Blood works bet­ter in colour to cut hospi­tal queues

The Weekend Australian - Travel - - General Appointments -

Dwyer, head of the de­part­ment of health man­age­ment at Flin­ders Univer­sity school of medicine, says Aus­tralia, the UK and the US are all work­ing on prin­ci­ples of re­design­ing hospi­tal care, ‘‘ but no one has cracked it en­tirely’’.

‘‘ One of the fun­da­men­tal prob­lems with the way hos­pi­tals work is they have not been man­ag­ing the end-to-end process of care for the pa­tient as a whole.

‘‘ Each hospi­tal de­part­ment is work­ing on its own but no one is look­ing at the whole.

‘‘ Where change has worked is where the peo­ple de­liv­er­ing the care have stood back and looked at all the steps in­volved.’’

Dwyer was in­volved in eval­u­at­ing an­other pi­o­neer­ing project — based at John Hunter Hospi­tal in New­cas­tle, NSW — which saw a 50 per cent drop in pa­tients ex­pe­ri­enc­ing ac­cess block when it was first in­tro­duced in 2003. And the im­prove­ments have been sus­tained.

The Mag­gie Project, named af­ter an 87-year-old widow who en­dured 55 days in hospi­tal af­ter fall­ing and break­ing her hip, also used sim­i­lar prin­ci­ples to im­prove the way pa­tients moved through the hospi­tal.

The re­sults led to the NSW Gov­ern­ment com­mit­ting $70 mil­lion over three years to drive re­form statewide un­der the badge of ‘‘ Clin­i­cal Ser­vices Re­design’’.

Fund­ing is due to run out mid-next year but on­go­ing sup­port is likely, says Tony O’Con­nell, di­rec­tor of per­for­mance im­prove­ment for NSW Health.

And while the re­cent furore over the state of Syd­ney’s Royal North Shore Hospi­tal is a clear in­di­ca­tion the scheme has far from solved NSW’s hospi­tal cri­sis, O’Con­nell says the gains have been sig­nif­i­cant.

Al­though the state’s per­for­mance on ac­cess block had been de­te­ri­o­rat­ing since 1999, things started to look up as soon as Clin­i­cal Ser­vices Re­design was in­tro­duced, O’Con­nell says.

‘‘ We met the na­tional bench­mark statewide for the first time since 1999 at the end of 2006 and have been around this level ever since.

‘‘ This is a sig­nif­i­cant achieve­ment in the face of ris­ing at­ten­dances at emer­gency de­part­ments and ad­mis­sions through ED to the wards.

‘‘ There is so much more to be done — we are not where we want to be but we have reached the best per­for­mance we have had.’’

Francis be­lieves his FASTPaTH sys­tem could help NSW — in fact he has pitched the idea to all state health min­is­ters.

But there has been a lack of re­sponse from other states other than Queens­land.

Ac­cord­ing to O’Con­nell, NSW is aware of the sys­tem — and sup­port­ive of it — but only if in­di­vid­ual hos­pi­tals de­cide it is right for them.

NSW is keen to avoid a ‘‘ one-size-fits all’’ approach be­cause it doesn’t want to im­pose statewide so­lu­tions on lo­cal staff, who he says are less in­clined to get on board with change if they’re not driv­ing it them­selves.

Even emer­gency medicine doc­tors con­cede that NSW might ac­tu­ally be on the right track.

‘‘ In terms of ac­cess block NSW has taken steps in the right di­rec­tion in the past three years though they could do more,’’ says As­so­ci­ate Pro­fes­sor Drew Richard­son, chair­man of road trauma and emer­gency medicine at ANU med­i­cal school.

Richard­son says while all states seem to be look­ing at some form of re­design­ing their hos­pi­tals, the ev­i­dence shows NSW is the only state hav­ing any real suc­cess.

But in his view, the key to emer­gency de­part­ment prob­lems is, and al­ways has been, a lack of avail­able beds.

‘‘ You can re­design the flow in ED as much as you like but if you don’t make the beds avail­able else­where in the hospi­tal it won’t make any dif­fer­ence.’’

O’Con­nell agrees that more beds are part of the so­lu­tion but he says if you don’t re­design your busi­ness pro­cesses in hospi­tal wards, pa­tients stay in th­ese beds for too long, and this just leads to emer­gency de­part­ments be­ing clogged with pa­tients who can’t get ad­mit­ted. Francis con­curs. ‘‘ It’s not just about build­ing more beds — that is not the so­lu­tion. We have to be smarter with what we have got.’’

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