Orange Health Service Emergency Department

Your info 'One Stop Shop'

This website is where you will find information about the OHS Emergency Department, its function and all manner of useful templates, guidelines, learning materials and proforma's for your work in the ED.

Feel free to get in touch if you want anything else added.  Please be patient, it is being developed all the time

**This site is UNOFFICIAL.  It is by and for the ED staff.  It is not affiliated with, formally endorsed by nor representative of Orange Health Services or NSW Health**

The EPIC Project: 

Emergency Physician In-house challenge 

click to view larger version

click to view larger version

Why?

  • Stressful working environment
  • Often heavy workload
  • Perception of 'digging a hole in sand'
  • Lack of engagement with educational activities especially WPBAs (work place based activities)
  • Poor recruitment and retention of staff especially in UK
  • Juniors have to work in ED even if they don't want to, as part of rotations

Background

Interesting talk about rewarding the brain and what makes people so addicted to gaming on TED.com by Tom  Chatsworth (http://www.ted.com/talks/tom_chatfield_7_ways_games_reward_the_brain)

click to link to the full online Pennine Newsletter

click to link to the full online Pennine Newsletter

I started to think that maybe we could introduce some of those motivating, fun principles to our work in the ED and thus EPIC was born. To my knowledge (and a literature search) there is nothing like this out there currently.

We managed to get funding from Better Training Better Care, a part of Health Education for England for a 1 year pilot project in The Royal Oldham Hospital, Lancashire, UK which ran from August 2012 to August 2013.

It has proved very popular and successful and has now rolled out to all the other ED's in Pennine Acute NHS Trust and we are looking at introducing it in Orange, NSW.  It is currently being written up for submission for publication.

Aim

  • Motivation
  • Competition with peers and see where you sit on a live 'Dashboard'
  • Early detection of outliers, with reward for 'high fliers', and early support for those struggling
  • Improved educational activities (medical student teaching, WPBA's, courses etc)
  • Encourage positive (audit, service improvement, procedures) and discourage negative (coming late, patient complaints) activities through giving or fining credits (respectively)
  • Recognition from peers and others as you move from 1 level to the next level (Levels 1-6) with medals and certificates (in the pilot small actual prizes e.g. gift vouchers, iPod shuffles etc were given)
  • Use of gathered data to guide training needs with trainers

How? 

  • See Project Details
  • See Rule Book and detailed Process
  • Credits earned by seeing patients (weighted for triage category) and linked automatically to Dashboard
  • Credit slips filled completed and entered into Access database & linked to Dashboard for medical procedures (weighted), Work Place Based Assessments (WPBAs), taking medical students for the day, Audits, life support courses etc. Some grade specific (e.g sedation for Registrars)
  • Bonuses for early WPBAs completed, seeing patient between 7-8am (traditionally a lag period)
  • Rarely fines for complaints, repeatedly arriving or leaving late
  • As certain credit score levels reached, person moves from Level 1 up to 6 with small prizes at each level
  • Overall highest score for the year award
  • Top 2 high scorers on Dashboard have names on (rest anonymous) to give encouragement
  • EPIC steering group with representatives form all trainee groups to guide changes, rules etc

Results

Dashboard for Foundation Doctors

Dashboard for Foundation Doctors

  • it was FUN! & well received by trainees (and trainers)
  • Productivity improvement of 20% in JMO (FY2, GPVTS, ACCS etc) grade
  • Massive improvement in educational activities, especially WPBA's (25% in foundation docs and 2-3 fold increase in GP VTS and ACCS groups)
  • No increase in adverse incidents or complaints over the period despite increased workload

See full report HERE

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