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St George Emergency Department Redevelopment
Dr Trevor Chan Director of Emergency
Can building a new ED solve your NEAT?
• The redevelopment process and important factors to consider
• The major concerns prior to opening the new ED
• The hard facts and figures
• Lessons learnt and where to from here
Program
• Planning for the current new build scheme commenced late 2011 ( 50+ options and designs)
• Early works completed in 2013
• Construction of New ED main building April 2013 to mid 2014
• Occupation on 15th Oct 2014
Our Vision
To Design and build a department that meets the needs of patients, staff and
the diverse community that we
serve.
Provide a welcoming and
caring environment
Ensure patients consistently receive
timely, safe and high quality care.
Create additional capacity
supported by contemporary
models of care.
Emergency Department
Emergency Department
Emergency Department
Emergency Department
Emergency Department
Emergency Department
Emergency Department
Emergency Department
Emergency Department
St George Hospital
o Level One Trauma centre
o 2011: 62,500 presentations
o ED treatment space = 39
o And 10 bed short stay unit
o Hospital bed base 607 beds
Demographics
• Serve a population base of over 200,000
• Large CALD community 33%
• Aged population (25 % >70y)
• Paediatrics:25 % of presentations
• Admit rate of 35%
Airport
Botany Bay
Bondi
Beach
Trauma Presentations
Site map
St George Hospital ED Patient Journey
Self
Ambulance
Police
Mental Health
Adult Fast Track
Paed Fast Track
Paed Assessment
Medical Assessment and Decision Making
in EmergeNcy (MADMEN)
Acute Hall 1
Acute Hall 2
Resuscitation
Trauma
EDSSU MAU
PECC
Pharmacy
ASET
Pathology
POC Testing
Imaging
Physiotherapist
MH CNC
Specialty Team Review
NEAT
Home
Wards
Operating Theatre
CCU / HDU / ICU
Transfer
Mode of Arrival Model of Care Reception Essential Support Services Disposition
T R
I A
G E
R E
G I S
T R
A T I
O N
Initial discussions
• Staff engagement
• User groups
• Executive support
• Project Managers and Architects
• FFE ( Furniture , fixtures and equipment)
Medical Assessment & Decision Making in EmergeNcy
(MADMEN)
Dr Trevor Chan – Director SGH ED
Allan Ajami – NUM SGH ED
2012 2013 2014 2015
Phase 1 Phase 2 Phase 3
Move into new ED (March 2014)
ED Redevelopment
4 Hr RuleED Flow Co-ordinator
Triage Cat 2
2011
Point of Care testing
JMO eMR entry
Pre-Lead
Reduce work place variations in senior staff practiceIntern Assignment
Admit Phone
Individual phones
Reduce overheads
Streamline ED FormsSTOP
Reducing the frequency and volume of interruptions
Decrease non-specialists tasks being done
eMR efficiency
JMO Assignment
Dual Med Reg cover
Dual Surg Reg cover
ED Pt Flow Coordinator
ED Clinical Notes documentation
ED workforce review PA, ED techs
Surgical Assessment Unit
MAU after hours admission criteria
Dual ED SS cover 7 days ED SS cover P3
Team Structure P2 Team Structure P3
Day Shift Roles Evening Shift Roles
Phase 4.....
LEAD
St George Emergency Department: MADMEN
Solutions timeline: The ED Vision
Models of Care
• Transfer of Care
• Triage
• Team based model for medical staffing
• Emergency Journey Coordinator
• Resuscitation rooms
• Changes to ED SSU
• New Adult Fast track
• Paediatric
Old ED
What needed to be improved?
• Improvement to the waiting areas and public access
• Ambulance bay parking
• Adult and paediatric treatment spaces
• Resuscitation bays
• Isolation rooms
• Mental health assessment areas
• Teaching, training and staff facilities
Pretty Much Everything!
What were we expecting?
• Site visits for design and flow
• QLD- Princess Alexandria, Townsville, Royal Brisbane
• NSW- Royal North Shore, Nepean, John Hunter
• How busy where the new hospitals?
• New Hospital vs New ED only
Change Management
• Identify all changes and their impact
• Engage stakeholders (internal and external)
• Manage resistance and expectations
• Service/ Operational readiness
• Transitioning and commissioning
Transition day WED 15th OCT 2014
• Planning for the move is the key to a smooth day- bed availability
• Open new ED at 0800, closed old ED at 0800
• No transfers from old to new
• Old ED staffed with senior staff to decide disposition, including paediatrician, medical physician and surgeon
• Signage, CDA, local councils
St George83% NEAT ?%81%
The NEAT Challenge
St George Emergency
Presentations per year 2008 54876
2009 59017
2010 59755
2011 62653
2012 66507
2013 67682
2014 70010
NEAT
0
20
40
60
80
100
Jul-12 Sep-12 Nov-12 Jan-13 Mar-13 May-13 Jul-13 Sep-13 Nov-13 Jan-14 Mar-14 May-14 Jul-14 Sep-14 Nov-14 Jan-15 Mar-15 May-15 Jul-15 Sep-15 Nov-15
Percentage
NEAT Percentages
Discharged Combined Admitted
TARGETS2013 - 76%2014 - 83%2015 - 90%
Schematic design-Ground floor
Relationships, flow and models of care
Detailed design
Detailed design-colour schemes
Detailed design
Don’t forget
• ICT and Comms considerations
• Security and Fire
• Infection control
• Consumer engagement
• Media
• Australian Health Facilities Guidelines
• ACEM Emergency Department Design Guidelines
ER
Staffing• Medical: Open with same staff. Long lead in
time to recruit. Relied on new medical year in Feb 2015.
• FACEM 3/2 Monday to Friday and
• 2/2 Sat and Sun
• REGS 4-5/4/2, SRMOs 2/2/2, JMOs 12/6 FTE
• Nursing: Triage model and design. Teams of 2 per 6 beds. Flexible to bed base per shift.
• FTE increased from 105 to 146
Staffing
• Clerical: Based on model of care for clerical registration FTE from 19.4 to 24.4
• Orderlies: Size of department
• FTE from 8.3 To 11.7
• Corporate services- cleaning, linen, kitchen, security
• Satellite radiology staffing
Back of bus
St George Emergency
Artistic Impression Actual photo
The numbers
0.0
20.0
40.0
60.0
80.0
100.0
NEAT Statistics
Admitted Discharged Total
0
500
1000
1500
2000
Presentations
New EDOld ED
10 Lessons learnt
• 1. Start the model of care change process at the same time as the design process
• 2. Schematic design very, very, important
• 3. Engage widely for specific areas but maintain decision making for the core user group
• 4. Some-one needs to have attention to detail
• 5. What do you want, really, really want
10 lessons learnt• 6. Start the case for staffing early and
maintain your resolve
• 7. Remember ICT, Communications Radiology, pathology, media, rest of the hospital
• 8.Build for flexibility and for the future
• 9. The new building is the beginning, not the end
• 10. It won’t solve NEAT but it will help if other factors line up
How can we improve?
• Fast track review
• Medical staffing review
• Communication system
• IT integration
Stage 2 – Acute services Building
Old ED
