www.iaem.ie [email protected]

Update 08: Hospital Management & EMP Implementation

EMP Implementation

Hospitals have been asked to provide updates on EMP implementation in response to a request from Ms. Laverne McGuinness, National Director for Integrated Services and Dr. Aine Carroll, Director of Clinical Programmes and Strategy. This aims to focus hospital management teams on the need to support EMP implementation and the work of EDs. Feedback on progress will be collated and shared with hospitals and the HSE management team.

Major Trauma Audit

The inaugural meeting of the National Emergency Medicine Audit Committee of the National Office of Clinical Audit (NOCA) took place on Thursday 26th June. The Committee will focus on implementation of Major Trauma Audit over the next 18 months. EM representatives on the committee are Ms. Fiona McDaid (CNM3/Nursing Co-lead EMP; Ms. Ger Shaw (DON for EMP); Ms. Trish Houlihan; Dr. George Little; Mr. Gerry Lane; Prof. Ronan O’Sullivan (PEM) and Dr. Conor Deasy (Chairman).

Advanced Nurse Practitioner Strategy

A Report and Strategic Plan to Enhance ANP Nursing Services across Emergency Care Networks has completed consultation and will be published shortly. This will recommend a phased increase in the number of registered ANPs in emergency care to 147 nationally.

ED Nursing Workforce Framework Study

A project is underway to develop a framework tool to assist ED teams in managing their nursing staffing requirements. This is being led by Ms. Susanna Byrne, EMP Nursing Workforce Planner. It has been sponsored by the Office of the Nursing and Midwifery Director (OMNSD) and is being undertaken by the Royal College of Surgeons in Ireland, Institute of Leadership.

Medical Workforce Issues

A strategy document Building and Sustaining an Emergency Medicine Medical Workforce has been published and the EMP is actively engaging with HSE MET with regard to ongoing staffing shortages in EM.

Audio Visual Separation of Children in EDs

Capital funding has been approved to enable small infrastructural projects to enable the audio visual separation of children in EDs where this is a problem. The EMP is advocating for more significant future capital funding for new builds to replace EDs that have inadequate infrastructure.

Clinical Microsystems Quality Improvement Training

The first phase of ED team training in Quality Improvement (QI) coaching using the Dartmouth Institute Microsystems Academy methodology commenced with a two-day on-site training session at RCSI on 11th and 12th June 2013.

Teams from EDs that did not participate in this first course will be invited to participate in the second phase that will commence with a web-based training session next January and on-site training in March 2014. This is an unprecedented investment in knowledge and skills training in EM in Ireland enabled by the National Leadership and Innovation Centre of the Director of Nursing and Midwifery Services. It will enable ED teams to drive QI within their EDs and hospitals. I wish to express the EMP’s grateful thanks to the OMNSD National Centre for Leadership and Innovation for its support for this initiative.

Work-streams that relate directly to HIQA Tallaght Report Recommendations

  • ED Monitoring Protocol and Early Warning Score: Ms. Fiona McDaid has been seconded to lead the pilot phase of the Patient monitoring and Clinical Escalation Protocol, thanks to the support of OMNSD. First phase pilot sites include: Galway University Hospital, Sligo Regional Hospital and St. James’s Hospital, Dublin;
  • Transition of care: Discussions regarding the EMP draft protocol at the newly established Clinical Programmes Unscheduled Care Group led to the development of referral guidance that has been distributed. This is not as detailed as our proposed protocol but is nonetheless a step in the right direction;
  • Ambulance Patient Handover: Dr. Niamh Collins and colleagues have completed development of the web-based training programme to support the protocol and we are currently awaiting resourcing of a pilot implementation in one ECN following which the protocol will be extended nationally;
  • Ambulatory Care and Observation Medicine: Dr. Jim Gray is leading a subgroup that is making considerable progress in the development of CDU pathways, protocols and SOPs. These can be used by EDs with existing CDUs or in the planning of new CDUs in the future;
  • Triage Audit: ENIG is progressing guidance on Manchester Triage Score audit which will be published in the next 3 months;
  • Standardised ED discharge dataset for GP letters: The EMP is awaiting publication of the HIQA Standards for Discharge Documentation before final sign-off of the ED discharge dataset;
  • Guidance on the Management of Patients who Leave Before Completion of Treatment and Unscheduled Returns: These documents are in the final stages of consultation and will be due for release in the coming months.

Other EMP Work-streams

  • Clinical Guidelines: The Academic Committee of IAEM has published guidelines for the ED management of pain in children and adults. A broad suite of clinical guidelines is nearing completion and will be published in the coming months;
  • Infection Prevention and Control Protocol: The adult protocol has completed consultation but the Paediatric Protocol requires further work. Congratulations to Dr. Damien Ryan and colleagues for their poster presentation to the 3rd National Patient Safety Conference on their work in University Hospital Limerick, on which the national protocol is based;
  • EMP website: Nil to report for now – progress anticipated in coming months;
  • EDIS: Nil significant to report. Awaiting SDU/Clinical Programmes’ progress;
  • Irish Children’s Triage Pilot: The pilot is now complete and further testing will occur in the coming weeks. Well done to all involved – it is a superb piece of work. This is will be an extremely significant development for EM in Ireland and will have ramifications outside Ireland. The next step will involve consultation with external stakeholders and within EM.
  • Mental Health Patient Transport Guidance: A guide to assist matching staff clinical levels and mode of transport with the care needs of patients with mental health problems in the Emergency Department is being developed through a collaboration of the Liaison Psychiatry Faculty, the National Ambulance Service, PHECC and EMP. Special thanks to Dr. Emily O’Conor and Mr. Mark Doyle for their leadership in this work;
  • Mental Health Post Triage Observation Tool: A prioritisation tool for patients with mental health needs is currently being piloted and, on completion, will be further developed and rolled out to sites;
  • Patient Visiting Protocol: A national protocol is currently under development;
  • Major Emergency Plan Template: This has been successfully developed and completed under the direction of Mr. Mark Doyle. An electronic template for hospitals to generate their own tailored plans is currently under development;
  • Palliative Care Project: A QI project is being progressed as a collaboration between the Irish Hospice Foundation, the Palliative Care Programme and the EMP to improve awareness of end-of-life care issues in the ED setting.
  • LIU Staffing Guidance & Training: A model for staffing of LIUs is in the final stages of consultation before release. A draft plan for training in LIUs has been drawn up and being progressed. An LIU subgroup is being formed to help share experiences and challenges in the transition to LIU care.
  • Admin Project: A project is being designed to examine administrative and reception functions in the ED setting to determine how these functions might be aligned with achieving better quality, value and patient experiences of emergency care;
  • Excel Training: for Clinical Nurse Managers is being piloted which will be extended to other groups, if required.

EMP Working Group Membership Changes:

  • Ms. Sinead Lardner, CNM 3, Our Lady of Lourdes Hospital Drogheda has been appointed by the HSE Director of Nursing and Midwifery Services as Nursing Co-lead for the EMP and is already making a significant contribution to the EMP working group.
  • Dr. Ciara Martin is now the Paediatric Emergency Medicine representative on the working group.

Thanks to all who have contributed and volunteers welcome

Thanks to everyone who volunteered to participate in EMP subgroups to date – there is plenty more work to go around, so volunteers are always welcome! Please contact the EMP at [email protected] for any further information.

Una Geary,

5th July 2013.

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