Paediatric Ambulatory Care

Paediatric Ambulatory Care The Way of The Future Dr Susan Piper Staff Paediatrician Wyong Hospital May 2009 Outline • • • • WyPAC model of care Ou...
Author: Ambrose Lindsey
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Paediatric Ambulatory Care The Way of The Future

Dr Susan Piper Staff Paediatrician Wyong Hospital May 2009

Outline • • • •

WyPAC model of care Outcomes over the first 2 years Future directions and challenges Questions / discussion

Wyong Hospital • •

No paediatric ward

• • • •

‘Universal risk’ midwifery service ~300 deliveries / year

Busy ED (~150 patients / day) with high paediatric presentations (~12 000 per year)

35 minutes to Gosford 90 minutes to Westmead 60 minutes to Newcastle

The WyPAC model of care • • • • • • •

Daily acute review clinics



‘Bridge’ between primary care / community services and hospital services for acutely unwell children + chronic and complex patients



Current operating hours 0700 – 1800 weekdays, 0700 – 1500 weekends

Short stay area Telephone follow up / support Nursing outreach / hospital in the home ED / maternity consultation / support Routine general paediatric outpatient clinics Shared care with tertiary centres for chronic and complex (eg oncology) + burns

Staffing • • • • • • •

2 FTE paediatricians (staff specialists) 1 FTE NUM 6.6 FTE RNs 2 FTE clerical 0.8 FTE porter / cleaner 2 FTE registrar Future plans for fractional allied health appointments + additional registrar / RN cover to operate 0800 – 2200hrs 7 days / week

Patients / occasions of service ~390 patients / month, ~400 phonecalls / month GP Referrals

Acute Review Clinics

200

200

150

150

100

100 50

50

0 JULY

0 JULY

OCTOBER

GP REFS 06-07

JANUARY

GP REFS 07-08

OCTOBER

JANUARY

APRIL

APRIL ACUTE REVIEW 06-07

GP REFS 08-09

Phone Support

ACUTE REVIEW 07-08

ACUTE REVIEW 08-09

Short Stay Patients

600

70

500 400 300 200

60 50

100 0

20 10

40 30

JULY

OCTOBER

JANUARY

APRIL

0 JULY

PHONE CALLS 06-07

PHONE CALLS 07-08

PHONE CALLS 08-09

OCTOBER

SHORT STAY 06-07

JANUARY

SHORT STAY

07-08

APRIL SHORT STAY

08-09

Patients / OOS cont. Wyong Emergency Dept Consultations

Maternity Consults

80

20

60

15

40

10 5

20

0

0

JULY

JULY

OCTOBER

ED CONS 06-07

JANUARY

ED CONS 07-08

OCTOBER

JANUARY

APRIL

APRIL ED CONS 08-09

MAT CONS

MAT CONS

07-08

MAT CONS

06-07

Wound Care OOS

Home Visits

200

40

150

30 20

100

10

50 0 JULY

0 JULY WOUND CARE

OCTOBER 06-07

JANUARY

WOUND CARE 07-08

OCTOBER

JANUARY

APRIL

APRIL WOUND CARE 08-09

HOME VISITS 06-07

HOME VISITS 07-08

HOME VISITS 08-09

08-09

Outcomes Paediatric Presentations by ED

 ~20% reduction in paediatric admissions from Wyong ED to Gosford

12500 12000 11500 11000 10500 10000

July 05-June 06

July 06-June 07

July 07-June 08

Wyong ED

10717

11252

12105

Gosford ED

10928

11273

11744

Wyong and Gosford ED Paediatric Admissions

 Paediatric admissions to Gosford have decreased despite an increase in paediatric ED presentations

3000 2000 1000 0

July 05-June 06

July 06-June 07

July 07- June 08

Wyong ED Admission

1017

924

823

Gosford ED Admission

2473

2226

2142

 High levels of patient / parent satisfaction on survey March 2008

Outcomes Wyong ED Paediatric Presentations and Admissions by Year 15000 10000 5000 0

July 05-June 06

July 06-June 07

July 07-June 08

Presentations

10717

11252

12105

Admissions

1017

924

823

Admission/Presentation Percentages by ED 25 20 15 10 5 0 Wyong ED Gosford ED

July 05-June 06

July 06-June 07

July 07-June 08

9.48

8.21

6.79

22.62

19.75

18.24

Challenges and barriers •

Data!!

• •

Existing data systems not suitable for recording activity Need a system linked with EMR that will allow us to accurately document a patient journey and record our activity (Western Child Health Network data project underway currently)

• •

GP awareness / communication / liaison



Operating hours don’t coincide with peak ED paediatric presentation times

Change from traditional nursing / medical models of care and staff attitudes to same

Future directions  For Wyong – Multidisciplinary team with fractional allied health appointments – Extended hours operation (ideally 0700 – 2200 7 days / week) – ? Nurse practitioner role  For acute paediatric care – Reconfigure existing paediatric inpatient units to incorporate ambulatory care (daily acute review clinic, short stay unit) – Statewide (?nationwide) paediatric ambulatory care network with uniform data collection and benchmarking – Paediatric ambulatory care options available to all children – High quality health care as close to home as possible (at home if possible)

Questions / discussion

2008 – 2009 ED data

WYONG PAEDIATRIC ED PRESENTATIONS BY MONTH 1300 1200 1100 1000 900 800 700

July

August

September

October

November

December

January

February

March

April

May

June

.05-06

792

963

946

839

865

898

860

846

950

936

840

982

.06-07

935

1077

1125

963

851

903

821

778

997

832

1017

953

.07-08

1062

1237

1041

955

938

1104

847

861

1027

882

1096

1055

.08-09

1038

1270

1064

948

960

1032

962

857

1105

1012

ED paediatric presentation times

Wyong ED Paediatric Presentations by Time

1000 800 600

2005-2006

400

2006-2007 2007-2008

200 0 0000- 0100- 0200- 0300- 0400- 0500- 0600- 0700- 0800- 0900- 1000- 1100- 1200- 1300- 1400- 1500- 1600- 1700- 1800- 1900- 2000- 2100- 2200- 23000100 0200 0300 0400 0500 0600 0700 0800 0900 1000 1100 1200 1300 1400 1500 1600 1700 1800 1900 2000 2100 2200 2300 2400

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