RAPID is a collection of projects that were developed by staff at Shoalhaven Hospital to address a range of issues. These issues contributed to a delayed medical patient journey across three areas: limited bed access, aged care assessment team referral process, fragmented interdisciplinary communication.

The Paediatric Access Support Service (PASS) aims to transfer patients to and from Sydney Children’s Hospitals Network inpatient settings efficiently. This would reduce associated workload, and improve the patient and staff experience.

An auditing process at Sydney/Sydney Eye Hospital revealed that patients are not as involved as they could be during the routine bedside handover processes that occur between nursing shifts. A project was established to address this, and in doing so, improve the safety and satisfaction of the patient.

This program evaluates and re-invents St Vincent's Hospital’s weekly rapid discharge rounds model. This is carried out by introducing ward-level clinical leads and creating better documentation around discharge plans. The goal is to improve safe and timely patient discharges.

The I AM Project aims to implement a more sustainable and accurate screening process at Prince of Wales Hospital for patients who are malnourished, or at risk of malnutrition.

This project brings together patients, families, carers and healthcare staff to act as partners in care and treatment planning.

Wollongong Hospital implemented a program to optimise the pre-operative haemoglobin and iron stores of patients undergoing major elective colorectal, upper gastrointestinal tract and orthopaedic surgery. This will prevent avoidable blood transfusions and their complications, along the patient peri-operative journey.

NSW Ambulance introduced a falls package to address the year-round problem of falls in people aged 65 and over in the community. It incorporated a new falls risk assessment, protocol, clinical pathway and screening tool for paramedics, as well as education materials for consumers and general practitioners.

Broken Hill Health Service in Far West Local Health District implemented the person-centred sunflower tool, to improve communication and build a rapport between staff, patients and carers.

Nepean Hospital provided patients in a trial ward with a template containing prompts, so they could deliver a handover of their healthcare journey once a day to nursing staff.

Murrumbidgee Local Health District developed a process to ensure all patients have a best possible medication history recorded on admission to hospital.

Sutherland Hospital implemented a new procurement process, to provide staff with efficient access to products that deliver safe patient care in the right place, at the right time.

Royal North Shore Hospital designed and implemented an efficient, patient-centred model of care in the transit lounge, which improved patient flow and satisfaction.

Sutherland Hospital Mental Health Rehabilitation Unit implemented new policies and processes for managing admissions, then educated staff on the changes.

Hunter New England Mental Health implemented a new screening tool and staff education to ensure patients with delirium are provided with the right care pathway.

This project addressed barriers experienced by nursing staff when using the malnutrition screening tool, by introducing staff education, streamlined education pathways and a cheat sheet for nursing staff.

MNCLHD introduced a number of solutions to improve the flow and patient journey through its Mental Health Acute Care Services.

This project conducted a review of the care delivered to patients admitted to the oncology and palliative care wards at Westmead Hospital. As a result, changes were implemented that aimed to improve the coordination of care, reduce length of stay and streamline the discharge process.

MLHD identified an alternative option for iron replacement therapy and developed guidelines to deliver it in the community setting where clinically indicated, in collaboration with patients and carers.

This project aims to reduce waiting times and improve the quality of care delivered to orthodontic patients at the Sydney Dental Hospital.

Mirrabrook Mental Health Unit introduced a new policy to help nicotine-dependent consumers quit smoking during their inpatient stay. It was supported by staff training, nicotine replacement therapy and carbon monoxide monitoring.

This project will implement a number of solutions to reduce clinical variability and length of stay in acute adult mental health inpatient units. These include a new model of care, new care coordination and discharge process, new patient flow and demand management systems, enhanced consumer engagement, and workforce review and development.

Macksville Hospital developed a 24-month New Graduate Program for nursing staff that involved a 12-week intensive induction period, with clinical exposure and support over the course of the program.

Blacktown Hospital educated administration staff on the importance of maintaining accurate contact details in patient records. It also displayed signage in the emergency department to remind families and carers to include their contact details on the patient’s admission form.

The structured interdisciplinary bedside rounds (SIBR) project involved a restructuring of the Medical Unit at Orange to allow care to be delivered via daily interdisciplinary patient and family-centred rounds delivered in plain English with collaborative care and goal planning involving patient, family and the multidisciplinary healthcare team.

This project improved education and workflow processes around medication administration, to reduce instances where patients either don’t receive their medication or don’t have a documented reason as to why their medication was not administered.

The project will identify barriers to compliance and introduce solutions that aim to improve nursing assessments for new admissions at St George Hospital.

The Subjective, Objective, Assessment and Plan (SOAP) methodology was selected as a prescriptive documentation style for use in all nursing progress notes. Staff education and resources were provided to support the implementation of this methodology in clinical practice.

Prince of Wales Hospital developed a communication pathway that reported incidental findings, unexpected findings and changes to provisional medical imaging reports back to the referring clinician within an agreed timeframe.

Blacktown Hospital implemented a number of processes to track the use and improve the storage of walking belts and sticks in the Stroke and Aged Care Ward.

This project identified and examined the systemic issues leading to the use of seclusion at The Children’s Hospital at Westmead. It implemented preventative strategies to reduce the use of seclusion, including multidisciplinary team care plans, staff education, daily intake and handover meetings, as well as supervision sessions for nursing and allied health staff.

This project reimagined the way hospital food is delivered to patients in public hospitals, using new workflow processes, menus, staff training and technology, while remaining inside the current budget footprint.

This project developed initiatives to reduce waiting time and delays for patients receiving chemotherapy and other treatments in the haematology and oncology units at Concord Cancer Centre, within Concord Repatriation General Hospital. New business processes were developed, patient information brochures distributed, patient education needs reviewed, a staff education ladder developed and minor building and refurbishment works planned.

Mid North Coast Local Health District developed a clinical guideline that allows stable patients with specific diagnoses to have a direct bed-to-bed transfer from Kempsey District Hospital to Port Macquarie Base Hospital, with contingency plans for situations that may negatively impact the patient.

This project reviewed the admission pathway and model of care for admitted general medicine patients, and optimised the workforce structure to improve the delivery of safe, efficient and high-quality care.

This project developed a standardised capacity testing and guardianship application process for confused patients, with a multidisciplinary approach to support decision making in the hospital environment.

A staff engagement and education process was developed by Bombala Multipurpose Service (MPS) and Delegate MPS, to improve admission documentation for high-risk patients.

Royal Prince Alfred Hospital implemented the first randomised controlled trial in the world that demonstrated the benefits of using an in-line speaking valve in an Intensive Care Unit, to restore the voice of mechanically-ventilated tracheostomy patients.

This project implemented a new End of Life Care Plan at Concord Repatriation General Hospital, including end of life care guidelines, staff education and resources for families and carers.

Broken Hill Base Hospital implemented a streamlined discharge process, a discharge lounge and a Hospital in the Home service, to improve the flow of patients through the emergency department.

CCLHD developed a new referral pathway and model of care, to improve access to mental health services in the community.

The Arts and Culture Program at Blacktown and Mount Druitt Hospitals creates welcoming and safe spaces by collaborating with local artists and community groups.

This project implemented a more effective method for cleaning dentures in hospital and delivered education session to staff and patients on the link between oral health and systemic infection.

This project implemented a nurse practitioner led service that delivers care to older people in the community within residential aged care facilities or at home.

The Forensic Hospital made changes to its treatment and management plan, introduced the NSW Mental Health Care Plan and conducted staff and patient education on the value of developing a care plan in collaboration with consumers.

The Elouera Unit promoted healthy weight through education and review of the meal provision program, in collaboration with patients.

This project developed nurse-led protocols for the insertion, removal and management of indwelling urinary catheters at John Hunter Hospital.

John Hunter Hospital implemented advanced computed tomography (CT) imaging, which allows patient profiling, prognostic accuracy and personalised acute stroke care.

This project aimed to improve the patient flow of restricted weight bearing (RWB) patients through the acute orthopaedic service, by implementing a reconditioning program that optimised recovery following surgery. Communication processes were also incorporated into the model of care, to keep patients informed and improve their experience.

Shellharbour Hospital developed a model of care that provides engaging, therapeutic, recovery-orientated mental health services to consumers, their carers and families.

Camden Hospital implemented a multidisciplinary review meeting (Safety Huddle) following all inpatient falls and near miss falls, which developed strategies in consultation with the patient to prevent the incident from reoccurring.

The project team redesigned and implemented a new care coordination model which has transformed care delivery on the medical respiratory ward, improving safety, patient, carer and staff satisfaction.

Liverpool Hospital implemented a sustainable process for monitoring, management and early escalation of long stay patients. The goal was to provide a structure for helping clinical teams develop appropriate and high-quality patient management plans.

Royal North Shore Hospital redesigned the process of transferring information from the hospital to primary and community health services, including reintroducing a transfer of care risk screening tool and expanding the acute and post-acute care liaison role.

This project developed guidelines and resources to improve occupational therapist staff compliance with departmental protocols in place at Blacktown Mount Druitt Hospital.

This project implemented training and staff communication to improve the accuracy and amount of data collected in the electronic patient record, with a focus on pathology International Classification of Diseases (ICD) code, disease stage, tumour laterality, date of diagnosis, performance status and acute radiation toxicity.

This project provided a Coordinated Discharge Package, including a discharge summary and follow-up call, to patients discharged from Medical Assessment Units (MAUs) at Coffs Harbour Health Campus.

This project trained residential aged care facility and emergency department staff in the Identify, Situation, Background, Assessment and Recommendation (ISBAR) clinical handover tool to enhance the effectiveness of the Aged Care Emergency (ACE) service.

The APPLE project developed a new process to obtain and store Alternating Pressure Air Mattresses at Orange Health Service. Patients identified at ‘high risk’, those who have an existing pressure injury and/or those who are clinically indicated, are provided with pressure relieving equipment in a timely manner.

The group activity program was expanded and used evidence based practice to inform the content and structure of the program. The new program includes tai chi and yoga, social and cognitive stimulus activities including afternoon tea, an outdoor/community access group, an indoor walking group, a standing exercise group and interactive games

This project installed a patient safety board and innovation board to engage staff in the process and allow patients and visitors to see how clinical practice impacts on safety and quality.

This project developed an integrated model of care that facilitated early discharge from inpatient units and transferred care back to the community, with home-based treatments provided by an Acute Care Team.

Following results of a successful trial, the QASCIP implemented three clinical protocols to manage fever, hyperglycaemia and swallowing in stroke (the Fever, Sugar, Swallow (FeSS) clinical protocols). The Nursing Research Institute partnered with the ACI, 15 local health districts, clinicians and the National Stroke Foundation to implement the FeSS clinical protocols in all 36 NSW stroke services.

Approximately 50 CVADs are inserted per month by CVAD Procedural Clinical Nurse Consultants (CNC) at SVH. By implementing small-scale changes within the hospital, SVH has been able to reduce the usual incident rate for CVAD patient bookings from one in five at the beginning of 2014, to one in 20 by the end of the year.

Patients transition through their episode of care and often require changes to their diets based on allergies, intolerances, procedural and/or diagnostic requirements. Clinicians often become confused by the diet choices available and do not assess the patient’s diet history due to a lack of understanding on the impact that an incorrect diet can have on the patient. This project aimed to investigate the causes of the errors and develop solutions that were systematic, achievable and sustainable....

This project aims to enhance multidisciplinary teamwork in a rural hospital, by ensuring that acute ward and community health staff participate in care planning for admitted patients and improve the interface between the acute settings and community health services.

This project will audit the medical records of Australian Refined Diagnostic Reference Group G70 – Other Digestive System Disorders patients at Gosford Hospital to investigate the reasons for increasing length of stay and implement strategies to decrease this rate.

This project implemented a range of tools to reduce discharge delays at every stage of the patient journey, reducing length of stay and improving patient satisfaction and access to inpatient beds.

Essential to seamless transfer of care is the engagement of and communication with relevant clinicians from the inpatient and community settings, as well as the consumer or carer during discharge planning. This project has highlighted the real issues underlying care coordination, which have persisted and become more complex as local services have evolved. An objective analysis of these issues has occurred with focused strategies and an implementation plan that places the patient at the centre of care....

To reduce blood culture contamination rates at Campbelltown Hospital, a blood culture kit was introduced to the adult departments. The project foundation is built on getting it right the first time and reducing unwarranted clinical variation by implementing one standardised kit with one set of instructions. This has embedded better practice focusing on aseptic technique.

Under the GRACE model hospital staff work in collaboration with general practitioners and aged care facilities to avoid hospital admissions and reduce access block and length of stay for older patients at Hornsby Ku-ring-gai hospital.

ACE is a shared care model between physicians, geriatricians and their teams. It integrates comprehensive geriatric assessment into the optimal medical and nursing care of patients in a multidisciplinary environment.

The Electronic Patient Journey Board is a highly visible interactive touch screen, able to feed data directly from the electronic medical record and patient administration system. It is designed to facilitate multidisciplinary handover meetings with information displayed in a highly visual medium with graphic icons and colour schemes to discretely share clinical, financial and demographic information.

Stepping Home with Cellulitis results in reduced length of stay for patients admitted to RNSH with Cellulitis through implementation of a clinical pathway.

This project aims to work with acute, community and primary care services to better support patients with chronic heart failure to live well, at home.

The Far West Mental Health Recovery Centre (FWMHRC) is public mental health admission facility to be operated in partnership with a Community Managed Organisation (CMO) in NSW. The FWMHRC is a 10-bed unit in the grounds of Broken Hill Health Service. It provides step-up step-down care to people requiring support to overcome mental ill health. The inclusion of the FWMHRC into the spectrum of integrated mental health and drug and alcohol programs in Far West NSW has solved a number...

The outpatient and visitor buggies provide less mobile patients and visitors with a safe, accessible and enjoyable method of transport along main pedestrian corridors of Westmead Hospital while maintaining dignity and respect. Volunteers at Westmead Hospital recognised that many less physically mobile outpatients and visitors experienced difficulties walking from the main entrances of the hospital to their destinations, over 200 metres away. Transport by orderlies using wheelchairs was not suitable for many of these people. After an extensive planning and...

The Ballina Haemodialysis Unit is a seven chair satellite facility providing 84 dialysis treatments weekly. The majority of 28 patients are aged 70 years or older with comorbidities including diabetes, cardiac, cardiovascular and haematological conditions. The aim of the project was to raise the awareness among our patients of Advance Care Directives (ACDs) and to reach a compliance of 80% by Christmas 2010. We have now achieved 84% compliance with the NSW Health ACD Policy. Implementation of the policy required...

The ACTIVe Program on the Acute Aged Care Ward at Royal Prince Alfred Hospital was designed to improve the hospital experience of older patients. Elderly hospitalised patients can experience a decline in their physical and mental abilities. This can make it difficult for them to fully recover from illness and return to their previous ability to function. Trained volunteers providing therapeutic interventions can reduce the consequences of delirium and assist in maintaining patient cognition and physical functioning. Volunteers play an...

To review and streamline the discharge process on an acute medical and surgical ward in order to reduce waiting times for patients at all stages of their hospital journey.

The project aims to streamline the admission process to the two drug health wards. From admission, staff will work with the patient to develop a comprehensive care plan for their discharge back to the community, ensuring access to education and services to help keep them well. This will in turn reduce the number who are readmitted after relapse and help to keep people healthy in their community....

The project aimed to design and implement a model of care for the Wagga Wagga Mental Health Sub-Acute Unit. The decision was made to design a new service model rather than adopt an existing model of care used by another District or service. The model created was based on feedback from consumers, families, carers, mental health staff and staff of other service partners. The model reflects the unique needs of the District. It is a product of what stakeholders within...

"Stranded Sam" is an organisation wide communication strategy. The strategy aimed to: build understanding of factors that keep patients in hospital longer than their acute illness and the impact on the patient and the hospital when care is not coordinated, increase the visibility and transparency of waste within the hospital and engage key stakeholders and support the change management project.

The Prince of Wales Hospital (POWH) is a tertiary hospital and a Neurosciences hub, providing specialist Neurology and Neurosurgery services. It was identified that length of stay (LoS) for neurosciences patients at the POWH was above the state benchmark. A multidisciplinary project was undertaken to explore opportunities to optimise the patient journey and improve access to services and reduce LoS. Evaluation reveals impressive results with improved access to beds due to patient flow, enhanced coordination of care more than 20%...

This project at Nepean Hospital aims to improve the flow of patients throughout the hospital, thus improving the overall patient journey by: increasing the number of discharges by 10am to 30% hospital wide within a 12 month period realigning the mismatch between discharge and admission times within 12 months increasing the confidence and satisfaction of patients, carers and staff regarding the discharge date and time within a 12 month period....

The Children's Hospital at Westmead (CHW) developed an electronic multi-resistant organism (MRO) flagging and information system, an infection control note in the Electronic Medical Record (EMR) and an individualised electronic MRO care plan which includes input from families. These are all available in the Patient Management System and the EMR for round the clock accessibility in order to ensure continuity of safe care. In addition, 556 Multi Resistant Staphylococcus aureus (MRSA) positive patients had their MRO status reviewed for clearance,...

The program is a nursing staff recruitment and retention strategy for the Nambucca Valley. It is designed to attract new graduate Registered Nurses (RNs) to the Nambucca Valley by assisting their transition from study to nursing practice and offering exposure to a variety of settings as potential future career pathways. Two six-month rotations are completed in aged care and acute care settings. The program involves education, skills development and professional development support....

The Kids Acute Liaison in Mental Health (KALM) project established a clear pathway and guideline for all Mental Health presentations to the Emergency Department (ED). This improved collaboration between the ED and Psychological Medicine, ensuring patient care was always the prime focus. This also helped eliminate lengthy delays for patients which in turn improved the National Emergency Access Targets (NEAT).