After Hours Care Models - PMCT · After Hours Care Models The Royal Children’s Hospital Dr Jye...
Transcript of After Hours Care Models - PMCT · After Hours Care Models The Royal Children’s Hospital Dr Jye...
After Hours Care Models
The Royal Children’s Hospital
Dr Jye Gard
Chief Resident Medical Officer, Junior Medical Staff Training & Support
After Hours Medical Lead, Short Stay Unit, General Medicine
Paediatric Clinical Teaching Fellow, University of Melbourne
Contents
1. RCH after hours
2. Our JMS
3. Deciding to change
4. Changes and how
5. What we learnt
Royal Children’s Hospital (RCH)
RCH After Hours
RCH After Hours
On floor 8:30am – 5:30pm After hours
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Other craft groups
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Patients JJJJJJJJJJJJJJJJJ
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Our JMS
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Our JMS
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Our JMS
Changes to RCH After Hours
Changes to RCH After Hours• Nurse Hospital Manager
• Most senior person in the hospital after hours
• Operational decision maker: patient flow, code gray
responder, bed management, staffing allocations
• Clinical Nurse Consultant
• Senior nurse – ED nurse practitioner
• Can review unwell patients, transfer, proceduralist (site
IV, administer nitrous, venepuncture), assist JMS with
procedures, reviews
• Medical Lead
• Acute care trainee to coordinate workflow, provide
support, proactively identify and communicate risk,
develop anticipatory care plans
Changes to RCH After Hours
1. Know your team:
• 2100 multidisciplinary handover
• 0100 multidisciplinary huddle
2. Communication:
• 24/7 use of electronic task board
3. Additional staffing:
• New Medical lead and Clinical Nurse Consultant roles
• Change in Social Worker hours in ED
• Extended Cardiology and Oncology resident hours
• Additional evening General Medicine registrar
Outcomes so far
• Identification of patient of concern after hours a
(plan in place)
• Staff medical satisfaction and sense of team work
after hours
• Discharges after hours
• Time to admission from 1800 – 0800 and number
of General medicine admissions handed over to the
night team
• Cardiac and Oncology JMO overtime
• Unplanned admissions to PICU after hours
• MET calls after hours
Outcomes so far
Outcomes so far
Outcomes so far
Outcomes so far
Lessons learnt
Lessons learnt
• Difficulty navigating new roles
• Role vs. responsibility vs. expectations
• Integration within organisation
• Development of the after hours ‘team’
• Tensions with pre-existing teams
Lessons learnt
1 The most effective tools were not
costly or particularly onerous
• Multidisciplinary handover and huddle
• Improved visibility of workloads
2 Workshop issues with all craft groups,
this includes the JMS
3 Models need to be tailored & creative
Acknowledgements
• Paula Howard, RCH, Improvement Manager, Strategy and
Improvement
• Margot Nash, Director of Junior Medical Staff Training and
Support Unit, RCH
• Ed Oakley, Chief of Critical Care, RCH
• Bernadette O’Connor, Director of Allied Health, RCH
• Sheri Waldron, Director of Operations & Chief of Information
Nurse, RCH
• Tal Galdish, Intensive Care Unit Consultant, RCH
• Tom Connell, Director of General Medicine, RCH
• Georgina Tiller, General Medicine Fellow, RCH
Questions?
Outcomes so far
After Hours Care
Contents
1. RCH after hours
2. Our JMS
3. Deciding to change
4. Changes and how
5. What we learnt