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Improving the patient experience at Waikato Hospital

Waikato DHB is investing in systems to improve the flow of patients through Waikato Hospital and get patients admitted to wards quickly for treatment.

The Patient Flow Programme aims to cut down the amount of time patients are waiting in the Emergency Department which can lead to a delay in treatment, worse outcomes and a longer stay in hospital than needed.

Initiatives include:

  • An online central bed and patient status dashboard will let clinicians and managers quickly see where the bottlenecks are so they can be promptly addressed.
  • Extra emergency physician positions established and being recruited.
  • A new patient flow policy will mean all patients would be reviewed by a senior doctor before 10am.
  • All patients will have an expected discharge date agreed by clinical team.
  • Staff will aim for 50 percent of patients to be discharged before mid day.
  • Long stay patients will be reviewed weekly to look at what needs to be done to make it safe for them to be discharged.
  • A specialty referral guideline and escalation protocol will help clinicians decide which specialty should see a patient.
  • Improving ward round discipline and discharge planning. Patients can be ready to leave but just waiting for a doctor on a ward round to have a final check or for a test to come back.

Marc ter Beek, Executive Director of Operations and Performance, said that Waikato has never met the health target for 95 percent of patients being assessed, treated, admitted or discharged from ED within six hours.

“The target is there for a good clinical reason and helps us focus our efforts on patient flow – studies show that ED overcrowding is associated with significantly increased mortality and length of stay in hospital. Recent Auckland University research showed that lives were being saved by admitting, discharging or transferring people out of ED in a timely manner.”

The six hour target is made up of three hours for people to be initially assessed in ED, two hours for them to be assessed by a specialist doctor and one hour for them to be transferred to a ward, once it’s known where they should receive care. Over the last year 10,219 patients spent longer than 6 hours in ED in Waikato Hospital.

Mr ter Beek said the DHB is increasing the number of doctors by 10 FTE and nurses by 6 FTE in the Emergency Department but it was a ‘whole of hospital’ issue which was why the project would help make a difference.

“The length of stay in ED is an important measure of the quality of acute care in any hospital system and is a measure of patient flow across the organisation as a whole.  This means ensuring that our patients receive the care they need, when they need it, and that there are no undue delays while patients are in the hospital.  It is about us valuing the patient’s time, provide the care that the patient requires in a safe and timely fashion so our patients can get on with their normal lives.”

The number of people turning up to Waikato Hospital ED has increased 20 percent over the last five years. Over the last year alone there have been 3,500 more people turning up at the Waikato Hospital ED than the year before. The busiest days are Monday and Tuesday.

Mr ter Beek said: “Not only have we seen our population in the Waikato District increase but we’ve also seen an increase in the proportion of the population coming to ED. In addition, patients are spending longer in the hospital, which is putting additional pressure on the available hospital beds.  Volumes and complexity are forecast to increase so it’s really important that we do things differently to improve the care and safety of our patients.”

The huge demands in ED have led the DHB to implement an overflow bed policy which identified additional beds on 24 wards, in family rooms or treatment rooms, throughout the hospital. These can be used in times of high bed occupancy, when inpatients in the Emergency Department experience delays moving into a specialty ward bed.

He added: “We have been experiencing very high demand in our Emergency Department recently, particularly between 6-7am when people who are due to be discharged haven’t left the ward yet, but we have many patients in ED waiting for a bed.

“It’s much safer for people to be on a ward with specialist nursing care than lying in ED. Under the new protocol, at times of acute pressure, patients who are ready for discharge home would go into the overflow bed, which have electronic call bells and privacy curtains, and new patients would be given an ordinary bed.

“At busy times during the day we may need to use ten or sometimes more of these beds in a day.  The decision to use the overflow beds is taken by on call nurse management in the morning of each weekday, based on clear criteria assessed by our bed capacity manager before making a decision to trigger the protocol.”

He also encouraged people to keep the Emergency Department for emergencies and if people were feeling ill to first think about whether they could see their GP or contact Healthline.

People can also sign up online for the DHB’s new SmartHealth service which provides a free out of hours online doctor and access to doctor-approved health information. It can prevent people coming to ED and having a long wait when they don’t need to. Visit www.SmartHealth.org.nz  to sign up.

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