1. CLINICAL TASKFORCE UPDATE Peter Castaldi 19 June 2007 ACHSE Executive

2. CLINICAL TASKFORCE Future Challenge is Chronic Disease: l Prevention - smoking, medications, lifestyle l Primary Care - pivotal - team work and continuity l Integration - Clinical Governance - incident monitoring - institutional renewal

3. CLINICAL TASKFORCE Large Hospital Emergency Department 24 Hour 130 – 180 presentations 50 – 60 admissions (42%) 30 – 40 medical – includes older multi-system

4. CLINICAL TASKFORCE Roadblocks: Queues for tests - CT Negotiating specialties / sub-specialties Referral to clinics / rooms Specialist : RMO ratio ED 1:4 for 30 patients Ward 4 : 2-3 for 10 – 30 patients

5. CLINICAL TASKFORCE Clinic Referral for those not admitted: Specialist availability in clinics or rooms ED is 24/7 Rooms 9/5 Post Acute Care – effective route

6. CLINICAL TASKFORCE ED – Community: Post-Acute Care (PAC) for defined conditions (pneumonia, cellulitis, DVT, anaemia, musculo-skeletal, seizures) Camden – Campbelltown experience NZ experience Pegasus Health (PCO) 230 GPs – acute admissions project Community alternatives to hospital care Effective with decline in ED attendance and acute admissions

7. CLINICAL TASKFORCE Collaboration required: Community - GP CAPAC (Community Acute / Post-Acute Care) ED clinicians

8. CLINICAL TASKFORCE Information Exchange: Access from outside Feedback The ideal is one record

9. CLINICAL TASKFORCE Undifferentiated Symptom Complex: (breathless, chest pain, fever, delirium) No ‘General Physicians’ Referral to specialist – which? Consultation process may be protracted

10. CLINICAL TASKFORCE Physician Taskforce: Develop care pathways Provide access to assessment – acute & early follow-up Define acceptance / responsibility Establish acute care location

11. CLINICAL TASKFORCE Resistance to Change:  'We are not paid to ponder'  "Nurses are trained to follow guidelines, we are trained to break them"  Brand et al, Engineering a safe landing...... Int Med J 37, 295, 2007

12. CLINICAL TASKFORCE Leadership l From whence? l Coordinate, attract, inveigle, coerce l Lead from within l Bottom-up reform works - eg St Vs, JHH l "Commitment and not compliance"

13. CLINICAL TASKFORCE Leadership: From AHS – collaboration between GPs, ED Clinicians, Physician Specialists From NSW Health – eg. Clinical Redesign improving access to assessment, treatment & follow-up From Physicians – availability, prompt discussion, appropriate consultation & referral, engagement of craft groups