Improving the emergency department patient experience
NSW Health provides the best clinical care in the world. The Improving Patient Experience in the Emergency Department (ED) pilot aims to improve peoples’ experience by creating an environment that makes patients, carers and their families feel welcomed, safe, cared-for and empowered.
The improvement program is being tested in four emergency departments at Blacktown, Lismore, Liverpool and Nepean. The pilot will run over a six month period commencing from November 2018 with the pilot scheduled to be completed in May 2019.
The Pilot Program aims to enhance the patient experience by ensuring patients:
- Know who to report to when they arrive at the emergency department
- Are communicated with by staff in a caring manner appropriate to their circumstances
- Receive information on what to expect during their time in the emergency department
- Have access to water, refreshments, free Wi-Fi and other essentials
- Can keep key communication devices charged within the waiting environment
- When waiting for care are updated on when they are likely to be seen, the status of test results and any delays
- Are provided with key facts about tests ordered, their clinical condition and what to do once they have completed their visit to the emergency department
The pilot supports the implementation of the NSW Health Emergency Department Patients Awaiting Care policy. This is an evidence based policy that describes the requirements for NSW Emergency Departments to care for patients waiting for treatment to commence.
The pilot program includes four strategies that were derived from completing a system and local stocktake of current patient experience activities, identifying existing policies and guidelines, reviewing Bureau Health Information survey data and through the Clinical Excellence Commission scrutinizing the Incident Information Management System (IIMS) and patient complaints in relation to patient experience.
Patient Experience Manager
The Patient Experience Manager role is being trialled in the pilot sites for 6 months. This role is a non-clinical role that was partly informed by the principles of the concierge role in Service NSW centres.
The components of the Patient Experience Manager role are:
- The Patient Experience Manager is a non-clinical role
- During the pilot, two Managers are allocated to each emergency department participating in the pilot
- Managers work principally during the peak demand times however also work a range of shifts to understand the challenges across the day and support staff development
- Consistent with the Service NSW concierge role, the Managers have been recruited according to interpersonal skills and personal resilience including working with challenging behaviours
- Strategy 2 Information Technology has a range of strategies that support the Manager in their role
NSW Ministry of Health project team, the pilot sites and Service NSW have worked collaboratively to design a training and mentoring program to support the Patient Experience Managers in the emergency department. There are two models being tested a secondment and a buddy model. Meetings are occurring weekly to work through the logistics and risks associated with both approaches.
There are three components to the information technology strategy. A mobile application for patients and carers, enhancements to the existing Emergency Access View (EAV) application and the provision of a NEXA customer feedback kiosk at each pilot site.
Mobile application for patients and carers
A web based application that enables information to be sent to patients and their carers’ mobile device is being trialled.
An adult ‘Welcome to ED’ animation that has been developed and translated into nine languages. The animation describes the emergency department process and is based on information contained in the existing “welcome to the ED” paper brochure. A second child friendly animation is in the process of being developed.
The Agency for Clinical Innovation patient fact sheets developed by the Emergency Care Institute are linked to the application and can also be sent to a patient’s device on discharge.
Enhancements to EAV
EAV is a real-time dashboard displaying live patient demand and key patient flow metrics. This tool has been further developed for the use of the Patient Experience Manager and clinical staff to:
- View all patients in the ED Waiting Room
- Provide staff with information to facilitate conversations regarding the next steps in the patient’s care
- Enhance communication about patient progress in the ED system
- Document information such as parents needing to collect children from school, able to eat and drink, interpreter requirement
- View other information about patient activity across the whole Emergency Department (e.g. total number of patients in the ED, number of ambulances waiting to offload, patients by triage category)
Customer Feedback Kiosks
The Customer Feedback kiosks allow the four pilot emergency departments to collect specific patient and carer experience data. The real-time data capture is used to assist with process improvements throughout the pilot. The questions in the kiosk reflect questions in the Bureau of Health Information ED Patient Experience Survey and allows for free text comments by patients and families. Each site is able to view their results on a simple web application. At the end of the six month pilot sites can choose to keep the kiosk but will need to continue to pay for ongoing licensing and Wi-Fi access.
Department amenity and facility design
There are two components to the amenity and facility design strategy. A gap analysis was completed with Health Infrastructure, NSW Ministry of Health and the pilot sites to identify quick facility improvements in the waiting room. A longer term approach to facility design based on the outcomes of the pilot will be recommended for future ED facility design.
Quick facility improvements
The gap analysis identified a range of simple enhancements to improve the waiting room experience for patients and families.
Each site now has comfortable seating, free patient Wi-Fi, mobile device charging stations, water, and tea and coffee vending machines. The gap analysis included the assessment of way finding and confusing information such as multiple posters on the walls.
The Australasian Health Facility Guidelines (AusHFG) for the Emergency Unit is currently under revision and is being led by Health Infrastructure, recommendations have been given as part of the pilot for items to be included in that document.
A package of initiatives is being trialled to support staff working in the emergency department reception, triage and waiting areas with the aim to provide professional support, and enhance skills and capability in customer service.
The Pam McLean Centre have conducted two half day workshops at each of the pilot sites. The interactive workshops explored current approaches to communication and customer service by staff working in the reception areas, to challenge current thinking and practices.
Content from the workshops will form the scripts for a series of educational videos created by the Pam McLean Centre. The videos will be available to all NSW EDs to be used either in staff orientation or during inservice to facilitate reflection and discussion about customer service in ED.