The National Emergency Access Target (NEAT) was introduced in Australia 2011 to measure the percentage of patients who, after attending an emergency department (ED), are admitted to the respective hospital, referred to another hospital, or discharged within four-hours.
For a number of years, Royal Darwin Hospital (RDH) had consistently not met its performance benchmarks. For example, the benchmark for patients seen within four hours was 85%, but RDH’s performance was 68%.
This led to a range of issues which impacted the patient journey, including placing two patients per bed bay in the ED, and caring for patients in ward corridors. The lack of discharge policy also led to inconsistent practices, including a disparity between the time of discharge at 4pm and peak admission times to the ED at 11am.
Discharge from hospital was identified as the key action required to improve the flow of patients from the ED and increase access to beds for those who need care.
Patient and staff satisfaction surveys were undertaken to identify the extent of the problem, in addition to staff workshops and data analysis. Process mapping and root cause analysis identified two issues common to the Division of Medicine and Division of Surgery at Royal Darwin Hospital. These were:
- Patients were not aware of their Estimated Date of Discharge (EDD), which left them unprepared to leave hospital
- Multidisciplinary teams were often not aware of the patient’s EDD, causing delays to the discharge process
Miya Precision was implemented to provide an electronic patient journey board, which allows referrals and discharge information to be viewed by all staff on iPads, so better decisions can be made by multidisciplinary teams.
Miya Precision collects the necessary data and builds the clinical intelligence to best manage patient care, from the ED through to the hospital wards. Clinicians can access individual patient information on a myriad of mobile devices and view clinical information, such as pathology and radiology results as well as access clinical documentation. Furthermore, the platform identifies emerging clinical risk and highlights at risk patients.
In the ED specifically, clinical staff can quickly identify those patients nearing the National Emergency Access Target (NEAT) and plan care accordingly. The solution provides an overview of capacity and demand at both the ward and unit level, providing real-time information about open and available beds, patients coming in (together with the admission source) and potential and confirmed ward discharges.
Within six months of implementing Miya Precision, RDH recorded the following results:
- It’s NEAT performance showed steady improvement
- The number of patients moved from the ED to a ward within four hours increased by 10%
- The number of patients processed within the ED in the four hour target also increased by 10%
- The number of patients discharged by midday increased from 23% to 27%
- Staff surveys showed the electronic patient journey board was a useful tool for understanding the EDD and improving the discharge process
Following this successful project, Miya Precision was also implemented at all other Northern Territory Health hospitals.