Improving the ma na g e me nt of a dult pa tie nts pre se nting - PowerPoint PPT Presentation

Improving the ma na g e me nt of a dult pa tie nts pre se nting to the E me rg e nc y De pa rtme nt a t SWH Wa rrna mbool with a tria l fibrilla tion with ra pid ve ntric ula r re sponse , throug h the de ve lopme nt of a n e vide nc e ba se d c linic a l pa thwa y. e a d . Sue Ande rton (NP/ ANUM) Proje c t L Proje c t te a m: F ra nc o Sc hre ve , Christine He na , Me g a n Rie lly, Ca t Ge rvis, Be c She e n, L a ura Co nn, Ma rg Bull, E mily Ba tt a nd Chris Ba rr.

T he proble m • Atria l fib rilla tio n is c o mmo n in E D • De spite pub lishe d g uide line s va ria tio n in pra c tic e is c o mmo n • AF -RVR wa s o ne o f the to pic s a va ila b le to E D in the 2013 E CI I CN e vide nc e - b a se d c a re impro ve me nt pro je c t c yc le

Me thods • Multidisc iplina ry e xpe rt pa ne l de ve lo pe d re c o mme nde d tre a tme nt pa thwa y, inc luding drug re c o mme nda tio ns • L o c a l imple me nta tio n • Be fo re a nd a fte r e va lua tio n • E va lua tio n e ndpo ints • Pro po rtio n o f pa tie nts ma na g e d a c c o rding to a lo c a l pa thwa y • Pro po rtio n with do c ume nte d c hro nic ity o f AF • Pro po rtio n with do c ume nte d ra te o r rhythm c o ntro l stra te g y • Pro po rtio n with do c ume nte d CHADS2 sc o re (o r simila r)

D About Wa rrna mbool E

About Wa rrna mbool E D • Only E D in a rura l c ity, le ve l 2 tra uma c e ntre , 15 b e ds inc luding 2 re susc ita tio n b a ys, 24,610 pre se nta tio ns 2013. • Po pula tio n a ppro x. 34,000 • L o c a tio n 348km so uthwe st o f Me lb o urne – o n the c o a st • Wa rrna mb o o l is ho me to F e ma le So uthe rn Rig ht Wha le s June –Se pte mb e r (c a lving se a so n). • T o urism is a ma jo r drive r o f e c o no my with the po pula tio n e xplo ding o ve r summe r a nd during the Ma y Ra c e c a rniva l. • I npa tie nt c a re fo r pa tie nts with AF -RVR pro vide d b y: Ge ne ra l Physic ia ns.

T he South We st He a lthc a re Wa rrna mbool E me rg e nc y De pa rtme nt a pproa c h • E xtre me ly e nthusia stic pro je c t le a d a nd pro je c t te a m. • K no wn g a ps in the ma na g e me nt o f this pa tie nt po pula tio n. • Pre da ta c o nfirme d wha t we a lre a dy kne w. • E xpe c ta tio n this wo uld so lve the issue s surro unding the a dho c ma na g e me nt o f AF -RVR in the E D. • A pro je c t pla n wa s de ve lo pe d. • T he re wa s no inte re st o r e ng a g e me nt o utside o f the E D. • T he e vide nc e wa s e xa mine d a nd a pa thwa y wa s c re a te d.

De ve loping a nd imple me nting a pa thwa y • Cha lle ng ing ! • F e e db a c k initia lly minima l • Pa thwa y no t b e ing utilise d • Co ntinue d e nc o ura g e me nt o f c ha mpio ns • E vide nt initia l e duc a tio n did no t re a c h sta ke ho lde rs

Pa thwa y - A fe w of the dra fts

Simula tion to the re sc ue ! • We use d simula tio n o f the use o f the AF -RVR pa thwa y in multidisc iplina ry te a m e nviro nme nt. • Ma rke d inc re a se in e ng a g e me nt. • F e e db a c k wa s flo wing a nd wa s use d to furthe r the re fine pa thwa y.

Re sults • Sho we d a mo re c o nsiste nt a ppro a c h to the ma na g e me nt o f AF -RVR in the E D.  Pa tie nts tre a te d a c c o rding to a pa thwa y improve d from 0% to 41% .  Pa tie nts whe re c hro nic ity wa s re c o rde d improve d from 63% to 82% .  Do c ume nte d tre a tme nt stra te g y wa s re c o rde d de te riora te d a little 37% to 32% .  Pa tie nts with CHADS sc o re re c o rde d a lso de te riora te d a little 23% to 17% .

Suc c e ss fa c tors Ba rrie rs • De dic a te d pro je c t te a m • L a c k o f b uy-in fro m o utside o f the E D a nd • I nno va tive e duc a tio n thro ug h the use o f re a l • Susta ina b ility. time simula te d sc e na rio s to te st a nd re fine the e vide nc e d b a se d c linic a l pa thwa y a nd • T he suppo rt o f the E CI I CN.

Disc ussion a nd Susta ina bility • T he wa ve • E nc o ura g e me nt o f c ha mpio ns • A mira c le • De ve lo pme nt o f a po lic y b a se d o n e vide nc e d b a se d pa thwa y. • De ve lo pme nt o f Qua lity a nd Sa fe ty c o mmitte e in the E D.

Conc lusion • De ve lo ping a n e vide nc e b a se d c linic a l pa thwa y fo r the ma na g e me nt o f a dult pa tie nts pre se nting to the E me rg e nc y De pa rtme nt a t So uth We st He a lthc a re Wa rrna mb o o l with AF -RVR impro ve d the ma na g e me nt o f this po pula tio n. We c o ntinue to wo rk o n e xte rna l sta ke ho lde r a c c e pta nc e a nd susta ina b ility.

T ha nkyou / Re c ruitme nt • I wo uld like to tha nk the ve ry suppo rtive a nd e nthusia stic pro je c t te a m, no t tha t this is the e nd o f the pro je c t (so rry g uys) its is just in the susta ina b ility pha se .