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Detailing Strategies For Ambulance / ED Liaison: Reducing Time At This Critical Interface
 

Detailing Strategies For Ambulance / ED Liaison: Reducing Time At This Critical Interface

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Tony Walker, General Manager of Regional Services, Ambulance Victoria, VIC delivered this presentation at the 5th annual Emergency Department Management conference. For more information on the annual ...

Tony Walker, General Manager of Regional Services, Ambulance Victoria, 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

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    Detailing Strategies For Ambulance / ED Liaison: Reducing Time At This Critical Interface Detailing Strategies For Ambulance / ED Liaison: Reducing Time At This Critical Interface Presentation Transcript

    • Reducing time at the Ambulance - ED Interface Assoc Prof Tony Walker ASM FPA General Manager Regional Services
    • Challenges • Marked deterioration in response time performance over the past few years • Continued increased demand growth (approx 6% p.a.) • Increased Hospital Transfer Times (22% since 2007) • Increasing number of low acuity cases (ambulance safety net) • Increased utilisation and reduced resource availability • Significant media and political interest
    • Ambulance Demand Growth
    • Performance 5.2% 4.9% 20.0% 7.1% 5.0% 2.9% 2.9% 1.5% 6.2% -11.7% -15.0% -10.0% -5.0% 0.0% 5.0% 10.0% 15.0% 20.0% 25.0% TotalCaseTime UnitCaseTimeTotal TransferTime ActivationTime TravelTime TransportTime ReflexTime SceneTime ClearingTime TurnoutTime Growth%p.a.
    • Average Transfer and Clearing Times 0 5 10 15 20 25 30 35 40 Jul-07 Sep-07 Nov-07 Jan-08 Mar-08 May-08 Jul-08 Sep-08 Nov-08 Jan-09 Mar-09 May-09 Jul-09 Sep-09 Nov-09 Jan-10 Mar-10 May-10 Jul-10 Sep-10 Nov-10 Jan-11 Mar-11 May-11 Jul-11 Sep-11 Nov-11 Jan-12 Mar-12 May-12 Jul-12 Minutes Avg Transfer Time Avg Clearing Time
    • Performance 72.0 74.0 76.0 78.0 80.0 82.0 84.0 86.0 88.0 90.0 92.0 30.00 35.00 40.00 45.00 50.00 55.00 Jul-07 Sep-07 Nov-07 Jan-08 Mar-08 May-08 Jul-08 Sep-08 Nov-08 Jan-09 Mar-09 May-09 Jul-09 Sep-09 Nov-09 Jan-10 Mar-10 May-10 Jul-10 Sep-10 Nov-10 Jan-11 Mar-11 May-11 Jul-11 Sep-11 Nov-11 Jan-12 Mar-12 May-12 Jul-12 Code1%<=15min Utilisation%
    • Preventing avoidable ED presentations (RefCom) • Provides a more appropriate response to low acuity health-related 000 calls that do not require a traditional ambulance response • Suitable low-acuity 000 calls transferred to the Referral Service for secondary triage via nurses / paramedics using medically approved software. • Triage by Referral Service results in one of four outcomes: • Emergency ambulance dispatch • Non-emergency ambulance dispatch • Referral to an alternative service provider (ASP) • Provision of advice for the patient to self-manage the condition.
    • Preventing avoidable ED presentations (RefCom) • Service level agreements with a number of alternative service providers • Locum GP Services (after hours) • Nursing services • Crisis Assessment and Treatment Services • Hospital In-reach and out-reach services • Strict Key Performance Indicators agreed with each provider • Currently managing 100 cases per day in Melbourne and Barwon South West (10% of metropolitan emergency workload) • Working with Medicare locals to develop register of services • Plan to manage up to 30% of ‘000’ calls and introduce infield paramedic referral
    • Smoothing the flow of ambulance arrivals • Ambulance ‘clumping’ has a significant impact on ambulance patient transfer times and overall ED efficiency. • Smoothing the flow of ambulance arrivals and matching the capacity of health services with the number of arrivals is vital to improving transfer of ambulance patients to EDs. • ‘Arrivals Board’ piloted at 3 metropolitan hospitals with web based system to be rolled out across a number of hospitals later this year to increase visibility of ambulance caseload • Dedicated role within communications centre to manage flow and escalate when issues • Work progressing on decision support tool for paramedics
    • Improving Patient Handover • Timeliness of ambulance patient handover depends on a range of factors, including the number of other ambulance arrivals, ED capacity and patient flow throughout the whole of the health service. • Protocols developed to enable the release of low acuity patients into ED waiting rooms or other appropriate spaces to be treated in turn with walk in patients • Standardised escalation processes for delays in patient handover • Work underway to develop standardised process on arrival at ED