Acknowledgements Mr Tim Free Director Clinical Operations CCLHD Steering Committee & Project Team Emergency Department Clinicians Mental Health Clinicians Lynne Blanchette ISLHD Conclusion Working collaboratively with the Emergency Department (ED) has highlighted the complexities and barriers to timely and efficient care of mental health consumers in this environment. The Beat It! project is demonstrating gradual improvement in performance with current ETP average of 70% and non-admitted ETP average of 80%. Solutions are being implemented across both Wyong and Gosford Hospitals. Engagement with the Whole of Health program has led to solutions being rolled out state wide including streamlining of current assessment documentation and clinical guidelines for physical assessment of mental health consumers in emergency departments. Objectives By December 2015, people presenting to Wyong Hospital Emergency Department with a primary mental health diagnosis will be discharged, admitted or transferred from the Emergency Department within 4 hours, thereby improving the Emergency Treatment Performance (ETP) (formerly known as NEAT) from 47% in 2013 to 81%. Case for change Mental Health consumers presenting to the Emergency Department at Wyong Hospital have in the past faced delays in assessment and treatment. During 2013, only 47% of these consumers met the National Emergency Access Target (NEAT) of being admitted, discharged or transferred within 4 hours. Of those consumers requiring admission from the ED, 69% waited longer than 4 hours. For the mental health consumer, Emergency Departments present a high stimulus environment that may increase arousal and anxiety and contribute to mental distress. Prolonged waiting times can lead to frustration, increased risk of symptom exacerbation, aggression and the risk of consumers leaving without completed treatment. Diagnostics Over 200 issues were identified through: Process Mapping Patient & Carer Experience Trackers (PETs) Patient interviews Staff Interviews Brainstorming Data analysis Compliments & Complaints Planning and implementing solutions Implementation of solutions are being staged in order to monitor effectiveness of each solution Streamlined assessment & documentation procedures Expanded Scope of Practice for ED mental health nurses allowing admission to PECC and discharge of low risk consumers Dedicated FirstNet monitor & electronic patient journey boards for quick view of referrals and bed status Clinical Initiatives Nurse pathways for mental health consumers Staggered shift times to meet peak demand periods Video Conference assessments Physical Review and Assessment pathway ED Staff Specialist allocated for mental health Structured combined education and orientation Assessment clinics Results Since commencing the project we have seen a gradual improvement in mental health ETP performance Mental Health consumers who do not require admission are being assessed, treated and discharged within 4 hours with non-admitted ETP achieving target of 81% Consumers leaving ED without being seen has reduced despite presentation rates remaining constant Quick Wins Standard Operating Practices for FirstNet referral, notes & discharge have been developed and published to standardise practice and improve KPI reporting Dedicated FirstNet monitor & electronic patient journey boards have been installed to provide quick access to ED referrals and inpatient bed status Beat It! every patient, every time Mental Health Emergency Treatment Performance 81% within 4 hours Anne Louise Elsom Clinical Nurse Consultant Ben Roberts Nursing Unit Manager Goal To improve the experience for people with mental health issues presenting to Wyong Hospital Emergency Department by reducing waiting times and treatment delays. Method Sustaining change Weekly Dashboard reports on KPI - displayed Monthly Performance Report on related KPIs Fortnightly FirstNet data report Structured Clinical Handover and Case Reviews to ensure safe and consistent practice. Policy & Procedures amended Ongoing education, orientation & training Leadership and modelling by sponsors Solution ownership by teams Staff recognition awards Contact Anne Louise Elsom [email protected] Ben Roberts [email protected] Project Initiation Diagnostics Solution Design Implementation Planning Implementation Evaluation Sustainability Steering Committee & Project Team established Communication Plan Process Mapping Patient & Carer Experience Trackers Patient & Staff Interviews Brainstorming Benchmarking Literature Review Prioritisation Develop plan Ensure sponsorship Circulate for comment Staged implementation Patient Journey Boards Expanded Scope of Practice Weekly Dashboard Report Monthly Performance Report Structured Clinical Handover & Reviews 0% 20% 40% 60% 80% 100% 0 5 10 15 20 25 30 35 40 Length of MH Ax Psych Reg Delay Physical Ax Firstnet Processes Admitted NEAT Triage Impact on NEAT MH NEAT Delay Root Causes 50% 55% 60% 65% 70% 75% 80% 85% 90% Mental Health Non-Admitted ETP Process Measure 1 - MH Non-Admitted ETP Data Process Measure 1 - MH Non-Admitted ETP Target 50% 60% 70% 80% 90% May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Mental Health ETP Data Target 81% 0 1 2 3 4 5 6 7 Number of patients Did Not Waits Data Target 0 50 100 150 200 250 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Mental Health Presentations to ED by Hour of Day Hourly Totals Jun-15 May-15 Apr-15 Mar-15 Feb-15 “The second monitor makes it easier to navigate between systems” “My daughter was seen quickly and the staff were caring and professional”