Improving Unplanned Emergency Access Pathways (IUEAP)

Transcription

1 Central Adelaide LHN Mental Health Directorate Improving Unplanned Emergency Access Pathways (IUEAP) Consultation Paper May 2015

2 Acronyms C3: Ward C3 at the current Royal Adelaide Hospital. Central Adelaide LHN: IUEAP: MHD: MH Short Stay: MOC: New RAH: PECU: RAH: RAH ED: TQEH: TQEH ED: UEAP: Central Adelaide Local Health Network. Improving Unplanned Emergency Access Pathways (project name). Mental Health Directorate. Mental Health Short Stay. Models of Care. New Royal Adelaide Hospital. Psychiatric Extended Care Unit in the current Royal Adelaide Hospital. The current Royal Adelaide Hospital. Royal Adelaide Hospital Emergency Department. The Queen Elizabeth Hospital. The Queen Elizabeth Hospital Emergency Department. Unplanned Emergency Access Pathways. 2

3 Introduction As part of our ongoing Commitment to Care, Central Adelaide Local Health Network (Central Adelaide LHN) is committed to delivering the highest quality health care possible and taking active steps to continuously review and improve its services. The intent of this work is to ensure sustainable service delivery into the future, as well as preparing for enhanced service provision in the new Royal Adelaide Hospital (new RAH). As a foundation to improving our services, we are committed to best support the right consumer being seen at the right time and in the right place by the right people. The Mental Health Directorate (MHD) is a part of this thinking. To support this commitment we are improving the clinical pathways and care environments used by consumers making unplanned access to Emergency Departments. We propose to achieve these improvements with new models of care (MOC) within the current Royal Adelaide Hospital (RAH) for later adoption across The Queen Elizabeth Hospital (TQEH) and the new RAH. The major transformation stages are shown below. 1. Current state: RAH ED and PECU, TQEH ED. 2. Relocate C3 beds to Glenside Health Services 3. Development of new MOC and processes in partnership with RAH and TQEH mental health teams 4. Trial and improve processes in current RAH ED and Mental Health Short Stay in RAH East Wing 5. Inpatient and Mental Health Short Stay beds relocated to new RAH. UEAP MOC operating in new RAH and TQEH Workforce engagement and consultation This consultation paper and attached proposed model of care is being shared near completion of steps 2 and 3, and as the plan for the establishment of Mental Health Short Stay services in the RAH East Wing. We are seeking feedback on: proposed new Models of Care for Mental Health Unplanned Emergency Access Pathways and Mental Health Short Stay beds, proposed workflows for the initial implementation of the Models of Care within the current Royal Adelaide Hospital Emergency Department and Short Stay beds, proposed relocation of PECU beds to the RAH East Wing and implementation of the proposed Short Stay Model of Care using these beds. 3

4 Key Features The key features of the Unplanned Emergency Access Pathways Model of Care and Workflows include: Clearly articulated pathways to support collaborative practice across emergency and mental health teams within the Emergency Departments. Consistent parallel processing of consumers requiring both emergency and mental health care. Nurse-initiated medical screening to replace universal medical clearance for all mental health consumers presenting to triage. Early identification and actioning of appropriate care pathways out of the Emergency Departments. Clear decision-making process for safe transfer of consumers from the Emergency Department into Mental Health Short Stay (at RAH). Improved escalation protocols for consumers waiting for extended periods in any Emergency Department, to proactively support removal of barriers to transfer. Key features of the proposed relocation of PECU beds to RAH East Wing, and the proposed Mental Health Short Stay Model of Care using these beds include: Transition from universal 15-minutely observations in current PECU to criteria-led observation practices based on the existing Observation Bedded Units procedure. The ability to provide seven single bedrooms and access to a dedicated lounge / dining room. Provision of a sensory / comfort room, to improve consumers use of sensory modulation skills as self-management strategies. Increased access to interview spaces. Provision of step-down lounge facilities for consumers placed on Sub-Acute and Supported Self-Management Discharge Disposition pathways and no longer requiring a bed. Changes to the environment to support the safe operation of Mental Health Short Stay services, converting current double bedrooms to single bedrooms and the provision of after-hours secure access to facilitate transfers from the Emergency Department. Workforce considerations In changing the current Unplanned Emergency Access Pathways and Mental Health Short Stay Models of Care, to support the current workforce, it is proposed: Additional support and clinical leadership to nursing staff will be available through a Clinical Practice Consultant (CPC) position based in Mental Health Short Stay. Additional clinical support to consumers is being facilitated through improved access to occupational therapy resources, inclusive of a Comfort Room within Mental Health Short Stay. Further detail regarding the proposed Models of Care and Workflows for implementation within the current RAH ED and East Wing are provided in the attached document: DRAFT UEAP Models of Care for Royal Adelaide Hospital and Queen Elizabeth Hospital Emergency Departments. 4

5 Proposed as, the next steps in developing Unplanned Emergency Access Pathways Week beginning Major Step Released on Commence consultation on Unplanned Emergency Access Pathways model and Friday workflows. 22 May 2015 Develop East Wing transition plan with workforce. 5 June 2015 Minor works to convert former C3 space to Mental Health Short Stay. 25 June 2015 Written response to consultation feedback. PECU relocation to former C3 space in the East Wing. 30 June 2015 Commence operating as Mental Health Short Stay. Commence regular meetings with workforce to monitor and improve implementation Transition UEAP and Mental Health Short Stay models to new RAH. Providing feedback on this consultation paper We are seeking feedback from consumers, carers and workforce regarding the content of this paper, ahead of implementation in the current RAH Emergency Department and East Wing. We encourage you to provide feedback by ing todd.bamford@health.sa.gov.au. This consultation closes at 1700hrs on 20 June