The RCH Emergency Department (ED) continues to experience unprecedented demand, with more than 80,000 presentations in the 2013/14 financial year.
Record-breaking demand
The RCH Emergency Department treated 75,000 children and young people last financial year, which represents an increase of 4,750 patients. With an additional 8,000 patients seen in the RCH GP clinic that totals 83,284 presentations for the 2013/14 period. It’s the first time that the department has seen more than 80 thousand presentations in a financial year.
The hospital also saw a very significant increase in in-patients, with more than 6,000 additional in-patients coming through the hospital, compared to the previous financial year.
“We’ve delivered great care to a record number of patients and families throughout the hospital. We are treating more patients than ever; but we are meeting that demand – so we are performing better than ever,” Deputy CEO John Stanway said.
National Emergency Access Target
The National Emergency Access Target, or NEAT, requires 81 per cent of emergency patients to be sent home, or admitted to a ward, within four hours of presentation. At the RCH, meeting the NEAT is more than an operational requirement; it is at the heart of our commitment to delivering great care. This financial year several initiatives were launched to allow the RCH to achieve our best ever results against the NEAT, and meet the target during the third quarter of the financial year.
“We’ve had to become more efficient and more effective in the work that we do to ensure that every patient is getting the right quality of care,” ED Director Dr Ed Oakley said. “It’s meant that we have had to re-design the ED models of care; introducing the fast track unit and new observation beds and continually work on communication and flow in our department.”
New observation beds
The ED introduced eight new observation beds in the medical imaging area, in which to monitor patients who have been treated in the ED, but are not quite ready to go home. By moving patients to this area, staff can free up space in the ED for new patients and create a quieter space for ongoing observation.
“Patients with certain conditions, including head injuries, gastroenteritis and croup might need to be monitored for more than four hours,” Dr Oakley said. “The new beds allow us to move these patients to a calmer environment, away from patients with acute illness, so that they can receive more consistent care and more regular observations.”
On the fast track
In 2013/14 the ED employed six new medical staff and opened up an after-hours ‘fast track’ area for acute patients, freeing up further cubicle is the ED. The implementation of a ‘flow nurse’ helps staff to transfer patients from the waiting room to the ED and then onto the fast track unit, observation wards or in-patients wards.
“Our aim is to see patients as quickly as possible upon arrival to the ED, and then to provide the care that they need as quickly as possible,” Dr Oakley said. “The ‘flow nurse’ has freed up the time of other staff to focus on clinical issues instead of access and management issues.”
Dr Oakley explained that improvement of access is a continual process for the ED team.
“Our work is never done in this area,” he said. “We constantly evaluate and improve our processes in the light of their efficiency, effectiveness and flexibility.”
Allied health
The ED has increased the integration of allied health services, expanding the scope of the department’s embedded educational play therapy services.
Educational play therapy helps clinicians interact with children in the ED. Educational play therapy helps reduce the child’s anxiety, and provides an easy means of gaining the patient’s cooperation during assessment and treatment.
“Play therapy is especially helpful with distraction during medical procedures,” Dr Oakley said. “This year the service was reviewed, and we have changed our play therapists’ hours in the ED to align with demand.”
The Emergency Observation Ward team won the 2014 RCH ‘CEO Great Care Award for Timely Access’, which recognises an outstanding initiative or achievement that has significantly helped the RCH to provide care to more children and adolescents, when and where care is needed.
This article originally appeared in the RCH 2013-14 Quality of Care report, find it here.