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Update 07:ED Implementation Teams Progressing

EMP Implementation

ED implementation teams are making progress despite numerous challenges and limited resources.

  • A HSE committee, of which the EMP lead is a member, has been established to oversee implementation of the HIQA Tallaght Report. We envisage that this will bring impetus to EMP implementation at hospital level;
  • The EMP is advocating through the SDU, the Director of Quality and Patient Safety and Dr Aine Carroll, the new national Clinical Programmes Lead, for resources in the HSE Service Plan 2013 to support Programme implementation. This includes ANP posts, Consultant in EM posts, infrastructural developments and resources to support our Clinical Microsystems Improvement work. These proposals have been submitted but there is major uncertainty as to whether or not any resources will be made available for such ‘developmental’ work;
  • The Emergency Nursing Interest Group (ENIG) has been very active in recent months developing multiple work-steams, many of which are listed below. An EMP newsletter that outlines this work will be issued shortly.

EMP Work-streams

A number of work-streams and projects are scheduled for completion early next year. Please review the attached draft documents and revert with your comments before 20th December to emp@rcsi.ie

(a) Work-streams that relate directly to HIQA Tallaght Report Recommendations:

  • ED Monitoring Protocol and Early Warning Score: The Emergency Nursing Interest Group and the EMP Working Group are developing a standardised system of patient monitoring from Triage to ED departure that will be reconcilable with ward-based EWS. 

    Download:     Attachment for Review
  • Transition of care: The EMP has developed a draft protocol based on an approach that is used effectively in New South Wales, Australia. This was provided for consultation with other specialties at a Clinical Programmes Leads’ group that was hosted by the SDU. The consultation proved more difficult than anticipated and I have referred the issue to the Directorate of Quality and Patient Safety to advance it. Please note that this is still a draft protocol and your input and comments are appreciated.

    Download:     Attachment for Review
  • Ambulance Patient Handover: A standardised protocol for Ambulance Patient Handover has been developed and indicates how the time of handover is defined and monitored. The EMP, National Ambulance Service and PHECC have collaborated to develop a standardised communication approach as part of the protocol. Dr. Niamh Collins is currently developing a web-based training programme to support the protocol and this project should be ready for launch in early 2013.

    Download:     Attachment for Review
  • Ambulatory Care and Observation Medicine: Dr Jim Gray is leading a subgroup and would welcome CDU/OU pathways, protocols and SOPs to be shared within a repository so that colleagues developing CDUs will not have to start from scratch but can implement or adapt existing evidence-based care pathways.

(b) Quality of Emergency Care:

  • Clinical Guidelines: The Academic Committee of IAEM is leading guideline development for the EMP and will be seeking sign-off of draft guidelines that have been submitted or will be submitted for review;
  • Major Trauma Audit: A submission has been made to have Major Trauma Audit funded through the HSE service plan 2013. Funding has also been sought for the development of a clinical audit system using uploaded EDIS data using a methodology that is currently in the early stages of development. Further information will follow;
  • Hyperbaric Medicine: On behalf of EMP, Prof. Stephen Cusack is leading a group that is developing a national approach to hyperbaric medicine. Please send your comments to Prof. Cusack (stephen.cusack@hse.ie) copied to emp@rcsi.ie;

    Download:     Draft Pathway Attached
  • IFEM Quality and Safety Framework: The EMP proposes to structure the future development of quality indicators for the Programme around the IFEM Quality and Safety Framework. This will assist in the development of a balanced suite of QIs for emergency care. This work will also be informed by the Academic Committee of IAEM Delphi Study for Quality KPIs and discussions to take place at the All Island Forum on Quality in Emergency Medicine in Belfast on 7th December 2012.

    Download:      Attachment for review

(c) Work-streams that relate to General Practice:

  • Standardised ED discharge letter for GPs: The EMP is consulting with the HSE Primary Care Directorate, ICGP and HIQA to agree a standard dataset for future electronic discharge communication between EDs and GPs. It is recommended that in future all ED attendances will be notified to GPs electronically via Healthlink, unless a patient declines this option. Implementation of this system will be dependent on EDIS. 

    Download:     Attachment and data fields documents for review
  • GPs working on a sessional basis in EDs: The EMP developed a governance framework to support the role of GPs working as members of the ED medical team. This was submitted for consultation with ICGP in August 2012 but we still await their input. I am sharing this with IAEM members now so that any EDs that are considering developing these roles might be able to use it as a resource.

(d) Programme Support:

  • EMP website: The development of the website is progressing, albeit at a slow pace. When complete it will include a members’ section that EMP implementation teams can use to share work in progress and other resources. Slide presentations to assist implementation teams will be made available on the website and there will be links to local ED websites. Draft wireframes are attached for consultation – please ignore typos and the tag line. It was not possible to edit these prior to circulation. Any suggestions for other areas to be included in the website are welcome.
  • EDIS: We remain frustrated by the delay that has occurred with this project. Discussions are ongoing with the SDU but there is still no agreed timeline for EDIS procurement. The EMP Working Group regards it as imperative that any development of an EDIS at local level meets the specifications drawn up for an EDIS at national level. We are happy to share material that has developed with any hospitals or groups considering developing local EDIS solutions in order to ensure that de facto national standardisation occurs;
  • SDU: The EMP met with the SDU to discuss how the Programme and the SDU might collaborate to improve emergency care. This was followed up with a presentation to the SDU to outline EMP implementation to date and the Programme’s vision. The slides used in this presentation are attached so that they can be used in local presentations.

    Download:     Attached is the SDU presentation and Powerpoint slides for local use. 

EMP Working Group and Advisory Group Member Changes

  • Prof. Ronan O’Sullivan resigned from the EMP Working Group in October and the Working Group and I would like to thank him for his immense contribution to the EMP working group;
  • Dr. John McInerney stepped down from the EMP working group some months ago and we would also like to thank John for his great contribution to the Programme;
  • Ms. Geraldine Shaw has been appointed by the HSE Director of Nursing and Midwifery Services as Director of Nursing for the EMP. Geraldine’s appointment will strengthen the Programme team and our existing nursing co-leads, ENIG and the EMP working group look forward to working with her;
  • I would like to thank the members of the EMP Advisory Group that have supported development of the Report 2012. Dr Gareth Quin, as chair of ICEMT, and I have decided that it would be more efficient to have ICEMT undertake the role of EMP Advisory Group to support EMP implementation;
  • New regional and subregional leads have been nominated to liaise with Regional Directors of Operations and the RDO Programme Implementation leads until hospital groups and emergency care networks have been finalised. Attachment for information

Thanks to all who have contributed and volunteers welcome

Thanks to everyone who volunteered to participate in EMP subgroups and to everyone who edited material for the HSE A-Z web-based patient advice material. The door is always open to anyone who would like to contribute to the ongoing work of the Programme. We are developing some interesting work with the HSE Patient Advocacy Unit to increase patient participation in emergency care. Would any Consultant colleague who might be interested in this work please contact the Programme via emp@rcsi.ie.

Other Programmes

Transport Medicine – Dr Geoff King, Lead for the Transport Medicine Programme (TMP) asked that we circulate the attached executive summary of the Transport Medicine Proposal for Funding for the HSE Service Plan 2013 to IAEM members for review. The TMP proposal is premised on providing better and quicker retrieval and transfer for critically ill, time-urgent seriously ill and system-urgent patients. It is acknowledged that the proposal is a phased proposal, and as such will not meet all Ambulance, EM, AMP/Acute Surgery or Critical Care/Anaesthesia patient needs, but is a big step in the right direction. Attachment for information.

The National Clinical Programme for Older People’s Model of Care is available at:

The National Asthma Programme has issued a slide presentation that you may wish to use for Asthma Teaching in your ED. Attachment and slideset available for information.

Please contact the EMP at emp@rcsi.ie for any futher information.

Una Geary

30th November 2012

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