EMA Quality & Safety Newsletter – December 2023

A message from the leadership team

This edition we would like to acknowledge the FHED and Access teams who received a Best Care award for Coordinated Care in relation to Footscray Short Stay Unit Flow.
The Short Stay Unit is crucial in achieving the flow required to see new patients in a timely manner. The team identified two interventions to implement in the unit – capping the number of patients admitted to the SSU and allowing better flow by defining criteria for direct admission. By implementing these changes the unit was able to see measurable improvement in the way the SSU ran but also the whole of the ED.

Patient Story

A 72 year old female was admitted to Ward 2C on the 15th September 2023. She had been recently discharged from hospital to a new RACF but represented within 38 hours due to ongoing behavioral issues secondary to a history of Alzheimer’s Disease and Vascular Dementia with Behavioural and Psychological Symptoms of Dementia.

On arrival to the ward, the patient was identified as a high Occupational Violence and Aggression risk and required multiple code greys to manage her behaviours of concerns. Although she had an Additional Care Resource to support her care, her behaviours were challenging for the multidisciplinary team to manage.

A behavioural management plan was developed and included medication reconciliation, planned code greys, use of Greek music and dolls as a distraction. Her family were also involved in the planning of her care. The outcome was positive with better management of her behaviours of concerns.

The patient was transferred to the treating teams home ward several days later, where she became unsettled and had an altercation with another inpatient. She was transferred back to 2C, where her behaviours quickly settled again. This story demonstrates the quality of care provided by the 2C team and highlights their ability to develop relationships and manage difficult behaviours well.

A transfer to the Dementia Management Unit was planned for the patient while work continued on her discharge planning.

Well done to all staff involved in the care of this patient with a complex condition and needs.

Kindness Corner

“My father was recently admitted to 3E, I understand there was a serious incident, and my father was transferred to Cath lab for the duration of his stay.

There was an in-charge on Saturday morning, who actually did a double shift (not sure her name) and in her hectic day she went above and beyond her job description by keeping me updated regarding my fathers’ management.

I also have to commend an ANUM from 3E who on Sunday took some time and went searching for my father’s missing belongings while coordinating his discharge. She was reassuring in her delivery of care to me.

While we always hear the negative, I want to acknowledge the above as well as all the staff on the ward who took great care and showed compassion to my elderly father. They managed to keep it all together in a frightening situation.

I am proud to say I work for Western Health and how we work not only as a team but a family.

I feel that this needs to be highlighted for all to see.” (From a WH staff member)

Improvement Initiatives

There are multiple improvement initiatives underway across EMA. Do you know about these? (If not, feel free to ask your manager).

• Standardised Operating Processes for the Bed Coordinator teams to improve time to allocate beds from ED• Implementation of Virtual communications between our Urgent Care Centres and main Emergency Departments, improving clinical support to Urgent Care

• Ongoing access and flow initiatives across our EDs, including the use of Short Stay Units, AV Offload, Front of House and Fast-Track models, Category 2 time to be seen, use of Lower West Ward at Williamstown

• Comprehensive Care Improvement project across our EDs and Urgent Care Centres, focusing on nursing leadership and risk assessment and tools, including FirstNet implementation/utilisation and revision of audit tools and processes

• Timely Emergency Care Collaborative (TECC) aiming to improve the timeliness of emergency care through improving system-wide patient flow – PDSA cycles continue within the ED & inpatient stream: Timely Emergency Care Collaborative – Home (sharepoint.com)

Achievements and Opportunities

We are proud of…

• Maintaining timely access to care for all of our patients – AV offload within 40 minutes was 75% at FHED in November!
• Ongoing recognition of our staff achievements across the Division
• Paediatric Emergency in-situ and interdisciplinary simulation program

We are looking forward to…

• Reviewing our Sunshine Behavioural Assessment Unit, Hub and Fast-Track models of care with key stakeholders to ensure they are providing Best Care for our patients
• Establishing our new Emergency Medicine Intranet site
• Establishing an ED/HiTH collaboration project
• Sunshine ED refurbishment
• Review of General Internal Medicine model
• EMR implementation at Bacchus Marsh and Melton
• Improving patient access to our EMA outpatient clinics through the use of guidelines and other improvement initiatives

Our focus continues on…

• Addressing our Falls & Pressure Injuries across the Division
• Improved compliance with risk assessments and utilisation of iPOCS across our inpatient areas
• Improving medical and nurse practitioner staffing (particularly across our EDs and Urgent Care Centres)

What is the data telling us?

Perceptions of the Patient Safety Culture within the Division of Emergency, Medicine and Access (EMA)

Click on the image to view the Summary of 2023 Survey Findings