“In 2012, Princess Alexandra Hospital was the worst performing hospital in Australia,” Dr Ian Scott, Director of the Department of Internal Medicine & Clinical Epidemiology at Princess Alexandra Hospital told the recent Improving Patient Flow Conference.
Following the release of the NHPA 2011-2012 report, Princess Alexandra Hospital undertook to reduce delays in their Emergency Department.
Presented with an overflowing ED, the hospital’s initial approach was to simply build a larger Emergency Department. However the preliminary reduction was counteracted by a 25% increase in medical admissions, and within nine months of commissioning the new facilities, they had returned to their baseline.
This was followed with a plan to optimise existing processes. Inquiries were carried out by KPMG, Accenture and QH – CARU, brainstorming was carried out and wishlists were created. Yet without ownership or an action plan, little changed.
“We were trying to fix what was essentially an adaptive problem with a technical fix,” said Dr Scott.
A Cultural Shift
Princess Alexandra Hospital implemented a massive shift in organisational culture to identify values, involve senior management, improve staff presence in AMI care, enhance communication between different groups and encourage an ethos of problem solving and learning.
They also implemented Emergency Department Reforms including:
- ED consultant assigned to Ambulatory Care area to fast track patients suitable for discharge
- Dedicated mental health area and rapid assessment and transfer
- ‘Straight through’ admissions of planned, clinically stable admissions
- Implementation of a ‘no bypass’ rule for the EDs of the four hospitals
- Explicit streaming criteria (following initial senior ED clinician assessment and triaging) of patients to short-stay wards, MAPU wards and critical care wards
- Procedure rooms transformed to SSW beds with additional staffing to improve patient turnover
- All patients presenting with Australian Triage Scale category 3 – 5 to be seen by ED staff in order of attendance, not clinician preference
To find out more about the changes implemented in Princess Alexandra Hospital, and to read further case studies from Fiona Stanley Hospital and Epworth Richmond Hospital, download the Improving Patient Flow ebook:
The next conference in this series, Whole of Hospital Strategies to Improve Patient Flow, takes place in May 2016. Book your place by February 19th to save $400.