Emergency Department Journey in the new world

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Betty Harris
7 years ago
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1 Emergency Department Journey in the new world Emergency Departments face significant challenges Uneven demand for services Complex environment Extremely high pressure Under resourced Many face new information system introduction Political focus area. All of the above is driving change: New models of care Step change and incremental Move towards a paperless environment. 1 HIC 2011: Digital hospital design workshop Designing the next generation emergency department

2 Emergency Department Journey in the new world This presentation will highlight the journey into the new world to: Define Emergency Department models of care The technologies required to enable change. That will: Improve patient care Reduce waiting time. We will discuss: The patient experience through the current and future journeys of the Emergency Department environment What needs to change What impact does the new world have on the building design. 2 HIC 2011: Digital hospital design workshop Designing the next generation emergency department

We will discuss: The patient experience through the current and future journeys of the Emergency Department environment What needs to

3 What kind of patient experience would you like? As a patient Parent of a child Son/daughter of a parent Partner. 3 HIC 2011: Digital hospital design workshop Designing the next generation emergency department

4 The situation: Patient experience Current state Patient presents with abdominal pain Patient experience Stressed with pain Worried The black hole of uncertainty Anxious, stressed, distaste, fear, uncomfortable, disempowered, unknown Relieved Reception Triage Diagnostic and assessment Case planning and intervention Admission Day ward IP ward Wait or bed OR Home Discharge Medications 5 mins Wait up to 4 hours Wait up to 4 hours Wait up to 2 to 24 hours Wait up to 2 to 4 hours The E.D. process hours 4 HIC 2011: Digital hospital design workshop Designing the next generation emergency department

and intervention Admission Day ward IP ward Wait or bed OR Home Discharge Medications 5 mins Wait up to 4 hours Wait up to 4 hours Wait up to 2 to 24

5 Current state Emergency Department process Source : Alfred Health Redesigning Care 5 HIC 2011: Digital hospital design workshop Designing the next generation emergency department

6 To move to the new world of ED Service Delivery Leaders need to shift the current thinking Current Provider first Waiting is acceptable Errors are to be expected Add resources Reduce cost Problems not visible Maximise use of capacity Functional management Knowledge is held personally. Future Patient first Waiting is unacceptable Defect free processes No new resources Reduce waste Problems are visible Minimise cost of capacity End to end processes Knowledge is held systemically. 6 HIC 2011: Digital hospital design workshop Designing the next generation emergency department

Future Patient first Waiting is unacceptable Defect free processes No new resources Reduce waste Problems are visible Minimise cost of capacity

7 Specifically, in the ED we need to embrace the following principles... Minimise the number of patient moves Get the patient to the treating team and place as soon as possible Time critical interventions delivered immediately as, and when needed Standard set of tests and care bundles implemented No point of refusal (referral is respected). 7 HIC 2011: Digital hospital design workshop Designing the next generation emergency department

Time critical interventions delivered immediately as, and when needed Standard set of tests and care bundles

8 Pit stop crew? Cowboys and pit crews...cowboys do their job today herding thousands of cattle. They have tightly organised teams, with everyone assigned specific positions and communicating with each other constantly. They have protocols and checklists for bad weather, emergencies, the inoculations they must dispense. Even the cowboys, it turns out function like pit crews now. It may be time for us to join them. Source: Dr.Atul Gawande NewYorker.com. May commencement address at Harvard Medical School What is a pit stop crew? Tightly organised team Assigned posts Communicate constantly Protocols and checklists. 8 HIC 2011: Digital hospital design workshop Designing the next generation emergency department

They have protocols and checklists for bad weather, emergencies, the inoculations they must dispense. Even the cowboys, it turns out function like pit crews now. It may be time for us to join them.

9 Can Emergency Department teams run like a pit stop crew? What features does an Emergency Department need to run as a pit stop crew? Change current operating and physical structure layout Improved I.T. Capabilities (workflow processes, EMR, decision support) Re-defined service delivery models. What do we need Change of thinking New processes Strong leadership Re-align the information flow using systems and processes. What are the key enablers IT systems and technology natives that will adopt the new world Move our processes more into the Emergency Department point of care model. 9 HIC 2011: Digital hospital design workshop Designing the next generation emergency department

What do we need Change of thinking New processes Strong leadership Re-align the information flow using systems and processes.

10 Emergency Department pit stop crew What does an Emergency Department Pit Stop crew look like They are a tightly organised and assigned teams They communicate constantly Bundle of care standard work lists and check lists Electronic workflow systems that included clinical documentation, processes and decision support functionality. 10 HIC 2011: Digital hospital design workshop Designing the next generation emergency department

check lists Electronic workflow systems that included clinical documentation, processes and decision

11 Emergency Department pit stop crew process Triage ED Risk Assessment (Provisional Diagnosis) + Admission Process (Patient ID Critical Info) Does the patient need access to services that require them to be admitted YES NO Do they need time critical interventions and/or investigations Consultation Rooms Short term targeted intervention one off YES NO Give them critical intervention and investigations Identify point of care emergency model of care 11 HIC 2011: Digital hospital design workshop Designing the next generation emergency department

investigations Consultation Rooms Short term targeted intervention one off YES NO Give them critical intervention and investigations

12 Imagine a better patient experience Patient experience Safe Know they will get timely treatment and attention Time critical intervention Senior Medical Staff Triage ED risk assessment process Streamed Theatre ICU Diagnostics Resuscitation Surgeons, intensivists Diagnosticians Emergency Department clinical team Standard work of Tests, interventions & Check lists Bundles of care 2 Consultation room General practitioners Nurse practitioners Allied health practitioners Electronic work flow, processes and clinical documentation The ED process Immediately on arrival Definitive point of care Ward specialist staff 12 HIC 2011: Digital hospital design workshop Designing the next generation emergency department

& Check lists Bundles of care 2 Consultation room General practitioners Nurse practitioners Allied health practitioners Electronic work flow, processes and clinical

13 Emergency Department Journey in the new world Models of care require changing which will impact the design of the Emergency Department Waiting times will be reduced patients being taken to the direct care points General practitioners/nurse practitioners/allied health practitioner model New Emergency Department design means that patient s go to the point of care areas instead of waiting in emergency for up to 24 hours for a hospital bed Emergency Department isn t an alternative definitive point of care environment any more Patients are at the right place at the right time getting efficient and effective treatment Patients will move through the new Emergency Department more quickly The patient experience is a good one! 13 HIC 2011: Digital hospital design workshop Designing the next generation emergency department

emergency for up to 24 hours for a hospital bed Emergency Department isn t an alternative definitive point of care environment any more Patients are at the right place at the right time getting

14 Thank you Katerina Andronis, Director, Consulting, Deloitte Mob: Gayle Smith, Executive Director, Quality & Planning, Eastern Health Debbie Nielsen, Bevington Group 14 HIC 2011: Digital hospital design workshop Designing the next generation emergency department

Gayle.smith@easternhealth.org.au Debbie Nielsen, Bevington Group Debbie.

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Before making any decision or taking any action that may affect your finances or your business, you should consult a qualified professional adviser.

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