Case study: Team based care
The following case study from Andrew Nelson, Western NSW LHD, provided a clinician's perspective on models of care from a local perspective.
What is important to know about your service?
Orange Health Service is a regional referral hospital in central western NSW that services a population of approximately 280,000 people. The hospital sees around 30,000 patients a year through the emergency department. Orange has the only rural, full-time cardiac catheterisation laboratory in NSW. It also offers a 24/7 call-in rescue percutaneous coronary intervention service that treats just under 200 ST-elevation myocardial infarctions (STEMI) a year. In general, the district has higher rates of obesity, smoking and diabetes than the state average. This reflects the below average life expectancy of the region, as well as the high activity of cardiology services.
What organisational model do you use?
Team-based care.
Diagnostic testing
Exacerbation management
Ongoing care
Last year of life
What is special about the way care is delivered?
The Coronary Care Unit has implemented two initiatives to support team-based care: safety huddles and multidisciplinary team video conferences.
Safety huddles occur before every nursing handover. This initiative has enabled the identification of at-risk, complex and/or deteriorating patients. These are run and driven by the nurse in charge of the shift and take up to three minutes.
The safety huddle covers:
- what went well and what can be improved from the previous shift
- the available resources needed to maintain patient safety
- the identification of patients at high risk of deterioration.
The unit also has weekly multidisciplinary team video case conferences with a Sydney cardiology tertiary referral hospital. Patients with complex and unique cardiac problems (many with significant heart failure) are discussed with a group of cardiology and cardiothoracic clinicians and specialists.
These are run and driven by cardiologists and cardiology advanced trainees, with the assistance of cardiology clinical nurse consultants. They take approximately 30 minutes. The case conferences include the review of angiograms, echocardiograms and cardiac MRIs over a high-resolution video link. This facilitates the specialist consensus management and planning of diagnostic and interventional procedures for cardiac patients across the Western NSW LHD.
A companion document describes options for organisational models in CHF. One option is a team-based care – this vignette describes the model from a local perspective.
How does it make a difference?
The video case conferences have helped to firm up referral relationships, as well as ensure chronic heart failure patients are getting the best and most appropriate care available in the shortest possible time.
What tips do you have for others?
- The weekly video case conferences have improved referral relationships.
- Create a schedule and structure for meetings tailored to the people who are required at each meeting to foster greater attendance and engagement.