Redesigning the ED. Dr Paul Jarvis. Consultant in Emergency Medicine

Transcription

1 The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and then insert it again. Redesigning the ED Dr Paul Jarvis Consultant in Emergency Medicine

2 Disclaimer The results shown here are specific to one health care facility and may differ from those achieved by other institutions Rev A 1/14 For In Vitro Diagnostic 2

3 Old System Tradi;onal ED System Walking Triage Dr Review Investigations Dr Review Treatment Disposal Nurse Assessment Ambulance Consultant Rev A 1/14 For In Vitro Diagnostic 3

4 What is the problem? System designed to make pa;ents wait (Triage is a step to decide how long you should wait) Two access points to the service Inves;ga;ons requested late Poten;al for inexperienced staff to order unnecessary inves;ga;ons Rev A 1/14 For In Vitro Diagnostic 4

5 Redesign ED Process EDIT System Consultant Consultant Ambulance Walking EDIT ED Dr Treatment Disposal Rev A 1/14 For In Vitro Diagnostic 5

6 Introduced Point of Care Testing Introduc;on of Point of Care Tes;ng (POCT) i- STAT System CHEM8+ CG Rev A 1/14 For In Vitro Diagnostic i-stat is a registered trademark of the Abbott Group of Companies in various jurisdictions For Intended Use Information See Intended Use Section 6

7 3 Phase Trial Phase 1 Evaluate the performance of the tradi;onal ED model - 1st April to 24 th May 2013 (3835 pa;ents) Phase 2 Evaluate introducing POCT into tradi;onal ED model - 28 th May to 29 th September 2013 (7033 pa;ents) Phase 3 Evaluate POCT and EDIT model together 30 th September to 18 th October 2013 (1200 pa;ents) Rev A 1/14 For In Vitro Diagnostic 7

8 Point of Care Testing Before Trial Median Blood Results being available: 63 minutes Trial Results Median: 3 minutes Able to do 60% of ED bloods using i- STAT Rev A 1/14 For In Vitro Diagnostic 8

9 Results 40% Overall Reduction Time hh:mm 60% Overall Reduction 68% Overall Reduction Effect of the 3 Different Working Models on the Median ED Times Rev A 1/14 For In Vitro Diagnostic 9

10 Breach Performance Monday to Friday 9-5 Non-EDIT EDIT Consistently meeting 4 hour target Much less variation with EDIT based model Rev A 1/14 For In Vitro Diagnostic 10

11 Results * * - only 1 consultant * UCL When only 1 consultant causes special cause variation in performance r = -0.8 *Two consultants on duty, except during the days noted Rev A 1/14 For In Vitro Diagnostic Dates 30 Sep 18 Oct

12 Results With tradi;onal model 9 pa;ents are undergoing ED Care in the ED central area at any one ;me (Monday to Friday 9-5) EDIT & i- STAT reduces this to 5 due to quicker processing of pa;ents Reduces Overcrowding Frees up time to Care Rev A 1/14 For In Vitro Diagnostic 12

13 Results With Tradi;onal Model 3% of pa;ents seen in ED Central Area Monday to Friday 9-5 are discharged with 30 minutes of arriving. With EDIT & i- STAT this is increased to 10% with the addi;onal benefit of being seen by a consultant. Reduces Overcrowding Frees up time to Care Rev A 1/14 For In Vitro Diagnostic 13

14 Results With Tradi;onal Model 11.4% of pa;ents seen in ED Central Area Monday to Friday 9-5 return within 7 days of their ini;al presenta;on With EDIT & i- STAT this is 9.1% Shorter pa;ent journey ;mes do not equate to more pa;ents having to return to the ED within 7 days Rev A 1/14 For In Vitro Diagnostic 14

15 Rates of Admission Old System 21.5% Old System & i-stat 21.7% EDIT & i-stat 19.0% 360 ED a_endances per day cross site 2.5% reduc;on = 9 few admissions per day Rev A 1/14 For In Vitro Diagnostic 15

16 Conclusion Introduc;on of a consultant- led assessment process (EDIT) and POCT provides: 40% reduc;on in the median ;me from pa;ent arrival to being declared ED Ready 2.5% reduc;on in the median number of pa;ents admi_ed Rev A 1/14 For In Vitro Diagnostic 16

17 Intended Use Information (CG4+) Lactate The test for lactate, as part of the i- STAT System, is intended for use in the in vitro quan;fica;on of lactate in arterial, venous, or capillary whole blood. The i- STAT lactate test is useful for (1) the diagnosis and treatment of lac;c acidosis in conjunc;on with measurements of blood acid/base status, (2) monitoring ;ssue hypoxia and strenuous physical exer;on, and (3) diagnosis of hyperlactatemia Rev A 1/14 For In Vitro Diagnostic 17