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Enhancing Emergency Department Outcomes: The 3-2-1 Approach to Data and Process Improvement

This presentation by Kerrie Freeman, Service Improvement Leader at Bay of Plenty District Health Board, outlines a strategic 3-2-1 approach to improving data collection and processes within the Emergency Department (ED). Adopting principles from NSW models of emergency care, the initiative focuses on streaming care, especially for high-acuity patients. Key metrics track time to decision, admission, and discharge, resulting in incremental improvement in performance. The ongoing monitoring ensures sustainability and clinical engagement, backed by effective IT capabilities and leadership commitment.

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Enhancing Emergency Department Outcomes: The 3-2-1 Approach to Data and Process Improvement

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  1. Bay of Plenty District Health BoardA 3-2-1 approach to data and process improvementin the Emergency DepartmentA Work in ProgressPresenter: Kerrie Freeman, Service Improvement LeaderHospital: Picus1 and Picus2HRT0915 17-18 September 2009

  2. Key contacts: Derek.Sage@bopdhb.govt.nz 021 228 5914 ED Clinical Director / Medical Leader Clinical Support Services Marama.Tauranga@bopdhb.govt.nz 021 227 4649ED/APU Clinical Nurse Manager

  3. Context • Adoption of the principles of NSW models of emergency care by Clinical Governance Committee – contextualised by clinical staff to BOP • Streaming and standardising care – stroke, chest pain, appendicectomy, diverticulitis, CNS trial (single injury, single illness pts) • Supporting work – APU, CAU, WOW, ED imagine, leadership capacity building, cart tart, barcoding • From March to August 6 hour target moved from 81% to 87.2% - incremental, sustainable shifts (Tga from 74% to 81.2%) All this with high % DNWs, pandemic, winter overload… • 3-2-1 reporting and monitoring

  4. What is 3-2-1 • Decision to admit <3 hours (from time of arrival to referral to inpatient team) Acceptance for care <2 hours (from referral to inpatient team to decision to admit/discharge) Transfer <1 hour (decision to admit/discharge to admit/discharge) • Difference between 3-2-1 process and 3-2-1 reporting and monitoring • Focus on complex and high acuity patients • Agreement by clinical staff that key time-points are appropriate for cohort

  5. Why 3-2-1 for reporting and monitoring? Paradigm shift from broad brush to targeted approach

  6. Our current situation – the shotgun Which IP team is > 6 hours? Pt discharge status? Level of diagnostics?

  7. Our future situation – the sniper • 3-2-1 to target process work • Ongoing monitoring through Clinical Governance Committee for sustainability • Data collection commenced 1st September – new timestamps in PMS, new processes for data collection, new forms • Critical success factors – IT capability and engagement, clinical leadership with an agreed change imperative, sustainable incremental change

  8. "Every system is perfectly designed to get the results it gets.  If we want better outcomes, we must change something in the system.  To do this, we need to understand our systems." - Berwick 1996

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