Toward a Statewide South Australian Retrieval Service

1. Toward a StatewideSouth Australian Retrieval Service Dr Matt Hooper

2. Outline Recent experience The challenge for South Australia Key principles A focus on: Coordination Retrieval Clinical Governance Rural GP integration Summary & future directions

3. Queensland“Beautiful one day………….. > 7 million square kilometers Population > 4 million Diverse geography Multiple key stakeholders: 8 RFDS bases 4 Community Service Providers 4 Government Rescue Bases > 20 aircraft 8 Retrieving Hospitals Regional Ambulance Variable: Coordination Competency Training Clinical oversight Quality Assurance Outcomes

4. Queensland…..perfect the next?” One service (QEMS) One point of contact 2 Clinical Coordination hubs 2 Critical Care Retrieval Hubs Harnessing assets Streamlining service delivery One key service provider Standardisation of: Staffing models Training Equipment Operating Procedures Clinical Governance

5. Service and personal achievements Recruitment Teaching and training Equipment Standard Operating Procedures Clinical Governance Research Outcomes

6. SA - Where are we now Much history Many good people Commitment to patient care Access to assets Favourable geography Opportunity for change Duplication Fragmentation Poor communication Disharmony Complexity Delay

7. The challenge To provide an integrated single service To work in unison with relevant key stakeholders across the State To effect positive change without disruption to service delivery To build on current foundations Move forward

8. Key Service Principles One service One number Uniformity of: Team appearance Training Standard Operating Procedures Audit processes One aim: Safe, effective & professional Medical Retrieval for the people of South Australia ‘A service than binds relevant key stakeholders together’ An extension of existing EMS and Health Care providers

9. Structure Referral facilities Key service providers Retrieval Coordination Resource utilisation Equipment Personnel Assets Retrieval teams Receiving facilities Clinical Governance

10. Key Coordination Principles The effectiveness of the SARS will be completely dependent upon an effective Clinical Coordination (CC) process All staff involved in CC should be clinically active, appropriately trained and involved in clinical governance activities SARS CC should be an operational partnership with the South Australian Ambulance Service (SAAS) Early notification of Primary trauma Appropriate resource utilisation Streamlined patient transport SARS CC should be easily accessed via one number (1300 ‘SARS’) or via appropriately triaged ‘000’ SAAS calls Telehealth and teleconferencing will be key tools

11. Coordination – A model SARS Coordination Centre ‘An extension of SAAS’ Retrieval Nurse/SAAS 0800 – 1800 1800 – 0800 Medical Clinical Coordinator 0800 – 1800 1800 – 2300 On-call 2300 – 0800 1300…….. Early Primary tasking Statewide Telemedicine Centre Major Incident/Disaster Coordination

12. Retrieval Teams – Key Principles There will be an ability to provide up to 3 Retrieval teams 24/7 for all modes of transport Safety, clinical outcomes, cost effectiveness and team performance are key considerations The Medical response to a primary incident is an extension of the Ambulance Service Retrieval Nurses currently have expertise in Inter-hospital Transport (IHT)* Senior Medical and Nursing staff will continue base Critical Care Unit attachment Structured ‘down time’ Familiarity: Each other Equipment Environment Operating Procedures

14. Key Principles ‘Medical Retrieval is a multidisciplinary process. All training, coordination, service delivery and clinical governance activities must reflect this’

15. Key Principles ‘A small group of highly trained people performing a complicated task frequently will deliver safer and more effective patient care than a large group performing a complicated task infrequently’

16. Retrieval teams – A model

17. Retrieval Teams M1 First call: All RW Primary response All RW IHT

18. Retrieval Teams M2 First Call: Road Primary/IHT First Call: FW tasks (via airport) Second Call: RW tasks (via nearest)

19. Retrieval Teams M3 Second Call: Road IHT/Primary Second Call FW tasks Third Call: RW tasks

20. Retrieval Teams P1*/N1# Doctor/Retrieval Nurse First call: Road from WCH RW via RAH Helipad FW via airport

21. Clinical Governance – Key Principles ‘Audit must be meaningful, multidisciplinary & layered. Furthermore, it must drive measurable improvements in patient care, service delivery and overall safety’

22. Clinical Governance – A tool Monthly Multidisciplinary Longitudinal Audit Service based Selected case(s) Cross pollination of learning: Referral facility Coordination Aviation Crew Medical/Paramedical/Nursing Data Outcomes Closing the loop Building the team Enhancing the service Improving patient care

23. Rural integration Activation Primary response within the RRZ Preparation for transport/clinical support Clinical Governance/Feedback Teaching, training and professional development

24. Activation One number (1300 SAS WRS?) Access to the right advice at the right time Not a faceless call centre Linking other support services ICARNET Maternity advice line ……………. Extending telemedicine network and support

25. Primary response SARS rapid response Increasing primary load Reduction of IHT Integration with GP Rural Emergency Response International examples BASICS UK

26. Professional development Rural Emergency Response program Combined training Bi-annual SARS training week Telemedicine support Time with the SARS Clinical Coordination Centre Retrieval activities Governance activities Refresh EMS/APLS etc. Governance activities

27. Summary A Statewide South Australian Retrieval Service is both desirable and achievable The Service must enhance and extend existing EMS and Health Care providers Key Principles will guide service delivery details Integration of and communication between key stakeholders will be crucial The Rural Medical workforce will be integral to both the transition and the ongoing function of the new Retrieval Service