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CLINICAL TASKFORCE UPDATE

ACHSE Executive. CLINICAL TASKFORCE UPDATE. Peter Castaldi 19 June 2007. CLINICAL TASKFORCE. Future Challenge is Chronic Disease: Prevention - smoking , medications , lifestyle Primary Care - pivotal - team work and continuity

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CLINICAL TASKFORCE UPDATE

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  1. ACHSE Executive CLINICAL TASKFORCEUPDATE Peter Castaldi 19 June 2007

  2. CLINICAL TASKFORCE Future Challenge is Chronic Disease: • Prevention - smoking , medications , lifestyle • Primary Care - pivotal - team work and continuity • Integration - Clinical Governance - incident monitoring - institutional renewal

  3. CLINICAL TASKFORCE Large Hospital Emergency Department 24 Hour • 130 – 180 presentations • 50 – 60 admissions (42%) • 30 – 40 medical – includes older multi-system

  4. CLINICAL TASKFORCE Roadblocks: • Queues for tests - CT • Negotiating specialties / sub-specialties • Referral to clinics / rooms • Specialist : RMO ratio • ED 1:4 for 30 patients • Ward 4 : 2-3 for 10 – 30 patients

  5. CLINICAL TASKFORCE Clinic Referral for those not admitted: • Specialist availability in clinics or rooms • ED is 24/7 Rooms 9/5 • Post Acute Care – effective route

  6. CLINICAL TASKFORCE ED – Community: • Post-Acute Care (PAC) for defined conditions (pneumonia, cellulitis, DVT, anaemia, musculo-skeletal, seizures) • Camden – Campbelltown experience • NZ experience Pegasus Health (PCO) • 230 GPs – acute admissions project • Community alternatives to hospital care • Effective with decline in ED attendance and acute admissions

  7. CLINICAL TASKFORCE Collaboration required: • Community - GP • CAPAC (Community Acute / Post-Acute Care) • ED clinicians

  8. CLINICAL TASKFORCE Information Exchange: • Access from outside • Feedback • The ideal is one record

  9. CLINICAL TASKFORCE Undifferentiated Symptom Complex:(breathless, chest pain, fever, delirium) • No ‘General Physicians’ • Referral to specialist – which? • Consultation process may be protracted

  10. CLINICAL TASKFORCE Physician Taskforce: • Develop care pathways • Provide access to assessment – acute & early follow-up • Define acceptance / responsibility • Establish acute care location

  11. CLINICAL TASKFORCE Resistance to Change: • 'We are not paid to ponder' • "Nurses are trained to follow guidelines, we are trained to break them" • Brand et al, Engineering a safe landing...... Int Med J 37 , 295 , 2007

  12. CLINICAL TASKFORCE Leadership • From whence? • Coordinate, attract, inveigle, coerce • Lead from within • Bottom-up reform works - eg St Vs , JHH • "Commitment and not compliance"

  13. CLINICAL TASKFORCE Leadership: • From AHS – collaboration between GPs, ED Clinicians, Physician Specialists • From NSW Health – eg. Clinical Redesign improving access to assessment, treatment & follow-up • From Physicians– availability, prompt discussion, appropriate consultation & referral, engagement of craft groups

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