Best Practice in Emergency Departments & Intensive Care Settings

About

Facing the current and future challenges for EDs and ICUs
This event takes a close look at the highly stressful areas of the Emergency Department and Intensive Care, and the current challenges facing staff and patients. With expected workforce shortages and an older, urbanised and more ethnically diverse population with more complex medical problems, how will these units look in the future? We examine examples of best practice in developing safe staffing levels and how the workforce is adapting to meet future need.

Focus on new initiatives to improve patient outcomes
We look at some initiatives to improve patient outcomes; the 6-hour targets and hospitals after hours. Does primary care need to do more to remove the barriers to patient care in the community?

Rights and responsibilities in difficult situations and adverse events
We also investigate the requirements for care and how to deal with some of the difficulties that eventuate when dealing with patients and their families. What treatment options are available for mentally ill and addicted patients and what protection is available for children in critical care?

Registration specials
• 2 for 1 special: bring along a colleague for free! Simply register two people from the same organisation at the same time and the 2nd attends for free (conference only).
• Register and pay before 16th December 2011 to take advantage of our early bird specials. 


Workshop

The art of managing patient flow   

Full day separately bookable workshop: 22 February 2012
9.00am – 5.00pm

Solving the issues of flow in an Emergency Department requires a whole-of-health system approach. This workshop will provide insight into the tools and concepts that enable a complex health system to create flow. Participants will have the opportunity to practice these new skills and will leave the workshop having a better understanding of the key design elements for redesigning patient flow.

In this all-day workshop you will explore how health can learn about the art of designing business processes to enable flow from manufacturing and service businesses. Participants will be asked to redevelop a fictitious pharmaceutical business using techniques and ideas borrowed from industries such as auto-manufacturing, logistics and telecommunications. Participants will apply their learning using simulation exercises which replicate a complex manufacturing environment. The group will explore the impact of these ideas on our health system, and look at how these ideas can be incorporated into daily health operations.

Key areas of learning will involve:
• Queuing theory (understanding  and managing variation in patient demand)
• The  importance of single piece flow vs batch processing patients
• The foundation principles of Lean Thinking and Constraint Theory
• An overview of production planning principles applied to health
• The art of managing change in complex systems

Your workshop facilitators

Richard Hamilton, Business Development Manager, Canterbury DHB
Richards’s primary focus for the DHB is process redesign built around value streams, implementing the use of production planning methods in conjunction with Lean Thinking management principles.

Richard has over 20 years’ experience in production planning and management for logistics and service industries. Richard has specialised in working with service industries which can’t cap demand, such as Postal Authorities, Health Services, and Call Centres.

The key focus of Richard’s work is on identifying opportunities to improve process flows, and focusing on what information and tools frontline staff need to maintain a regular rate of work. ‘Improving the Patient Journey’ is a significant strategic programme focused on delivering these attributes within the Canterbury DHB.

Brian Dolan, Director of Service Improvement, Canterbury DHB; Director, Dolan & Holt Consultancy Ltd, UK
Brian’s role includes work on the ‘Improving the Patient Journey’ programme incorporating Collabor8 (lean thinking and leadership course) and the ward-based ‘Making Time for Caring’ projects. In the UK, he works with organisations undertaking leadership development, improvement in patient flow and systems reform. He did his psychiatric nurse training in Ireland and his general nurse training at St Mary’s Hospital, Paddington and worked in a number of London A&E departments.

Brian recently ran the ‘Lean thinking and leadership’ workshops for the Nursing and Midwifery Office of New South Wales Health, Australia. He has published over 100 papers in a range of nursing, medical and paramedic journals and is the co-editor of an international best-selling book on emergency nursing, the third edition of which will be published in 2012. He is currently writing up a doctoral dissertation at Oxford University into the consultation skills of emergency nurse practitioners. 


Agenda

Agenda: Day 1

8.30

Registration and coffee

9.00

Opening remarks from the Chair

9.10

Setting the scene: Big picture problems for ED and ICU

We start with a discussion about the current challenges and opportunities facing those working in ED and ICU settings and their patients. Both services face unpredictable demand and budgetary constraints and must respond to issues and problems in other areas of the health service. How can they plan future service development and lead the provision of acute care, and how should they work together?
• ED and ICU as the “safety police” of the health service
• Skill mix, appropriate service utilisation and service interfaces
• Championing quality and cost-effectiveness at the heart of the public health system

Dr Tim Parke, Clinical Director Adult Emergency Department, Auckland DHB

9.50

Meeting the targets while maintaining the quality of outcomes in the ED

The Government’s health targets are looking favourable operationally but what have been the benefits of the 6 hours targets for staff and patients?
• How the different DHBs have been meeting their target
• Have reduced waiting times seen a measurable improvement in quality of care?
• Meeting the targets within existing resources and the effect of seasonal variation

Professor Mike Ardagh, Professor of Emergency Medicine, University of Otago

10.30

Morning tea

10.50

Meeting increasing demand for the ICU

Demographic and health trends are expected to see the demand for ICU treatment double over the next 20 years. With an already stretched workforce and resources, how is anticipated future growth in demand going to be managed and what are the other pressures on intensive care departments?
• Clinical governance in the ICU
• The increase in demands from surgery
• Pressure to move people out of ICU before they are ready

Dr Janet Liang, Clinical Director Intensive Care Unit, Waitemata DHB

11.30

Access block and its effect on the ED targets and the ICU

This session examines access block and the effect a lack of beds is having on the ability of hospitals to meet the ‘Shorter Stays in ED’ target and length of stay in the ICU. We ask what effect treatment delay is having on patients requiring critical care.

Dr Peter Jones, Director of Emergency Research, Auckland DHB

12.10

Helping families make the best decision

We look at how health professionals can help families overcome some of the difficulties associated with making critical decisions about loved ones which can be stressful for both families and staff.
• Breaking bad news and who should be delivering it
• Managing the family dynamic
• Communicating the options and their consequences
• The cultural issues to be considered in end of life decisions

Cindy Penny, Social Worker, Emergency Department
Matalau Loli, Practice Supervisor Adult Social Work Team, Auckland DHB
Joanne Herd, Practice Supervisor Adult Social Work Team, Auckland DHB

12.50

Lunch

1.40

Hospitals after hours: Improving ED and ICU outcomes

Research has shown that patient outcomes are worse for those presenting at night times and during the weekend. We examine how Canterbury DHB has improved patient handover and patient care at times when there are less staff available.

John Crozier and Jane Goodwin, Clinical Team Coordinators, Christchurch Hospital

2.20

Case Study: Why patient flow is not just about the ED and ICU

Having spent many billions round the world on expanding ED and ICU capacity, the smartest money in healthcare is now being spent at the back door and before the front door of hospitals. This session will look at why this makes such a difference, and how Canterbury’s whole-system approach of ‘Improving the Patient Journey’, the Canterbury Initiative and other related programmes have yielded dividends in patient flow, clinician engagement and systems thinking at all levels in the DHB.

Brian Dolan, Director of Service Improvement, Canterbury DHB

3.00

Afternoon tea

3.15

Case Study: Examining the primary care and ED interface and the need for more accessible primary care

This session will examine the reasons why more patients are presenting at the ED at Middlemore Hospital and how three Auckland DHBs are attempting to make attendance at A&M clinics easier for the more vulnerable groups in society.
• Cost, convenience and access: the blocks to primary care
• The further plans by primary care to lower the barriers to primary care experienced by some patients
• Is a 15-minute GP consultation suitable for all patients?

Dr Vanessa Thornton, Clinical Head Emergency Care, Counties Manukau DHB
Dr Ian Scott, Chair, Afterhours Alliance Taskforce; Chair, Auckland PHO

4.05

Panel Discussion: Is primary care coming to the ED?

We look at the bundle of care now expected to be provided in ED, alongside the care required for the immediate reasons for attendance. Is this adding to the workload of the ED and making the targets harder to achieve?
• The extra resources required for extra screening
• The expected effect of integrated family health centres on the bundle of care

Dr Vanessa Thornton, Clinical Head Emergency Care, Counties Manukau DHB
Dr Ian Scott, Chair, Afterhours Alliance Taskforce; Chair, Auckland PHO
Alex Boersma, Service Manager Emergency Care, Counties Manukau DHB

5.00

End of day one & networking drinks

Agenda: Day 2

9.00

Welcome back from the Chair

Dr Ross Freebairn, Vice President, College of Intensive Care

9.05

Dealing with the shortage of ICU specialists in New Zealand

New Zealand and Australia have a unique system with a primary lead specialist responsible for patient care in the ICU. This session examines how the system developed and what is being done to address the shortage of intensive care staff.
• The historical reasons for the shortage of intensivists
• Would NZ be better off adapting the model used in other regions?
• Addressing competency issues and a shrinking workforce
• The impact of less specialised and/or unregulated staff working in the traditionally closed environment of the ICU

Dr Ross Freebairn, Medical Director Intensive Care Services Clinical Director Acute Services, Hawke’s Bay Hospital

9.50

Case Study: Getting the staffing mix right in the ED: Best practice

This presentation will cover the processes and tools developed to assist the Bay of Plenty ED better match their demand and capacity. By using intelligent information in the form of capacity and demand indicators they can better match staffing to patients in the moment and over time.
• An agreed set of indicators for variance
• Triggers for action at ED and operations level
• Standard Operating Responses with accountabilities for action
• A multi-disciplinary approach

Rhonda McKelvie, CCDM Programme Consultant, Bay of Plenty DHB

10.30

Morning tea

10.50

Expanding the role of nurse practitioners

The nurse practitioner and nurse specialist workforce is growing with nurses being given more autonomy in the ICU and ED. What opportunities are available to nurse practitioners in acute care and what more can be done to increase these?
• What are the gaps in the service nurse practitioners are aiming to fill?
• Developing an independent and autonomous role
• Autonomous practice and clinical error

Michael Geraghty, Nurse Practitioner Adult Emergency Care, Auckland DHB

11.35

Learning from adverse events - managing information safely

Mistakes are an opportunity to learn but how can this be achieved safely? Concerns about patient privacy and staff vulnerability are barriers to the review of adverse events. This session will consider how to manage information collected in quality improvement processes. When, can and must information about an adverse incident be disclosed and how can it be managed in a way that facilitates review while minimising the risk of inappropriate or unforeseen disclosure?
• Engaging staff in review processes
• Interviewing staff
• Protected Quality Assurance Activities
• Disclosure to patients and families
• Disseminating learnings to staff
• Providing feedback to third party providers such as GP or ambulance staff
• Use of information in other legal processes such as HDC or Coroners Court
• Media requests

Peter Le Cren, Legal Counsel, Auckland DHB

12.15

Lunch

1.05

Treatment for mental health patients in acute care settings

We examine the options available when dealing with patients with mental health and addiction issues. With the intense environment of the ICU and ED being an area of focus for immediate health concerns, what effect is the wait for admittance elsewhere having on staff and the patients?
• Options available when dealing with mental health patients
• Are the new health targets improving access for mental health patients?
• Understanding the Mental Health (Compulsory Assessment and Treatment) Act

Representatives from Department of Liaison Psychiatry,
Auckland DHB

1.50

When to say when: Managing patients’ demands for treatment, withdrawal of treatment, and dealing with difficult patients

All patients are entitled to care and treatment that meets their clinical needs, but there are times when the risks of medical intervention outweigh the benefits. Depending on the patient’s level of capacity, difficult decisions regarding provision of treatment can be overlaid by ethical and legal considerations in relation to consent. What are the legal implications for withdrawing treatment, with and without patient consent? What legal issues arise when patients demand, refuse to accept, or place conditions on, treatment?
• Demands for treatment by competent patients
• End of life decisions for the young
• Treatment vs care

Penny Andrew, Senior Associate, Buddle Findlay
Catherine Miller, Senior Solicitor, Buddle Findlay

2.35

Advance directives in the ICU and ED: Supporting the patient’s wishes

Individual autonomy is a key ethical principle that underpins the provision of health care in
New Zealand. Advance directives are an important mechanism by which a patient can make a choice about possible treatment in the future.
• The legal standing of advance directives
• Establishing the validity of advance directives
• Respecting the patient’s wishes when families and/or clinicians disagree
• Advance refusals vs advance requests for treatment
• Strengthening the right to express wishes about future treatment

Amy de Joux, Senior Solicitor, Buddle Findlay
Iris Reuvecamp, Senior Associate, Buddle Findlay

3.15

Afternoon tea

3.30

The rights and responsibilities of child patients in critical care situations

There are a number of special concerns when dealing with minors in intensive care and ED settings, with children lacking the maturity to understand the effects of treatments. What are the legal obligations that exist to protect minors?
• Patient confidentiality and the information that can be given to parents and caregivers
• Dealing with separated parents
• The State’s obligation to provide care

Maria Kazmierow, Family law barrister and mediator

4.15

Closing remarks from the Chair and end of conference

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