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Allied Health Making a Difference in a Rapid Assessment Medical Unit (RAMU)

The Health Roundtable. New Zealand. Allied Health Making a Difference in a Rapid Assessment Medical Unit (RAMU). 1 Allied Health Making a Difference. Presenter: Michelle Kotis Hospital Name: Eastern Health

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Allied Health Making a Difference in a Rapid Assessment Medical Unit (RAMU)

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  1. The Health Roundtable New Zealand Allied Health Making a Difference in a Rapid Assessment Medical Unit (RAMU) 1 Allied Health Making a Difference Presenter: Michelle Kotis Hospital Name: Eastern Health Key contact for this project ( name & details): Michelle.Kotis@easternhealth.org.au

  2. Key Problem • Box Hill Hospital has ~ 40,000 presentations annually • Rapid Assessment Medical Units (RAMU) have been around for a number of years • Box Hill Hospital’s RAMU was not meeting the stated aims of these units: • ALOS of 4.43 days • Discharges were not prioritised impacting patient flow • No consistent processes • No dedicated Allied Health • Not pulling patients from ED • Access KPIs impacted: 8 hour stays, 24 hours stays, Ambulance bypass

  3. Key Strategies / Ideas Implemented • In November 2008 the “new look” RAMU was launched • ED > RAMU fast tracking using a “pull” model – medical registrar in ED • Implemented monthly performance monitoring with targets: • Av. LOS • Reduce 8 hours stays in ED • Reduce ED bypass • Primary focus on Discharge Planning • Allied Health • Implementation of an interdisciplinary screening assessment and referral protocol to fast track referrals facilitate discharge planning • Directly facilitate discharge to residential care, sub-acute, sub-acute ambulatory and other community services • Continuity of care from RAMU into General Medical Units for more complex patients • Links with HITH and Residential Care Outreach to fast track discharge

  4. Timelines & Resources • Review of existing RAMU by project officer over 2 months • Implementation of new model of care over 3 months • Dedicated 24 bed unit with dedicated staffing: • 1.0 EFT new Medical Head of Unit • Medical team – 1.0 EFT new registrar role • Nursing – 1.0 EFT new Patient Flow Nurse • Allied Health – interdisciplinary model using “Allied Health Patient Flow Coordinators (1.2 EFT physio (new), 1.2 EFT OT (new), 1.1 EFT SW (new) across 7 days • Allied Health – Senior Clinician / Team Leader Patient Flow Specialist (SW) (existing) • Additional investment in Allied Health - $180,000

  5. Key Outcomes Achieved • General medical throughput more efficient • 11% increase in discharges from Aug 08 – Aug 09 • 74.2 % of all general medical patients admitted through RAMU • 57% increase from Aug 08 – Aug 09 • 54 % increase in the number of allied health contacts by allied health • Aug 08 – Aug 09

  6. Key Outcomes Achieved

  7. Key Outcomes Achieved

  8. Lessons Learnt • Dedicated Unit with multi-disciplinary clinicians • Interdisciplinary approach • Relationships- internal & external • 7 days per week • Patient-centred • Focus on discharge planning

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