July 2011 E-Bulletin

The Improve and Move E-Bulletin: a monthly bulletin to keep you informed about the latest news from the I AM Chest Pain project Latest News moving into the implementation phase The I AM Chest Pain team would like to say thank you to all of those that have been involved in the project to date. It is through your efforts that the project has successfully completed the diagnostic and solutions design phases of the project. The team would like to give a special mention to all of those now getting involved in the final phase of the project - the Implementation phase.

Ten initiatives have been identified in consultation with internal and external stakeholders to improve the patient experience for adult chest pain patients. Seven initiatives are currently in development across different hospital sites (numbers shown in red) and the remaining three initiatives (numbers shown in black) are being developed further in close collaboration with the appropriate state-wide networks. An overview of the initiatives is provided in the table below: Initiative name 1 2 3 4 5 6 7 8 9 10
Monitoring guidelines Internal transfer admission guidelines Criteria led discharge

This initiative aims to:

Reduce the delay in accessing monitored beds through a review of existing monitoring guidelines. Reduce patient waiting time in ED through clarification of the process for transferring patients from the ED to the appropriate Ward/Unit/Bed. Improve the patient experience through a structured discharge process, ensuring patients are discharged in a timely manner and avoid unnecessary extra wait times. Provide clarity and agreement around appropriate use of inpatient/outpatient testing options. Build on the work that has already been done on chest pain pathways and encourage further adoption of a structured, standardised and evidence based approach. Improve access to chest pain assessment services resulting in an enhanced patient experience through more timely admissions and discharge. Develop a model that supports health professionals other than doctors to supervise stress testing. Reduce avoidable admissions through investigating a model for the provision of appropriate outpatient investigation, testing and clinic review. Reduce delays by addressing issues relating to the logistics associated with transferring patients. Define an appropriate process and develop required relationships to provide easy access to cardiology advice.

Staff Feedback:
Monitored beds [are] not always allocated to the most appropriate patient

Testing regime/policy

Chest pain pathway Improved access to chest pain assessment service (CPAS) Exercise stress test staffing mix Rapid access chest pain clinics Inter-hospital transfer

Discharges [are] occurring at 1pm rather than 10am impacting the capacity to admit patients earlier in the day

Patients can wait days as inpatients, or weeks as outpatients.

More stress tests would help all of us.

Clinical advice and support

A message from the three clinical leads that have been working closely with the I AM Chest Pain team to support guiding the project and developing initiatives:
We fully support the initiatives that have been developed through the I AM Chest Pain Project. We believe these initiatives have the ability to improve patient care, and assist with patient flow for patients presenting to the Emergency Department with chest pain of possible ACS-origin across the project sites. Tony Brown, Louise Cullen and Will Parsonage Clinical Leads with the I AM Chest Pain Project

Any questions? Contact the team, on: P: 07 3131 1420 (new number!) or
E: IAMCHESTPAIN@health.qld.gov.au Intranet W: http://qheps.health.qld.gov.au/chi/CSRP/chest.htm