Pain identified as potential presentation suitable for streaming of care National Emergency Access Targets (NEAT)
  10. 10. PENINSULA HEALTH WHAT WE FOUND 6 Months of data from 2011 showed 1,320 patients presented with and average LOS for this cohort to be 6hrs and 55 min 80% of these patients were discharged home Working group established to look at options for this group (Naomi Winter RN, Sreyus Sreedhar RN, Kishan Ajjampur ED Registrar, Helen Hewitt ED Director)
  11. 11. PENINSULA HEALTH How could this group be better managed? • Identify low risk patients early in presentation • Manage their stay outside the ED • Develop new pathway for this group • Decrease waits
  12. 12. PENINSULA HEALTH OLD PATHWAY FOR THIS GROUP
  13. 13. PENINSULA HEALTH NEW PATHWAY FOR THIS GROUP On arrival moves to assessment cubicle Registration Moves to acute cubicle Moves to ESSU 95% Home Admit or Home
  14. 14. PENINSULA HEALTH Objective of the new pathway was to identify low risk chest pain patients and stream their care early to a short stay unit managed by the ED
  15. 15. PENINSULA HEALTH On arrival moves to assessment cubicle SO HOW DID THIS WORK? • Key was early assessment • Hx • ECG • Early Decision ACHIEVED BY • Dedicated Dr & Nurse (Cat 2) • Called by Triage • See, Assess, Send
  16. 16. PENINSULA HEALTH DID CHANGE ANYTHING? WE GOT BUSIER & % OF CHEST PAIN PRESENTATIONS INCREASED
  17. 17. PENINSULA HEALTH 50 150 250 350 0 200 400 600 800 Apr '12 May '12 Jun '12 Jul '12 Aug '12 Sep '12 Oct '12 Nov '12 Dec '12 Jan '13 Feb '13 Mar '13 No.ofpatient-Allpatients No. of admissions to EDS All transfers to EDS All transfers to EDS - previous year Target population Target population - previous year Potential patients No.ofpatients-Targetpopulation 90% - 100% occupancy 9 beds 90% - 100% occupancy 8 beds - previous year 41% increasein the number of patients in the target population being admitted to EDS SO WHAT DID WE ACHIEVE?
  18. 18. PENINSULA HEALTH In the previous 12 months April 2012 to April 2013 • 224 patients were streamed directly to EDS • A further 1,408 went to EDS via an acute ED cubicle • A further 377 patients presenting with chest pain were discharged home from the ED
  19. 19. PENINSULA HEALTH 3 4 5 6 7 8 Apr '12 May '12 Jun '12 Jul '12 Aug '12 Sep '12 Oct '12 Nov '12 Dec '12 Jan '13 Feb '13 Mar '13 Hours Average Length of Stay All patients All patients - previous year Target population Target population - previous year 4hr Target * Target population: Patients presenting with Cat 2&3 chest pain receiving care form emergency physicians SO DID ANYTHING IMPROVE? LOS FOR CHEST PAIN GROUP DECREASED
  20. 20. PENINSULA HEALTH DID WE IDENTIFY PATIENTS APPROPRIATELY? We expected that less than 5% target of this cohorts of patients would require admission to an inpatient bed. To date this rate remains below 5%
  21. 21. PENINSULA HEALTH CHALLENGES 1. Assessment Area (3 cubicles) The area to be dedicated as an assessment area contained monitoring equipment. 2. Performing quick assessment Change of practice to undertake quick assessment and decision making 3. Standardising work practices Different staff working in different ways 4. Access to EDS beds EDS bed not available 5. Access block to inpatients No beds for patients requiring an inpatient bed
  22. 22. PENINSULA HEALTH STRATEGIES IMPLEMENTED 1. Removed equipment 2. Senior medical staff to undertake this role 3. SOP 4. EDS admission criteria & beds controlled by ED 5. Still working on them
  23. 23. PENINSULA HEALTH WHERE TO NEXT? 1. Increase in ED Short Stay Beds (15 as June 2013) 2. Working with Mental Health to stream to EDS 3. Identify other presenting groups for streaming 4. A new ED and Short Stay Unit
  24. 24. PENINSULA HEALTH QUESTIONS? pormrod@phcn.vic.gov.au
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