NSW Ambulance Year in Review 2014/15

34 Pages·2016·1.71 MB·English

excellence in care
NSW Ambulance Year in Review 2014/15
NSW Ambulance Year in Review 2014/15 1
Introduction
2014/15 has been a year of strategic Ambulance Infrastructure Reconfiguration culture. We updated our CORE Values
and operational milestones for NSW Program will improve 25 stations outside and produced a brand new poster for
Ambulance. We are continuing to of metropolitan Sydney, benefiting staff stations and workplaces across the
implement innovative developments in the and patients. This upgrade represents the state. We examined what a staff focused
way we deliver care as a mobile health largest single program of improvement organisational culture looks like through
service that takes care of patients, not just work ever to take place on our rural our Signature Behaviour workshops with
a transport service that takes patients to ambulance services. staff, which resulted in the identification of
hospital. Our Making Tomorrow Different specific behaviours that are needed today
We changed our name to NSW Ambulance
initiative was officially recognised in to make tomorrow’s culture different.
and changed our branding. We improved
November 2014, winning the NSW Health From the workshops, Our Eight Signature
our organisational structure, removing two
Integrated Health Care Award. Behaviours were developed, a matrix
tiers of management, creating a leaner,
developed by staff for staff to improve the
The NSW Ambulance Strategic Plan flatter and more responsive management
way we work together.
2015-2017 maps out the destination we’ve structure. We also reduced the number
set for the future of ambulance services of committees, ensuring the right mix of The new paramedic uniform was also
in NSW and builds on the Reform Plan representation is involved in every decision developed in consultation with our
for NSW Ambulance and the Reform Plan making process. The NSW Ambulance frontline staff and has been rolled out
for Aeromedical (Rotary Wing) Retrieval Advisory Council was renewed, with new sector-by-sector. This accompanied
Services in NSW. members appointed to advise on the a new uniform policy and operating
provision of ambulance services in the procedure, as well as a poster motivating
Changes to the response grid are assisting
state. staff to “Wear the most trusted uniform
us to prioritise the most urgent life
with pride”.
threatening cases; while increasing the use Our Professional Standards and Conduct
of secondary triage to Healthdirect allows Unit changed its name to the Professional I am proud of all achieved this year. This
callers to be directed to the right care, the Standards Unit, coming into line with is an exciting time for NSW Ambulance as
first time. Our formal partnership with the other emergency services and focusing we embark on creating more innovative
National Home Doctor Service and the on education, support, liaison and ways to provide first class emergency
Australian Locum Medical Service for after investigation. Our focus on staff this year frontline medical care to the people of
hours medical deputising services will see continued with the launch of our new NSW.
further improvments to our delivery of care electronic web based timesheet system
to patients out of hours and in an out of eTime - a user-friendly, more efficient
hospital setting. system.
David Dutton BM ASM
As part of a centrally coordinated, Although an organisation can have the
A/Chief Executive
locally delivered mobile health service, best strategic plan in place, it is never
the Paramedic Response Network will going to be successful if its culture is not
reshape our service delivery model for right. 2014 was the year for safety at NSW
metropolitan Sydney, enabling strategic, Ambulance, with the launch of Destination
sophisticated and dynamic deployment NONE: Not One; Not Ever with the aim
to meet community and patient need. The of reducing workplace injuries. In 2015,
$122 million allocated as part of the Rural the spotlight focused on improving our
NSW Ambulance Year in Review 2014/15 2
A year of reform patient centred, staff focused
THE REFORM PLAN FOR NSW of NSW Ambulance is complete, with the The implementation of the Reform Plan risk management, communication, crisis
AMBULANCE Whole of Hospital (WoH) program driving has assisted to ensure patient care is management and the health system.
improvements in patient flow, which delivered in a coordinated way across the
The journey
In December 2012, the NSW Minister coupled with sound handover training entire health system, increasing the ability
for Health released the Reform Plan procedures, is enabling paramedics to of paramedics to respond to urgent life The NSW Ambulance Advisory Council
for NSW Ambulance, which outlines be released more quickly to respond to threatening emergencies. provides advice to the Chief Executive on
emergencies in the community. Improved
five strategic directions aimed at the provision of ambulance services to the
NSW Ambulance is designed to make a
services for nursing home residents has
improving ambulance services for the community. The NSW Ambulance Advisory
difference to people’s lives in seconds
also been delivered via the release of
NSW community. NSW Ambulance was Council is not designed to supersede the
and minutes. However, if a patient
“building partnerships” - a framework
tasked with leading its implementation role of our management structure, rather
doesn’t require emergency assistance,
for integrating care for older people with
and formed a high level steering it will enhance it. The NSW Minister for
NSW Ambulance will build on the
complex health needs.
committee comprising key stakeholders Health appointed the following members
initiatives contained within the Reform
from across the health system to Strategic Direction 4 Ensuring NSW Plan to provide and/or coordinate an to the Advisory Council:
oversee the process. Ambulance has effective infrastructure alternative pathway of care with other • Ms Robyn Kruk AM (Chair)
The journey and has a funding model that will ensure health providers which meets the • Ms Patricia Azarias
financial sustainability in the future and patient’s needs in the right way, at the
• Adjunct Associate Professor Walter
Implementation of the Reform Plan has Strategic Direction 5 Strengthening the right time, every time.
Kmet
concluded. Of the 34 reforms contained leadership, workforce and governance
in the Plan, 33 have been completed structure of NSW Ambulance and The implementation of the • Mr Lewis Kaplan
and one is progressing in accordance embracing the CORE values of Reform Plan has assisted to • Ms Julie Babineau
with the wider reform program for non- Collaboration, Openness, Respect and ensure patient care is delivered • Dr Anthony Burrell
emergency patient transport. Empowerment have also been completed
in a coordinated way across the • Mr Raymond Creen ASM
with updated delegations being issued
Strategic Direction 1 Integrating NSW entire health system, increasing
across the organisation to assist streamline • Ms Julie Morgan
Ambulance within the broader health the ability of paramedics to
approval processes and delegate • Ms Kathryn Wood
system has been delivered and has
responsibility. A Leadership Framework has respond to urgent life threatening
resulted in improved working relationships The future
also been developed to enhance the skills emergencies.
between NSW Health entities. A
of the NSW Ambulance workforce. The NSW Ambulance Advisory Council
centralised booking system to manage
NSW AMBULANCE ADVISORY is to meet quarterly, with four meetings
Non-Emergency Patient Transport (NEPT) Formal monitoring of the implementation
scheduled over the next 12 months.
requests has been implemented and a of the Reform Plan has now concluded COUNCIL
range of providers are being engaged to and the Steering Committee has been The refreshed NSW Ambulance Advisory
deliver NEPT services. disbanded. The initiatives contained Following the release of the Reform Plan Council will continue to help NSW
within the Reform Plan have helped for NSW Ambulance, the Chief Executive Ambulance make a difference to providing
The implementation of Strategic Direction
to shape the way for the strategies sought to refresh the NSW Ambulance an even better workplace for our staff and
3 Developing new models of care and
contained in our Strategic Plan, Making Advisory Council membership to enable further improve the service we provide to
investing in new providers to effectively
Tomorrow Different. better representation of individuals with our patients.
manage demand, have a positive impact
expertise in process redesign, finance,
on response time, reduce paramedic
fatigue and improve the operating costs
NSW Ambulance Year in Review 2014/15 3
A year of reform patient centred, staff focused
NSW AMBULANCE to enhance communication and
GOVERNANCE FRAMEWORK engagement in the decision making
process. All other management and
The NSW Ambulance Corporate governance committees are well on
Governance Framework is aimed at the road to meeting the aims of the
driving performance improvement to Framework.
meet our obligations and legislative
The future
requirements. The Framework
outlines the interactions between The Framework allows a continual
management, governance and evolution to ensure organisational and
advisory committees designed service delivery objectives are met
to assist us monitor and drive effectively, efficiently and transparently.
performance, achieve our In the future the governance,
organisational goals and objectives management and advisory committees
and deliver on government reform. will be continually reviewing their aims to
ensure they align with the objectives of
The framework will mean staff the NSW Ambulance Strategic Plan.
can raise ideas, issues and This initiative will help NSW Ambulance
concerns with managers, staff by enhancing collaboration across
fostering a consultative process. the organisation in the decision making
process. It will also provide a mechanism
within which staff are able to raise ideas,
The journey issues and concerns with managers as it
fosters a consultative process. This will
The Corporate Governance Framework
improve staff engagement and morale,
provides a cohesive set of governance
thereby improving the services we offer
procedures for ensuring NSW
to our patients.
Ambulance is managed in the best
way possible and undertake policy and
service delivery responsibilities in an Mechanisms have been put in
open, accountable and ethical way.
place to enhance communication
Existing and new management, and engagement in the decision
governance and advisory committees making process.
started the process of aligning to the
new Framework throughout 2014 and
2015. As at 30 June 2015, the Executive
Leadership and Senior Leadership
Teams have put in place mechanisms
NSW Ambulance Year in Review 2014/15 4
A year of reform patient centred, staff focused
HELICOPTER RETRIEVAL proven track record, faster air speed and The future significantly enhancing the delivery of
SERVICES PROCUREMENT greater range than the current fleet. All 12 services via improved on scene response
The next 12 months will be a critical phase
new aircraft will be identically configured times with attending personnel utilising
in the implementation and will see the
On 17 July 2013, the NSW Minister for to ensure standardisation of operations, the latest in medical, rescue and aviation
arrival of the new aircraft, commencement
Health released the Reform Plan for maintenance, training and provide equipment and training. Retrieval services
of aircraft medical fit-out, substantial
Aeromedical (Rotary Wing) Retrieval resourcing flexibility. will be provided throughout NSW on a 24/7
completion of base building works, detailed
Services in NSW, which addresses the basis from all bases. Staff will have access
transition and training plans in place, and
second part of the Strategic Review of The new concept of operations substantial completion of the necessary to brand new state-of-the art aircraft and
NSW Ambulance. A key recommendation road vehicles, training facilities, bases, and
will significantly enhance the administrative systems and regulatory
of the Aeromedical Reform Plan was for rescue and medical equipment in order to
delivery of services via improved approvals to commence operations.
the review of the service delivery model provide the highest standard of care and
to rationalise provider numbers and response times with attending The new concept of operations will a safer operating environment in which to
aircraft types, standardise operations personnel utilising the latest in Make Tomorrow Different for patients by complete their demanding work.
throughout the state and subsequently medical, rescue and aviation
complete a procurement process to equipment and training.
provide helicopter retrieval services
throughout NSW under this new concept
of operations. Since the award of contracts, the
substantial task of contract implementation
The journey
has commenced including:
A comprehensive procurement process • internal medical fit-out design for the
was conducted by the NSW Ministry of aircraft
Health during 2014 resulting in the award • finalising aircraft configuration and
of two contracts (Northern NSW and commencing construction
Southern NSW) on 16 December 2014 for
• designing five new bases and
the provision of 24/7 Helicopter Retrieval
modifications to a further two
Services. The new contracts have an initial
• transition planning from current to new
term of 10 years with a further optional term
operators and bases
of up to five years and will commence on
a staged basis between January and June • planning the transition and ongoing
2017. training of staff
• commencing development of revised
The contracts include the provision of
operational, safety and administration
fully maintained helicopters, aircrews and
systems
ground support staff, base facilities and a
state-of-the-art training centre in Sydney. • ongoing implementation of the Integrated
An Agusta Westland AW139 helicopter Risk and Safety Management System
was selected as the most suitable for • seeking necessary development and
fulfilling the multi-purpose roles due to its aviation regulatory approvals.
NSW Ambulance Year in Review 2014/15 5
A year of reform patient centred, staff focused
OPERATIONAL RISK PROFILES across the network. This process, which
– AEROMEDICAL RETRIEVAL sets standards and a feedback loop, also
provides NSW Ambulance and its staff
The Reform Plan for Aeromedical with the necessary level of assurance of
(Rotary Wing) Retrieval Services in safe practice.
NSW defines the requirement for an
The introduction of Operational Risk
enhanced risk and safety management
Profiles provide staff with the assurance
system to be embedded into the
that the aeromedical retrieval system they
Aeromedical Division. Part of this
work within meets industry best practice
safety system is formal operational
standards; and that a robust system exists
risk management. Given each aircraft
to ensure that any intended changes to
has a composite crew across several
mission profiles, processes or equipment
aviation operators, a common risk
also meet the same standards.
understanding is to be achieved through
operational task profiling. The future
The journey Of the 61 ORPs, 42 have been
implemented with the remainder to be
The development of Operational Risk
completed by Dec 2015. Importantly, any
The introduction of Operational Risk Profiles provides staff with the
Profiles (ORPs) commenced in 2013.
intended changes to operational practice
A suite containing 61 individual ORPs assurance that the aeromedical retrieval system they work within meets
are now subject to the same rigorous risk
cover every operational level aviation industry best practice standards
management process.
task necessary for aeromedical retrieval,
including flight operations, operational
tasking, maintenance and facilities.
Each ORP is built by establishing the
sequence of steps each mission requires
(task profile), then grouping steps and
assessing the risk of these groupings for
each mission. Each risk is then assessed
in further detail to establish treatments to
ensure that this risk is tolerable and as low
as reasonably practicable.
2014/15 has seen the introduction of ORPs
into the aeromedical retrieval network,
providing a benchmark for existing
practices to be measured. Gaps identified
are treated to comply with the NSW
Ambulance ORP achieving consistency
NSW Ambulance Year in Review 2014/15 6
Making tomorrow different patient centred, staff focused
Our new concept of operations delivers the right care to the right patient at the right time - every time. Our patient centred, staff focused
approach is seeing improvements in everything from the way we deliver care, develop our staff and make decisions, from infrastructure to
eHealth. Although change of this magnitude will take time, we are steadily making progress.
URGENT CARE BOARD The journey The future callers to the right care, the first time.
The functional dispatch of ECPs has been The project will align with the work streams The journey
An Urgent Care Board was established
shown to improve overall efficiency in of the Paramedic Response Network,
at the Sydney Control Centre in In 2013/14 ambulance referred 27,140
several jurisdictions. Matching the correct where development of a modified
February 2014 as a six month Proof calls to healthdirect. Monthly service
resources to patients is critical to the sustainable model is being achieved.
of Concept (PoC), aiming to improve improvement meetings are held with
success of specialist models which target Clinical assistance will be provided to
the utilisation and overall efficiency of healthdirect to discuss operational
predetermined patient groups. both ECPs and control centre staff to
extended care paramedics (ECPs). The processes and identify improvement
enhance resource matching, increase
trial continued until October 2014 when By having an ECP in the control centre opportunities to ensure the best possible
capacity for paramedic crews and support
it was ceased for evaluation. The PoC during the PoC, the number of ECP patient journey.
the Sydney Control Centre with incidents
showed large increases in the use of patients requiring a double paramedic
ECP-relevant pathways, medications crew emergency ambulance fell to and decisions improved by application of During September 2015, four new
and interventions, reflecting a 2643 (33.6 per cent). Before the trial, secondary triage, clinical reasoning and Medical Priority Dispatch System
significant increase in the tasking of 47.5 per cent of all ECP attendances risk mitigation. (MPDS) determinants were approved
ECPs to appropriate patients. It also required an ambulance, and based on REFERRAL OF LOW ACUITY for secondary triage eligibility. These
showed an increase in the proportion of 7869 attendances by ECPs, the number PATIENTS TO HEALTHDIRECT determinants related to patients triaged
patients transported by ECPs. requiring a double paramedic crew under the sick person category for
vomiting, unwell/ill or with a new onset of
emergency ambulance would have been The referral of patients to Healthdirect
These factors reduced the demand on
immobility, as well as those patients who
3941 patients in the pre-PoC period. Thus, allows non-serious and non-urgent
double paramedic crews on emergency
have no priority symptoms following an
the PoC resulted in 1298 fewer double described conditions to be further
ambulances, releasing them from
accidental poisoning.
paramedic crew emergency ambulance triaged by Registered Nurses, with
unnecessary transports, freeing them
from hospital delays and increasing responses and transports. the opportunity to provide alternate As a result of the new determinants, an
their availability to respond to patients As a result of the PoC, the rate of dispatch care and referral pathways which may additional 9968 patients were referred to
who required an emergency ambulance of ECPs to ECP appropriate responses avoid an ED presentation. For patients healthdirect in 2014/15, which represents
response. more than tripled from 19.3 per cent to an referred back to NSW Ambulance, our a 36.7 per cent increase; the total referred
goal is to improve our understanding was 37,117.
astounding 64 per cent.
of their clinical condition and in turn
schedule an appropriate response. The future
Our new concept of operations
NSW Ambulance commenced the referral Over the next 12 months, MPDS
of a patient-centred mobile
of eligible secondary triage callers to determinants will continue to be reviewed
health service is to increase the healthdirect on a 24/7 basis in April 2013. for opportunities as secondary triage
use of secondary telephone A strategic priority as part of our new eligible. In addition, our processes for call
triage to direct callers to the concept of operations of a patient-centred referral and receipt will continue to be
right care, the first time. mobile health service is to increase the reviewed and refined to ensure patients
use of secondary telephone triage to direct are provided the right care, the first time.
NSW Ambulance Year in Review 2014/15 7
Making tomorrow different patient centred, staff focused
CLINICAL PROGRAMS models of care to drive further refinement. SNAPSHOT
EVALUATION
The journey
Service Delivery • enhancing the utilisation of single
Efficient use of NSW Ambulance The last year has seen a renewed focus responders
To ensure our patients receive the right
resources benefits patients as well as on assisting project managers to develop • providing alternative transport options
care at the right time, we need to provide
our organisation. Strategies developed evaluation strategies as part of the for non-urgent patients who need care
the right response everytime, whether it is
by NSW Ambulance ensure paramedics planning phase of new initiatives. This but have no transport
a life threatening emergency or urgent and
can deliver the right care to the allows necessary data to be collected to
unscheduled care. We have incorporated • introducing after hours medical
right patient at the right time – every ensure a robust evaluation of the clinical,
a number of initiatives on the frontline to deputising services.
time. Thorough evaluation of these operational and financial impact of new
support the right response decisions:
strategies highlights the successes and models of care in order to drive further The future
identifies areas for refinement so all refinement. • triaging Triple Zero (000) calls to ensure
• increasing the referral rate for appropriate
patients can enjoy a fast, reliable and the right response for the right patient
Major evaluations have been performed on secondary telephone triage
clinically-appropriate response to their • increasing the use of secondary
a number of clinical projects including: • simplifing the response priority system
emergency. telephone triage to direct callers to the
• Urgent Care Board proof-of-concept, • further improving our dispatch process
right care, the first time
NSW Ambulance has • Non-ED Alternate Referral trial • using improved control centre • expanding tacticians and clinical advisors
implemented programs to conducted in the Central Coast zone processes and technology that support in control centres
encourage paramedics to work • Mental Health Acute Assessment Team. our emergency response to patients • increasing the rate of single responder
and extended care paramedic responses
outside the historical “treat and Many of the strategies developed • implementing agreed response
to appropriate patients
transport” model, considering are novel to the out of hospital care timeframes for patients requiring urgent
“treat and release” and “treat community. An important focus of the last and unscheduled care • using alternative transport for appropriate
and refer” options. The role of 12 months has been to highlight these patients.
NSW Ambulance strategies by developing
Clinical Programs Evaluation is to
conference presentations and journal
develop monitoring strategies for
papers for publication.
these initiatives and to evaluate
the clinical, operational and NSW Ambulance is also working with
our partner agencies to evaluate the
financial impact of new models of
whole-of-health impact of innovative
care to drive further refinement.
clinical initiatives, especially around major
programs like the cardiac and stroke
NSW Ambulance has implemented reperfusion programs.
programs to encourage paramedics to
The future
work outside the historical “treat and
transport” model, considering “treat and
Much of the focus will be on collaborating
release” and “treat and refer” options. The
with project managers to prospectively
role of Clinical Programs Evaluation is to
build evaluation initiatives into project
develop monitoring strategies for these
plans, coupled with a continued focus on
initiatives and to evaluate the clinical,
publication of NSW Ambulance clinical
operational and financial impact of new
innovations.
NSW Ambulance Year in Review 2014/15 8
Making tomorrow different patient centred, staff focused
MEDICAL DEPUTISING Early analysis shows adequate uptake
SERVICES of this program by paramedics with a
possible trend of increasing utilisation.
NSW Ambulance recognises the The most commonly referred conditions
changing focus from pre-hospital care are cough/fever, nausea/vomiting, back
to out of hospital care and aims to pain and falls.
provide patients with the right care in
The program can be easily duplicated
the right place at the right time.
in line with the service providers’ plans
The Medical Deputising Service initiative to expand their services into the Central
aims to build on existing alternate referral Coast, Illawarra and larger regional
pathways for patients with low-acuity centres.
conditions, providing more suitable care
for patients who call Triple Zero (000), We recognise the changing
but whose condition does not require focus from pre-hospital care to
transport to an Emergency Department out of hospital care, providing
(ED). Previously, transport of these patients with the right care in the
patients resulted in long delays in the ED,
right place at the right time.
preventing the unavailability of paramedic
to respond to more urgent cases.
The future
The journey
At least one of the providers is preparing
Feedback from paramedics highlighted to commence operation in the Central
difficulties in providing patients with a Coast area. NSW Ambulance is continually
referral outside standard GP practice looking for opportunities to form
hours. NSW Ambulance sought relationships with Medical Deputising
expressions of interest from services to Service providers outside the Sydney
provide bulkbilled, after-hours GP home Metropolitan area. New relationships are
visits to patients referred by paramedics in also being established with additional
the Sydney metropolitan area. service providers to expand the range of
options for paramedics to refer suitable
NSW Ambulance entered into an
patients to after-hours GP services.
agreement with two Medical Deputising
Services, with the program commencing
in February 2015. Referrals to the
Medical Deputising Services have
reduced case cycle times and increased
ambulance capacity as well as reducing
demand on EDs.
NSW Ambulance Year in Review 2014/15 9
Making tomorrow different patient centred, staff focused
IS YOUR URGENCY AN The Future by LHDs, community groups, emergency messaging will remain relevant throughout
EMERGENCY? CAMPAIGN departments, health clinics, aged care 2016 and campaign elements will be built
The campaign will continue to allow greater
facilities, schools, pharmacies, stakeholder upon to ensure continuance of community
collaboration between NSW Ambulance
The Is Your Urgency an Emergency? groups and GPs. education.
and NSW Health LHDs by defining a
media and social media campaign was
unified message. Specifically designed to The campaign will assist changing The campaign can also be adopted by any
conceived to address a year round
be whole of health applicable, there are expectations of patients with low acuity health service, with interest from ambulance
whole of health problem, particularly
a range of campaign elements which are presentations across the state who call for services interstate and in the United Kingdom
experienced during the busy winter
relevant and can be adopted and promoted paramedics or attend hospital emergency regarding adopting our messaging and slogan.
season - NSW Ambulance paramedics
departments. Although timed for winter, the
attending non-medical emergencies
preventing them attending a patient
with a life threatening emergency,
potentially putting their life at risk.
The campaign aims to educate the
community on making the right call at
the right time, allowing our paramedics
to provide the right patient care in the
right place at the right time.
The journey
With the demand for NSW Ambulance
resources increasing, it was important to
educate the public on the alternative care
pathways that exist for low acuity cases;
that not every call required an ambulance.
The campaign prompted the public to
think before dialling Triple Zero (000),
ensuring appropriate patient care and the
best use of NSW Ambulance resources.
The first of its kind for NSW Ambulance,
the hard hitting, factual and thought
provoking campaign was carefully
designed to be whole of health relevant
to not only support NSW Ambulance, but
the wider health system we belong to. The
campaign is made up of four posters, an
urgency and emergency gauge, a raft of
key messages and interactive video and
photo content.
NSW Ambulance Year in Review 2014/15 10