Rapid Cardiac Assessment Unit
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Rapid Cardiac Assessment Unit Presenter: Damian Miners Hospital: Prince of Wales Hospital Key contact person for this project Roger Huntington Nurse Unit Manager, Cardiology Unit 3 North Prince of Wales Hospital [email protected] (02) 9382 0206. 30 March 2007 - Auckland.

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30 March 2007 - Auckland

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30 march 2007 auckland

Rapid Cardiac Assessment UnitPresenter: Damian MinersHospital: Prince of Wales HospitalKey contact person for this project Roger HuntingtonNurse Unit Manager, Cardiology Unit 3 NorthPrince of Wales [email protected](02) 9382 0206

30 March 2007 - Auckland


Key problem

KEY PROBLEM

  • Access block in Emergency Department identified Cardiology patients as one of the highest users of this service, along with Aged Care & Respiratory patients.

  • Access to cardiac beds limited by number of outlier patients in cardiology unit

  • June 06 average LOS in ED for ACS patient was 6.3 hours

  • June 06 access for ACS patients was 79%


Aim of this project

AIM OF THIS PROJECT

  • Provide a twenty four hour short stay unit

  • Expediting timely access for low to intermediate risk patients with chest pain to the cardiology unit.

  • Reduce length of stay in hospital for low to intermediate risk chest pain patients

  • Improve patient outcomes by prioritizing clinical assessment and provision of seven day stress testing.

  • Funding costed through clinical redesign of services


Aim of this project1

AIM OF THIS PROJECT

Project KPI’s

  • Improved cardiac access from ED - target 80%

  • Number of patients admitted to RCAU

  • % of patients exceeding 23hrs LOS in RCAU

  • Representation rates RCAU into ED within 48 hours

  • % patients requiring admission from RCAU

  • % patients requiring stress test within 24hrs of admission to RCAU

  • Patient & staff satisfaction


Key changes implemented

KEY CHANGES IMPLEMENTED

  • Cardiology statewide NSW DoH initiative

  • Executive support

  • Opened 4 bedded Rapid Cardiac Assessment Unit (RCAU) in June 2006

  • A clinical pathway was developed and implemented in the emergency department on admission

  • Criteria expanded to include patients with new onset Atrial fibrillation, investigation of syncope, short term cardiac monitoring and heart failure patients

  • This initiative required the medical team to prioritise clinical review and treatment of these patients to maintain 24 hour service

  • The opening of the RCAU required an additional 1 RN (1FTE). This also afforded senior nursing staff the opportunity to extend clinical and assessment skills working in an autonomous environment

  • Bed management required a generic cardiac population


Outcomes so far

OUTCOMES SO FAR

Av 6.3 hours

Feb 2007 - average ED LOS 4.5hours


Outcomes so far1

OUTCOMES SO FAR

  • RCAU LOS <23 hours

  • Aim to reduce ED LOS to < 3 hours


Outcomes so far2

OUTCOMES SO FAR

RCAU 4 beds – short stay flows

Flexible bed practice – other cardiology patients utilising RCAU beds.


Project evaluation

PROJECT EVALUATION

  • What would you recommend to other organisations?

  • Require adequate bed base to accommodate RCAU

  • Strong stakeholder communication and collaborative relationships esp. around ED physicians

  • Executive support essential

  • 3:2:1 target

  • Must be protocol driven but requires a level of flexibility between - coronary care

    - Thoracic Unit

    - RCAU


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