Toward a Statewide South Australian Retrieval Service

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Toward a StatewideSouth Australian Retrieval
Service

• Dr Matt Hooper

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Outline

• Recent experience
• The challenge for South Australia
• Key principles
• A focus on
• Coordination
• Retrieval
• Clinical Governance
• Rural GP integration
• Summary future directions

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QueenslandBeautiful one day..

• gt 7 million square kilometers
• Population gt 4 million
• Diverse geography
• Multiple key stakeholders
• 8 RFDS bases
• 4 Community Service Providers
• 4 Government Rescue Bases
• gt 20 aircraft
• 8 Retrieving Hospitals
• Regional Ambulance
• Variable
• Coordination
• Competency
• Training
• Clinical oversight
• Quality Assurance
• Outcomes

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Queensland..perfect the next?

• One service (QEMS)
• One point of contact
• 2 Clinical Coordination hubs
• 2 Critical Care Retrieval Hubs
• Harnessing assets
• Streamlining service delivery
• One key service provider
• Standardisation of
• Staffing models
• Training
• Equipment
• Operating Procedures
• Clinical Governance

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Service and personal achievements

• Recruitment
• Teaching and training
• Equipment
• Standard Operating Procedures
• Clinical Governance
• Research
• Outcomes

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SA - Where are we now

• Much history
• Many good people
• Commitment to patient care
• Access to assets
• Favourable geography
• Opportunity for change

• Duplication
• Fragmentation
• Poor communication
• Disharmony
• Complexity
• Delay

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The challenge

• To provide an integrated single service
• To work in unison with relevant key stakeholders
  across the State
• To effect positive change without disruption to
  service delivery
• To build on current foundations
• Move forward

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Key Service Principles

• One service
• One number
• Uniformity of
• Team appearance
• Training
• Standard Operating Procedures
• Audit processes
• One aim
• Safe,
• effective
• professional Medical Retrieval for the people of
  South Australia
• A service than binds relevant key stakeholders
  together
• An extension of existing EMS and Health Care
  providers

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Structure

• Referral facilities
• Key service providers
• Retrieval Coordination
• Resource utilisation
• Equipment
• Personnel
• Assets
• Retrieval teams
• Receiving facilities
• Clinical Governance

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Key Coordination Principles

• The effectiveness of the SARS will be completely
  dependent upon an effective Clinical Coordination
  (CC) process
• All staff involved in CC should be clinically
  active, appropriately trained and involved in
  clinical governance activities
• SARS CC should be an operational partnership with
  the South Australian Ambulance Service (SAAS)
• Early notification of Primary trauma
• Appropriate resource utilisation
• Streamlined patient transport
• SARS CC should be easily accessed via one number
  (1300 SARS) or via appropriately triaged 000
  SAAS calls
• Telehealth and teleconferencing will be key tools

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Coordination A model

• SARS Coordination Centre
• An extension of SAAS
• Retrieval Nurse/SAAS
• 0800 1800
• 1800 0800
• Medical Clinical Coordinator
• 0800 1800
• 1800 2300
• On-call 2300 0800
• 1300..
• Early Primary tasking
• Statewide Telemedicine Centre
• Major Incident/Disaster Coordination

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Retrieval Teams Key Principles

• There will be an ability to provide up to 3
  Retrieval teams 24/7 for all modes of transport
• Safety, clinical outcomes, cost effectiveness and
  team performance are key considerations
• The Medical response to a primary incident is an
  extension of the Ambulance Service
• Retrieval Nurses currently have expertise in
  Inter-hospital Transport (IHT)
• Senior Medical and Nursing staff will continue
  base Critical Care Unit attachment
• Structured down time
• Familiarity
• Each other
• Equipment
• Environment
• Operating Procedures

Grad Cert Retrieval Nursing
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Key Principles

• Medical Retrieval is a multidisciplinary
  process. All training, coordination, service
  delivery and clinical governance activities must
  reflect this

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Key Principles

• A small group of highly trained people
  performing a complicated task frequently will
  deliver safer and more effective patient care
  than a large group performing a complicated task
  infrequently

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Retrieval teams A model
P1/N1
M2
M1
M3
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Retrieval Teams

• M1
• First call
• All RW Primary response
• All RW IHT

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Retrieval Teams

• M2
• First Call
• Road Primary/IHT
• First Call
• FW tasks (via airport)
• Second Call
• RW tasks (via nearest)

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Retrieval Teams

• M3
• Second Call
• Road IHT/Primary
• Second Call
• FW tasks
• Third Call
• RW tasks

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Retrieval Teams

• P1/N1
• Doctor/Retrieval Nurse
• First call
• Road from WCH
• RW via RAH Helipad
• FW via airport

Primary Paediatric Trauma rapid response via
M1 Neonatal Retrieval also via FMC
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Clinical Governance Key Principles

• Audit must be meaningful,
• multidisciplinary layered. Furthermore, it must
  drive measurable improvements in patient care,
  service delivery and overall safety

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Clinical Governance A tool

• Monthly Multidisciplinary Longitudinal Audit
• Service based
• Selected case(s)
• Cross pollination of learning
• Referral facility
• Coordination
• Aviation
• Crew
• Medical/Paramedical/Nursing
• Data
• Outcomes
• Closing the loop
• Building the team
• Enhancing the service
• Improving patient care

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Rural integration

• Activation
• Primary response within the RRZ
• Preparation for transport/clinical support
• Clinical Governance/Feedback
• Teaching, training and professional development

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Activation

• One number (1300 SAS WRS?)
• Access to the right advice at the right time
• Not a faceless call centre
• Linking other support services
• ICARNET
• Maternity advice line
• .
• Extending telemedicine network and support

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Primary response

• SARS rapid response
• Increasing primary load
• Reduction of IHT
• Integration with GP Rural Emergency Response
• International examples
• BASICS UK

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Professional development

• Rural Emergency Response program
• Combined training
• Bi-annual SARS training week
• Telemedicine support
• Time with the SARS
• Clinical Coordination Centre
• Retrieval activities
• Governance activities
• Refresh EMS/APLS etc.
• Governance activities

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Summary

• A Statewide South Australian Retrieval Service is
  both desirable and achievable
• The Service must enhance and extend existing EMS
  and Health Care providers
• Key Principles will guide service delivery
  details
• Integration of and communication between key
  stakeholders will be crucial
• The Rural Medical workforce will be integral to
  both the transition and the ongoing function of
  the new Retrieval Service