QEII Jubilee Hospital is an urban district hospital on the South side of Brisbane with 181 inpatient beds. In October 2013, we opened a new, larger Emergency Department, but with no increase in inpatient beds. Over the next 3 years, attendances rose from a relatively consistent 37,000 patients per annum to 56,000, putting considerable strain on both ED and the whole hospital.
Simultaneously, there was an expectation of achieving the increasing National Emergency Access Target (NEAT). In order to continue to function safely and efficiently, a number of strategies were utilised.
There was a shared understanding that whilst the NEAT is perceived by some to be an Emergency Department target, its achievement relies on the whole of hospital flow processes. Prior to the opening of the new ED, a project team was formed and the ‘QEII United’ clinical redesign project commenced 1. This looked at all processes throughout the hospital and made significant improvements in discharge planning, the ED-Inpatient interface, and hospital avoidance strategies. More importantly, clinical redesign skills were gained by all involved which then were utilised to ensure high standards of patient care were maintained in the face of increasing presentations.
Some of the main successes included:
- The complete restructuring of Fast Track patient assessment and treatment, including the creation of a Fast Track waiting area within the ED itself. This resulted in greatly improved patient and staff satisfaction, and the reduction in triage staff workload.
- The introduction of an escalation process to inform ED function based on input, throughput or output issues.
- The utilisation of daily reports showing detailed information on delays in the patient journey. This then fed into a daily Executive safety meeting, which in turn fed into weekly Operational meetings and enabled potential safety risks to be rapidly acted on.
- Improvement on patient discharge information, including the introduction of discharge information packs. This resulted in QEII being rated as the 3rd best hospital in Queensland for written/printed information in the 2015 Patient Experience Survey2.
All of these were achieved without additional resources, which presented a challenge in finding the time for staff to work on and implement the changes. However, we learned early on that it’s essential to have the voice of both the staff and patients as a central point to any Quality Improvement Strategies that are introduced.
- Bell Anthony, Cochrane Alastair, Courtice Sally, Flanigan Kathy, Mathur Mandeep, Wilckens Daniel (2014) Strength in unity: the power of redesign to align the hospital team. Australian Health Review 38, 271-277
- https://www.health.qld.gov.au/__data/assets/pdf_file/0033/439809/edpes-2015.pdf (accessed 19th December 2016)
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