Adult Retrieval Victoria -An update. DR EMMELINE FINN Clinical lead (Acting)

Transcription

1 Adult Retrieval Victoria -An update DR EMMELINE FINN Clinical lead (Acting)

2 My Background Emergency Physician by trade Pre-hospital and Retrieval Medicine Specialist Disaster Management MIMMS and EMERGO Instructor From Adelaide to Darwin to Cairns to Brisbane to Melbourne ACEM Deputy Chair Faculty of Pre-hospital and Retrieval Medicine ACEM Accreditation Lead Inspector Associate Professor James Cook University North Queensland School of Public Health, Medicine, Dentistry and Veterinary Science

3 Adult Retrieval Victoria Clinical Coordination Medical Nursing Inter hospital retrieval missions Regional Metropolitan Trauma Victoria Guidelines REACH Retrieval and Critical Health Information System

4 Clinical Coordination 24/ First point of call is the Retrieval Administration Support Officer (RASO) non-medical Medical Coordinator Patient referral Clinical Advice Preparation for transfer Bed allocation Clinical care throughout mission central governance Pre-hospital Notification Trauma, STEMI, Victoria Stroke Team

5 Clinical Coordination Nurse coordination 7 days a week Critical Care trained (ICU, ED) Retrieval experience (Road/Air) Call taking, clinical advice, preparing patient for transfer Bed finding, liaison with bed management Clinical updates Triaging case priorities

6 Retrieval Staff Doctors -> critical care trained Registrars Training six month terms supervised and assessed Consultants - Critical care trained, Rural/Regional/Metro consultants ARV trained Nurses -> critical care trained Permanent since November 2016, ARV trained Patient transport officers (PTOs) AV trained AV MICA and ALS Flight and Road paramedics High Acuity Transport Service (HATS)

7 Retrieval Transport Platforms ARV Single Response Unit ARV Ambulance AV Ambulance HATS CPAV HEMS

8 Retrieval Equipment ARV Packs Critical Care ARV Medications ARV Equipment Continuously physiological monitoring Ventilator SIMV/PCV/CPAP/BIPAP Infusion pumps 20-50ml syringes Other Bloods, Ultrasound, Pacing Wires

9 Retrieval Training Induction Weekly Monthly Annual credentialing

10 Retrieval Quality and Safety Internal Incident management External s, AV, phone calls Ambulance Victoria State-wide Victorian Trauma Rounds

11 Clinical Cases Inter hospital transfers Regional Metro Critically unwell Sepsis Respiratory disease Trauma BURNS Intubated and ventilated Inotropic support ECMO Alfred team

12 Clinical Case 1 Pre- notification STEMI 40 year old female Presents to Rural Urgent Care Centre at 0940 AV Rural Clinician pre-notifies ARV ARV dispatches a Regional HEMS ARV continues clinical governance prepare patient for transfer, thrombolysis Patient arrives 1130 to Cardiac cathlab 1150

13 Clinical Case 2 Bariatric Patient Intubated in Regional Centre, admitted to ICU Requires Tertiary ICU Referred to ARV Scheduled interfacility transfer by roadthe next day Team and equipment fly to patient Rendezvous with Regional CPAV Road transfer 12 hours O2 resupply, multiple infusions, pressure area care, ventilation cares, team maintenance (toilet, food, water)

14 Clinical Case 3 Triple Zero call Neurosurgical Time-critical 30 yo gentleman found in a gutter by bystander called and patient transferred to an urban district ED at 2330 Patient referred to ARV for inter-facility transfer from Urban ED to Tertiary trauma centre at 2345 Time critical transfer ARV Called Triple Zero requested team and vehicle at 0000 Patient arrived tertiary facility at 0040

15 Clinical Case 4 Telehealth 80 yo patient with respiratory distress, likely sepsis ARV team dispatched via air Telehealth conducted to prepare patient for intubation Doctor caring for patient was not comfortable to proceed with intubation Preparation included: Patient positioning, utilisation of NIV, Preparation of medication doses for induction and post intubation, preparation of gear set up in order of use, documentation, reassurance to patient and family Handover of case on arrival of team

16 Preparing a Patient for Transport Expect to give clinical updates to ARV regularly Utilise ARV clinical coordinator as central resource point for all communication All clinical note copied and enveloped Line securing and labelling Suction of Oropharynx, Oro/Naso-gastric tubes Drainage of indwelling catheters, vacuum dressings Preparation of infusions in 50ml syringes Morphine, Midazolam, Noradrenalin, Adrenalin Family liaison, reassurance

17 Common feedback Professional team Helpful team Patient advocate Documentation Notifications of Team/Asset/Expected time of arrival Handovers

18 Handover Introduce self and team Situation of events leading to transfer Background relevant to current clinical episode Assessment Rx (treatments) requirements, requests Complying with NSQHS National standards relating to patient safety and care

19 Post Handover Timely transfer of patient onto hospital equipment Packing up of equipment and packs as soon as possible Further questions if any Notify that there will be a follow up call Please notify if any issues anytime Ongoing dynamic service improvement is key

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