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Excellence in Patient Care
Excellence in
Patient Care
This category is looking at patient experience, improvement or innovation. Previous submissions looked at mental health responses, individual patient stories, community paramedicine, and assisting high frequency 000 callers. Each service is emboldened to examine ways that their organisation has assisting specific patient cohorts where learnings were of the benefit for the field of paramedicine.
Sponsored by
Excellence in Patient Care Clinical Response to a Global Pandemic
NSW Ambulance
Team: : Martin Nichols
The aims of the NSW Ambulance (NSWA) clinical response during the COVID-19 pandemic were: • Maximise safety for clinicians
• Provide safe and contemporary care to patients, families and careers
• Ensure clinical practice is contemporary, evidence based, high quality, patient-centred and delivers value In early 2020 as Australia was observing the effects that the COVID-19 pandemic was having internationally. Accordingly, NSW Ambulance commenced planning for the pandemic operationally and clinically to ensure an effective response to the pandemic. One key initiative was the establishment of an Incident Management Team (IMT) which has been operational since early 2020. Additionally, NSW Ambulance embarked on a number of clinical initiatives to ensure that the needs of patients and clinicians were met. These initiatives included the establishment of a clinical lead role in the IMT; the establishment of a COVID-19 Clinical Practice Expert Reference Group; development and implementation of specific pandemic protocols; and the introduction of a number of clinical interventions to reduce the risk of aerosol generating procedures. These interventions included mechanical cardio-pulmonary resuscitation devices (mCPR), video-laryngoscopy, syringe drivers, continuous positive airway pressure (CPAP), and enhanced monitoring for Intensive Care Paramedics. The pandemic modifications to clinical practice continue to be reviewed monthly by the COVID-19 Clinical Practice Expert Reference Group, with oversight from the Clinical Practice Committee. This has involved both an ongoing review of emerging evidence as well as monitoring the use of AGPs to measure the ongoing impact of the pandemic modifications protocol in influencing clinical care decisions (i.e. MDI instead of nebulisation, and supraglottic airway used in preference to endotracheal intubation).
In early 2021 the NSW Health Agency for Clinical Innovation (ACI) Critical Intelligence Unit conducted a rapid evidence review of NSW1. This review did not identify any significant deviation from the evidence base and provided an added layer of external validity for the treatment modifications.
The COVID-19 ICP Update program was evaluated weekly through participant feedback and a review of clinical performance by the participants. The performance of participants was strong and the feedback evaluations reflected a high level of participant satisfaction with the program. Frequent comments included ‘best course I have ever attended with NSW Ambulance’.
The NSWA clinical response to the pandemic can be best evaluated and demonstrated by the low incidence of clinicians who have contracted COVID-19 in a clinical setting where PPE and new clinical intervention instructions have been followed. NSW Ambulance clinicians are better prepared, informed, and skilled in practices that are new or have been reviewed and articulated clearly to our front-line clinicians.
St John WA
Team: Rudi Brits (Team leader), Prof. Paul Bailey, Dan Rose and Kerryn Welke
St John WA in collaboration with Fiona Stanley Hospital (FSH) and the South Metro Health Service (SMHS) is revolutionising emergency patient care thanks to its Australia-first, Virtual Emergency Medicine (VEM) service – designed to improve ambulance and emergency department (ED) flow. VEM allows paramedics to initiate a remote consult for non-priority 1 patients aged 16 years and over, with the aim of discharging on scene or diverting them to another suitable inpatient/outpatient service. The initiative is particularly beneficial for geriatric cases. It has successfully operated for about a year at FSH since its launch in February 2021.
VEM was designed to improve patient outcomes with the aim of having far reaching impacts by significantly easing pressures on busy EDs and improve overall patient care and flow throughout hospitals and the wider WA health system. It could revolutionise ambulance patients’ transfer of care through its game changing emergency medicine model. VEM allows for a rapid pathway (e.g. ambulatory care, chest pain clinic or imaging) at FSH, or direct transport to Fremantle Hospital’s Geriatric Medicine. A concerted push for VEM consults in November resulted in one of FSH’s highest primary ED bed avoidance rates to date (n=105 out of 1235 ED cases or 8.5%) and signaled improved patient turnaround times. With SMHS providing initial and ongoing funding and resources, the WA government committed a further $2.3 million in the 2021 budget for SMHS to expand the service to Rockingham and Peel hospitals. As Omicron spreads in WA, much effort has gone into utilising VEM for COVID-19 cases, with the aim of expanding to Royal Flying Doctor Service admissions, burns patients, and engage with GPs. Eventually other patient cohorts can be identified, such as mental health consumers and direct patient/family contact.
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