EMpoweR

Non-Admitted Patient (NAP) consultations and consultations for new, unknown children make up almost 50% of total consultations undertaken by the neurology team at Sydney Children’s Hospital (SCH), Randwick. The purpose of these consultations is to provide advice for patients currently not admitted to SCH or unknown to the hospital, and are requested by external clinicians (e.g., paediatricians, general practitioners, emergency departments) via multiple avenues (e.g., phone, pager, e-mail). These consultations take place at all times of the day, in the middle of an already busy in-patient workload, with less than 5% of said consultations currently documented in the Electronic Medical Record (eMR).

Important clinical decisions are made during these consultations and ideally, these communications should be documented in the eMR. Accurate and efficient documentation accessible by all clinicians improves staff communication, patient handover, patient safety and quality of care. ¹ Whilst patients do not directly interface with eMR documentation, understandably, there are significant indirect consequences to patient safety and care.

Communication of consultations is historically done via various platforms and documented inconsistently. Our organisation’s centralised platform for patient records (eMR) is used ineffectively. It is perceived as non-user-friendly, time-consuming and difficult to access on the go. Despite recognising the importance of documentation, the current workflow of receiving external consultations is overwhelming for clinicians and documentation has not been a priority within this workflow.

This project aims to improve workflow within the neurology team to support clinicians in documenting these consults in the eMR. We expect to ensure accurate, clear and consistent documentation of consults occurs in the eMR. The eMpoweR team have identified the following solutions, with implementation currently ongoing:

• Generation of a Medical Record Number (MRN) by December 2023. We will utilise administrative support to generate MRNs in a timely fashion for patients not known to the health facility.
• Change to the workflow by January 2024. We will set up protected ward rounds with a dedicated Junior Medical Officer (JMO) to case manage consults.
• Implementation of a telephone triage system by January 2024. We will introduce a telephone triage system, refining incoming consultations into three categories: emergency calls addressed by a senior clinician immediately, priority calls addressed by the allocated JMO and “non-urgent” calls directed to an electronic referral system.

View this project's poster from the Centre for Healthcare Redesign graduation December 2023.

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