An after hours, multidisciplinary team based approach to care for Patients of Concern. Facilitated by the introduction of new nursing and medical leadership positions to provide: proactive clinical review for Patients of Concern; mentorship and support to more junior after hours staff; and new educational initiatives to improve staff recognition and response to clinical deterioration.
Up Late: An after-hours, team-based approach for patients of concern
Summary
Aim
- improve clinical outcomes for Patients of Concern
- improve patient perceptions of after hours care and safety
- improve after hours staff satisfaction
Benefits
- improved patient safety
- improved staff and patient perceptions of after hours care
- improved education in recognising and responding to acute deterioration
- improved governance with numerous quality improvement initiatives that have been able to be supported through greater visibility and measurement of problems
- outline in detail in the attached report
Background
An after hours, multidisciplinary team based approach to care for Patients of Concern. Facilitated by the introduction of new nursing and medical leadership positions to provide: proactive clinical review for Patients of Concern; mentorship and support to more junior after hours staff; and new educational initiatives to improve staff recognition and response to clinical deterioration.
Solutions Implemented
Senior clinical leadership positions are now established on evening and night shifts seven days a week. Enhanced Advanced Life Support Team (ALS) and Medical Emergency Response Team (MERT) training programs now exist for MERT leaders. Structured ward call education program with comprehensive curriculum and positive evaluation. Improved clinical handover across after hours shifts, particularly focussed on Patients of Concern and multidisciplinary in nature.
Evaluation and Results
A comprehensive evaluation strategy was undertaken with a pre-specified, mixed-methods protocol. External support was garnered from the health services research organisation AusHSI. Significant gains were made with respect to patient safety, in particular sustained improvements in the RBWH Hospital Diagnosis Sustained Mortality Ratio (86% pre / 75% post) with notable mortality risk reductions for Patient of Concern cohorts (inter hospital transfer and after hours admissions). Strong and sustained improvement in patient perceptions of after hours care were realised. Staff satisfaction and perceptions of after hours care also demonstrated improvements on repeated survey, with further supporting evidence in reduced unplanned leave and overtime for junior medical officers.