The Role of the Assistant Director of Nursing (ADoN) for Patient Flow ‘Challenges and Opportunities’ Andrea Kelly Assistant Director Of Nursing For ED Patient Flow. Letterkenny University Hospital. Emergency Department Taskforce Unscheduled Care Forum Tuesday 4th of September 2018 Dublin Castle.

HISTORY OF THE ROLE. - Established as part of the recommendations agreed between the ED Taskforce,the INMO and the DOH/ HSE in relation to the continuing issue of ED overcrowding and trolley waits December 2015 - 26 hospitals nationally approved for ED ADON for patient flow - A role dedicated to the improvement of patient flow throughout each Hospital department and the community. - A role dedicated to strategic planning and change management for the ultimate goal of improvements in patient flow.

My first day… Quote 1: ‘Ah sure that’s great you’ll have it sorted in no time…’ Quote 2 ‘You go stand down there and take no nonsense from those Consultants ‘cause they’d admit anything’ QUOTE 3 ‘So what are you going to do about this overcrowding…’

The Plan - Building Relationships And Planting The Seeds - Removing Misconceptions - Explaining The New Role

THE CHALLENGES…… WHERE TO BEGIN………..

1. CLINICAL BUY IN 2. ACCESS TO TIMELY DIAGNOSTICS 3 1. CLINICAL BUY IN 2. ACCESS TO TIMELY DIAGNOSTICS 3. CLINICAL PATHWAYS 4. AVERSION TO CHANGE 4.ONION LAYERS!

WHAT ARE THE KEY REQUIREMENTS TO FACE OUR CHALLENGES?

THE WILL….

IDEAS…..

OPPORTUNITIES: - TAKE OWNER ’SHIP’ - NEVER A BETTER TIME TO INSTIGATE/INITIATE CHANGE - DO THE SMALL THINGS WELL - NUMBERS AND FACTS……… HARD TO ARGUE - DO WE WANT TO CONTINUE FOREVER CARRYING OUT THE SAME ROUTINE THAT WE KNOW DOES NOT WORK - WE ARE HOLDING THE KEYS FOR CHANGE ….. TO GIVE OUR PATIENTS AND STAFF AN ENVIORNMENT TO PROVIDE AND RECIEVE THE SAFE AND APPROPRIATE CARE EXPECTED.

Success’s To Date: - Safety Flow Huddle - Part Re-establishment Of AMAU For Assessment even when in Escalation - ED/AMAU/Ward CNM Forum - LUH Ambulance Turn Around Improvement Group - Liaising With Community Regarding New Pathways For The Transfer Of Patients Out To Community Hospitals In A More Efficient Manner - Working With C.A.W.T. And Their Acute Pathways Manager To Establish More Effective And Efficient Methods Of Improving Patient Flow E.G. Discharge Lounge, Timetables For Ward Rounds - ‘Home By 11’ Education Initiative For All Admitted Patients, Their Families And Carers And For The Public

To summarise…….

Thank You For Your Time And Attention Thank You For Your Time And Attention. Andrea Kelly Assistant Director Of Nursing For ED Patient Flow Letterkenny University Hospital

REFERENCES: INSTITUTE FOR HEALTHCARE IMPROVEMENTS WWW.IHI.ORG