PROVINCIAL EMERGENCY SERVICES PROJECT PROGRESS REPORT presented by PHSA in collaboration With FHA, IHA, NHA, VCHA & VIHA to BC’s CEO Leadership Council April 2003 Â improving emergency services in British Columbia Province-wide solutions. Better health. TABLE OF CONTENTS EXECUTIVE SUMMARY 3 CHAPTER 1 INTRODUCTION 9 CHAPTER 2 BACKGROUND 11 2.1 The role of the PHSA.....................................................................................................11 2.2 Our objectives and goals ............................................................................................. 12 2.3 Accountability.............................................................................................................. 12 CHAPTER 3 LITERATURE REVIEW 14 3.1 Improving BC’s emergency services – a brief summary of published research ............... 14 3.2 Leverage Point One: Managing unscheduled demand ................................................... 16 3.3 Leverage Point Two: Accessing specialist care in hospitals ........................................... 18 3.4 Leverage Point Three: Dealing with congestion in the ED ............................................. 18 3.5 Leverage Point Four: Improving community linkages .................................................... 19 CHAPTER 4 ISSUES FACING BC’S EMERGENCY SERVICES – WHAT WE LEARNED 21 4.1.1 ED data analysis lacks face validity ............................................................................26 4.2.1 ED data collection systems are not standardized ....................................................... 27 4.2.2 Survey reveals many concerns, but staffing is “Problem Number One” ......................28 4.2.3 Geography and demographics ...................................................................................29 4.2.4 Pre-hospital transport and ambulance service organization.......................................30 4.2.5 Pre-hospital crews and inter-hospital transport .........................................................30 4.2.6 Nurse staffing and initial patient-nurse contact ........................................................ 31 4.2.7 Emergency physician and specialist availability ......................................................... 32 4.2.8 Diagnostic facilities .................................................................................................. 32 4.2.9 Emergency demand................................................................................................... 33 4.2.10 Options for referral ................................................................................................. 33 4.2.11 Procedures required of family physicians ................................................................. 33 4.2.13 Continuing education .............................................................................................. 34 4.2.14 Capacity of the system............................................................................................. 34 4.2.15 Physical work environment ...................................................................................... 34 CHAPTER 5 BETTER PRACTICES IN EMERGENCY SERVICES 36 5.1.1 Managing unscheduled demand................................................................................. 37 5.1.2 Accessing specialist care ........................................................................................... 38 5.1.3 Dealing with congestion in the ED ............................................................................. 38 5.1.4 Improving community linkages.................................................................................. 39 CHAPTER 6 SHORT-TERM RECOMMENDATIONS AND NEXT STEPS 47 6.1 HAs should gather better information that can contribute to better performance.........48 6.1.1 Getting started with indicators ..................................................................................49 6.1.2 Assessing inputs to the ED .......................................................................................50 6.1.3 Assessing practice within the ED ...............................................................................50 6.1.4 Assessing outputs from the ED ..................................................................................51 Ë Immediate action on Recommendation One ................................................................. 52 Â Recommendation 2 .................................................................................................. 53 6.2 A senior executive should lead system-wide planning for emergency services within each health authority................................................................................................................... 53 6.2.1 One HA has already proposed a regional coordinating structure................................ 53 6.2.2 Some initiatives will require Executive Team support for implementation in the HA .. 54 6.2.3 Clinical leadership is important................................................................................. 54 short term task group progress report – april 2003 1 6.2.4 Good data will be required to support policy development in HAs............................. 55 Ë Immediate action on Recommendation Two .................................................................. 56 Â Recommendation 3 .................................................................................................. 56 6.3 HAs should develop systemic approaches to coordinate and manage access to in- patient and diagnostic resources ......................................................................................... 56 Ë Immediate action on Recommendation Three................................................................ 57 Â Recommendation 4 .................................................................................................. 58 6.4 HAs should improve outcomes and access through better co-ordination in planning community services............................................................................................................. 58 Ë Immediate action on Recommendation Four ................................................................. 59 6.5.1 Create a province-wide information management program for emergency departments ........................................................................................................................................... 59 6.5.2 Apply Better Practice consistently............................................................................. 60 6.5.3 Use whole-system planning to manage complex issues............................................. 60 6.5.4 Develop solutions related to the patients’ journey..................................................... 61 CONCLUSION 66 APPENDICES 67 APPENDIX 1 CEO LEADERSHIP COUNCIL BRIEFING NOTE (APPROVED: NOVEMBER 18, 2002) 68 APPENDIX 2 PROVINCIAL EMERGENCY SERVICES STEERING COMMITTEE TERMS OF REFERENCE 70 APPENDIX 3 SHORT-TERM TASK GROUP MEMBERSHIP LIST 73 APPENDIX 4 INFORMATION MANAGEMENT SUB-COMMITTEE MEMBERSHIP LIST 75 APPENDIX 5 STAKEHOLDERS, CONTACTS AND OTHER CONTRIBUTORS 76 APPENDIX 6 DATA SOURCES 78 Emergency Departments...................................................................................................... 78 Emergency Room Visits for BC Hospitals by Health Authority and Health Service Delivery Area 2000/01, 2001/02 and 2002/03 .................................................................................. 83 Non Scheduled Emergency Room Visits for 2000-01 and 2001-02 ........................................ 87 APPENDIX 7 SURVEY QUESTIONNAIRE TEMPLATE & LIST OF SURVEY PARTICIPANTS 89 APPENDIX 8 JOINT PLANNING WORKSHOP 93 APPENDIX 9 TOP FIVE LIST 99 Provincial Emergency Services Project – Short Term Task Group “Top 5 list” of issues & solutions: February 6, 2003 .................................................................................................99 SHORT → LONG TERM SOLUTIONS ................................................................................ 104 SHORT → LONG TERM SOLUTIONS ................................................................................ 105 APPENDIX 10 WINTER ACTION PLANS 106 APPENDIX 11 BIBLIOGRAPHY 111 short term task group progress report – april 2003 2 EXECUTIVE SUMMARY In Chapter 1, we set out the purpose of this Progress Report, which is to improve emergency health services in British Columbia (BC). Pressures in Emergency Departments (ED) are due in part to demands upon the service, the supply of resources to meet the demands and the way in which supply and demand are managed. At times, these pressures create serious problems and may even result in unsafe patient care situations. Staff working in the ED experience frustration as they struggle to provide a safety net for more systemic problems. We acknowledge the significance of these problems and the urgent need for remedies. The work presented here will only partially address these very grave concerns. This Progress Report focuses on immediate actions that can be implemented without delay for modest costs. Therefore we have concentrated on those actions most likely to create the greatest impact. Recognizing both the pressures and the urgency, we have tried to identify “leverage points” where strategic actions can have big effects. Chapter 2 sets out the Background for the Provincial Emergency Services Project (PESP), including the project structure with a Steering Committee, Short Term Task Group (STTG) and Long Term Task Group (LTTG).