Wednesday, November 16, 2011

Consumer Focus Group on the Emergency Department at Calvary Hospital

In September, HCCA convened a focus group of consumers on their experiences of the Emergency Department at Calvary Hospital. This was done in conjunction with the ACT Health Directorate’s Emergency Care Network Coordinator and the Project Lead of the ED Redesign Project Calvary Health Care.  The focus group was attended by five people from within the HCCA membership who had recent experiences in the Emergency Department at Calvary.

The aim of bringing these people together was to gather information from them as consumers about their Emergency Department experiences and what they deemed ‘worked well’ and ‘didn’t work well’.  The information gathered at this session has been fed back into Calvary’s Emergency Department Redesign Program and will potentially assist Calvary Health Care towards improving the care provided to patients who present at Calvary’s Emergency Department.

The Redesign Team are using the Picker Institute Dimensions of Care as their framework in which they analyse comments.  NSW Health  have developed this model also.  A useful overview of these dimensions is available on their website.  The consumer comments their comments and the issues raised have been aligned to the Patient–Centred Dimensions of Care model. It provided an interesting insight into the quality of services delivered in the ED.

What did consumers say?
Overall the feedback was positive. However there were a number of instances where the experiences highlighted areas where improvements could be made.

Positive experiences included:
- the level of priority given to a male patient who presented with a shoulder injury, was seen by a doctor then transferred directly to TCH.  This patient was advised by doctors at TCH that had Calvary not acted so swiftly there was potential for him to have lost his arm. Spectrum:  Access, Coordination
- Patients felt that when staff knew the patient, respect was increased.  Spectrum: Respect

Negative experiences included:
- a patient who was ‘appalled’ by her treatment. On arrival by ambulance at 16:00hrs with a shoulder injury, she was initially ‘very impressed’ at being transferred directly onto a bed in a treatment area but then waited until 23:00hrs to be assessed by a doctor. She felt the lack of communication and the length of the delay in being seen was unacceptable. Spectrum: Access, Communication, Comfort, Respect
- concerns about staff not hearing patients who were repeatedly asked about allergies, however at no point was anything documented. Spectrum: Access, Communication, Comfort, Respect
- shift-handovers where discussions took place in a loud voice and in front of other patients - no privacy leading to the patient suffering a deal of embarrassment. Spectrum:  Communication, Comfort, Respect.
- an elderly patient waited several hours to be admitted after arriving by ambulance in the early morning. During this time a faulty ‘alarm’ rang continuously in both the ED and the upstairs area.  Spectrum: Comfort, Access 
- a patient presented with chest pain and was taken to a bed immediately where she was surrounded by doctors and nurses who all appeared confused about what medication was being given to her and why.  None of them communicated to her who these people were or who was responsible for looking after her. She then overheard one of the people ‘whispering to another to get an ambulance’ to transfer her to TCH.  She was questioned by staff as to ‘who removed a tube?’ but felt too sick to know or respond. The patient was then told upon discharge at TCH that she should not have been transferred to TCH in the first place. Spectrum: Emotional Support, Coordination, Information, Respect.
- criticism regarding the availability of interpreters available at Calvary. Spectrum: Respect for Patient Values, preferences.
- Pain management team not aware of treatment regime for patient.  No consultation with GP regarding patient medications and needs whilst an in-patient.  Information the patient provided was disregarded leaving the patient feeling she wasn’t being listened to. Spectrum: Coordination, Information, Respect.
- a patient who was misdiagnosed twice and sent home. When they returned a third time was diagnosed with shingles.  This patient spent six weeks in a ward then six weeks in rehab. Spectrum: Access,  Comfort, Coordinate, Respect, Transition
- Patient perceptions generally are that they are scared as to how their presentation will be perceived by the staff, patients idea of an emergency is interpreted differently by hospital staff. Spectrum: Access to care,  Emotional support, Respect.

Where to from here?
Focus group participant feedback is being reviewed by the Calvary team along with other responses from patient interviews, surveys and patient satisfaction reports, enabling the gathering of key themes and areas of improvement.  This information will then be documented in a brief report which will form part of the larger ED Redesign Project Paper.  During this time the participants are being kept informed by receiving copies of the Calvary Emergency Department Newsletter and a copy of the Patient Perspective report once it’s completed.

Kerry Burton
National Access Program
Consumer Coordiantor

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