Allied Health Nelson Hospital Emergency Department

1. Allied Health Nelson Hospital Emergency Department

2. Strategy & Governance • The strategy was to: • Support National Health Targets of reducing length of stay • Provide ‘Better Sooner More Convenient’ service delivery • Enhance clinical intervention • Provide integration across DHB and primary care services • Reduce inappropriate hospital admissions • Reduce frequent presenters to ED • Optimise patient’s journey • Facilitate access to community support services • Assess physical, mobility, rehabilitation, support, and psychosocial needs of patients • A Steering Group was established between AH, medical & nursing teams to ensure a robust quality & safety governance framework

4. Who are the Allied Health Team?

5. Physiotherapy Services in ED • Inclusion Criteria for Primary Intervention: • Triage 4 and 5 Primarily musculoskeletal injuries • Falls 2 Exclusion Criteria for Primary Intervention: • Red Flags • Significant mechanism of action/head injury • Open wounds • Children under five years • Major deformities • Confusion or agitated state/altered level of consciousness • Recent seizure activity • Observations triggering EWS

6. Patient JourneyPhysiotherapy Primary Referral • 14 year old female rolls L ankle during netball, unable to weight bear, presents to ED with swelling and 8/10 pain score • Ankle assessment, Ottawa rules applied, XRAY requested • No bony injury - Treatment as per musculoskeletal injury • Follow up into Primary Health Primary Consultation - No Doctor intervention Frees up medical/nursing staff - patient on optimal pathway

7. Patient JourneyPhysiotherapy Secondary Referral • 73 year old woman fell, presented to ED via ambulance • Medical review – XRAY NAD • Physiotherapy referral - acute pain at intervals on movement, discussion with Dr, CT ordered, # pelvis • Patient keen to go home, successful mobilization with aids • Follow up community team, # clinic Assisted with diagnosis, prevented admission, optimal patient pathway

8. Patient JourneySocial Work Referral • Referral received from ED SMO overnight • Mother had overdosed came in with 15 yr • Concerns • Action Social Worker in ED meant: - Concerns of staff followed up thoroughly - Timely liaison with MCT and CYF - Provides holistic care, considers family and environment

9. Multiple Presenters Project • Management Plans: • Best interest for patients • Time saving, therefore cost saving • Free beds for true emergencies • Redirect to GP • Social Worker’s Contribution: • Liaison with Community re plan • Central person to link concerned professionals • Update Management Plan details when changes happen

10. Added Value • Safety and Risk • Preventing admissions & Frequent Flyers • Effective use of staffing resources • Takes pressure off medical team – concentrate on triage 1, 2, 3 patients • Support for young doctors, second opinion, assessment and management • Bridging gaps in service delivery across the: • Age continuum • Community / Health sector • Community liaison • Falls for over 65 year olds • Improve patient satisfaction • GP Enrolments

11. Nursing Perspective • Team approach provides timely and safe patient care for patients in ED. • Early allied health assessment and interventions provide better outcomes. • Nursing staff now able to concentrate on nursing role.

12. What did the Data Say during the pilot?30th April – 1st October 2012 (22 weeks) • Total Patients 749 Physiotherapy 429 patients with 45 follow ups Social Work 320 patients with 287 follow ups • Total Contacts 1081 • Represents approx 7% of ED presentations over the 22 weeks • 56% female and 44% male • 2.8% patients lived out of NM Area • 9.2% identifying as Maori

13. Allied Health Contacts April 30th 2012 to September 2013

14. Allied Health Contacts April 30th 2012 to September 2013

15. Physiotherapy Referrals (September 2013)

16. Social Work Referrals (September 2013)

18. Consumer, Staff and Stakeholder Feedback (Time of Pilot) • Consumer, Staff and Stakeholder Questionnaire and interviews held post the pilot • Consumer’s feedback - 27/ 31 rated 5 extremely valuable • How were they helpful? • Provided information, treatment, practical support, follow up advice • Supportive and Professional service • Provided explanations , friendly • Good to talk to someone, empathetic • Follow up call to advise on community services/activities • Staff Questionnaires: • Social Work: 42/42 rated extremely helpful • Physiotherapy: 39/42 rated extremely helpful

19. Stakeholder Feedback Impact on services • Social worker improved communication across the hospital & community • Prepares background work, support and communication if patient admitted to the wards, flow through to ward MDT meetings • Admissions to hospital avoided as additional interventions put in place • Families more supported • Positive linkages to private providers • Increase follow up for urgent outpatients and community services in PT area and decrease referral rate in OT • Reduction in hospital based acute AH staff being called to ED • Early identification rehab clients i.e. stroke • Increase use of short term equipment loans • Improved communication / linkages to PHO and appropriate services

20. Project Financials Return on investments: • Admission avoidance • An estimated 3 per week (supported by whole Clinical Team and backed by Stakeholders) during initial Pilot. • Primary Contact Physiotherapy • Additional cost benefits – Falls, multiple variables

21. Current Quality Improvements and Future Directions Strategic • Continual integration and coordination of clinical teams across service boundaries ( Referrals to the Community Care Coordination Centre) • Electronic records , Shared Care view, EDAGG system • Continue to focus on the - Falls Prevention, Child and Family Concerns • Part of the wider approach to acute demand management and Alliance Work streams • Current case to extend to Wairau Hospital ED Consumer Focused • Care plans put in place to ensure consistency of care if re-present to ED • Commence discharge planning on admission • OPJ and consumer engagement in self management Workforce • Inter-disciplinary Team Model • Enhancements : Plastering , basic wound support – base on task competencies, nurse and AH initiated X rays

22. THANK YOU Questions?