MyED

Project members - Macquarie University

Chief Investigators: A/Prof Robyn Clay-Williams; Prof Jeffrey Braithwaite; A/Prof Reema Harrison; Prof Yvonne Zurynski; A/Prof Peter Hibbert; A/Prof Rebecca Mitchell; Prof Henry Cutler; Prof Leanne Holt (Chair Aboriginal Advisory Group); Dr Louise Ellis; Dr Elizabeth Austin; Dr Kate Churruca.

Associate Investigators: Dr Kylie Gwynne; Dr Karen Hutchinson; Dr Ann Carrigan; Dr Bronwyn Newman; Dr Janet Long.

Project members: Ms Mariam Safi (PhD Candidate); Ms Natália Ransolin (PhD Candidate); Dr Alicia Norman (Health Economist); Dr Rezwanul Rana (Health Economist); Dr Tolesa Okuba (Statistician).

Project members - External

Chief Investigators: Dr Matthew Vukasovic (ED Director, Westmead Hospital); Dr Reza Ali (ED Blacktown Mount Druitt Hospital Hospital); Dr Donna Gillies (NDIS Commission); Dr Ramesh Walpola (UNSW).

Associate Investigators: Mr Aaron De Los Santos (ED CNC, Blacktown Mount Druitt Hospital); Dr Margaret Murphy (ED CNC, Westmead Hospital); Professor Paul Salmon (USC); Ms Jacqueline Hrast (DSS); Ms Anne Dwyer (DSS); Ms Shai Griggs (WSLHD); Dr Satish Mitter (ED Blacktown Mount Druitt Hospital).

Partners: Graeme Loy (WSLHD); Alison Derrett (WSLHD); Kylie Smith (ACI); Trevor Chan (ACI); Anthony Brown (Health Consumers NSW).

Background

The demand for urgent hospital care is increasing in Australia and internationally, placing prolonged strain on acute care services provided by Emergency Departments (EDs). Despite some variation associated with COVID-19, overcrowding in the ED is becoming more prevalent, and has been linked with an increase in adverse events and poor patient outcomes, including increased mortality. Patients are staying longer in the ED, with fewer seen within 4 hours. Siloed efforts have not worked and a new, integrated system-level approach to ED care that incorporates evidence-based human factors principles, and a patient-focused collaborative co-design process, is needed.

Patients are not an homogeneous group: ED performance is worse for patients who are older with multiple comorbidities, have a disability, present with a mental health condition, are Aboriginal and/or Torres Strait Islander, or come from a culturally and linguistically diverse (CALD) background. Understanding and addressing the specific needs of these priority patient cohorts has potential to improve not only the outcomes and care experience for these people, but ED performance overall.

Over the next 5 years, we will apply our accumulated expertise in consumer-focused co-design, human factors and emergency department care to optimise ED performance; improving patient outcomes and the acute care experience for the diverse demographic cohorts of consumers who seek care in NSW EDs.

Our research objective is to co-develop and implement new or adapted models of care for NSW EDs that improve ED performance (e.g., shorter wait times, reduced length of stay), improve patient outcomes (e.g. fewer re-presentations and people who did-not-wait to be seen), and improve patient experience (e.g. satisfaction, respect and feeling safe) for these five priority patient cohorts. The research will be conducted in Western Sydney Local Health District (WSLHD), in collaboration with our research partners WSLHD, the NSW Agency for Clinical Innovation (Emergency Care Institute; ECI), Health Consumers NSW, the Department of Social Services, and the National Disability and Insurance Scheme (NDIS) Quality and Safeguards Commission (NDIS Commission).

Aims

Our aims are:

Aim 1: To elicit needs and preferences for delivery of acute care in WSLHD from five priority consumer cohorts (older adults, people with mental health condition, people with a disability, Aboriginal peoples, people from a CALD background) and the clinicians who treat them.

Aim 2: To co-design, develop and implement consumer-driven new or adapted models of care that enable EDs to meet the needs of our five priority consumer cohorts.

Aim 3: Using implementation science methods, work with the NSW Emergency Care Institute (ECI) to scale-up and spread successful models of care from Aim 2 to EDs in public hospitals across NSW.

Design and method

The MyED project will adopt a system perspective, over three stages, to improve ED performance, patient outcomes and experience:

Stage 1: Understanding the current context of ED care and care preferences, through a five-step process:

Step 1.1. Ethnographic observations

Step 1.2. Qualitative interviews with ED clinicians and professional stakeholders

Step 1.3. Qualitative interviews and focus groups with older people and people with a CALD background

Step 1.4. Qualitative interviews and focus groups with people with a mental health condition or disability

Step 1.5. Qualitative interviews and focus groups with ED clinicians and Aboriginal peoples

All data collection associated with the Aboriginal peoples cohort will be determined in collaboration with an Aboriginal Advisory Group and approved by the Aboriginal Health and Medical Research Council (AH&MRC).

Stage 2: Developing new or adapting models of care through an Experience Based Co-design (EBCD) approach. Consumers, ED clinicians and the research team will partner to co-design new or adapted models of acute care to meet the needs identified in Stage 1. We will refine and test the care models using our ED Work Domain Analysis model (previously developed by our team for this purpose, see: https://www.mq.edu.au/research/research-centres-groups-and-facilities/healthy-people/centres/australian-institute-of-health-innovation/our-projects/ed-cognitive-work-analysis?SQ_VARIATION_1209086=0) and select the most promising models via a business case for local implementation at Westmead, Blacktown, and Mount Druitt EDs. ED performance, patient outcomes and patient experience will be analysed longitudinally using linked routinely collected data to determine performance trends for the participating EDs in comparison with NSW ED peer groups; comparative effectiveness of the new models of care will be assessed post-implementation, to inform further dissemination in Stage 3.

Stage 3: Disseminating findings through broader implementation and evaluation of proven models across NSW EDs.

Current Progress

Step 1.1 – Ethnographic observations. This first part of the study has been very successful. The research team have completed a total of 164 hours of observations in the three participating WSLHD emergency departments (Westmead ED, Blacktown ED and Mount Druitt ED). The team will be analysing this data in conjunction with the interviews with clinicians and consumer cohorts.

Step 1.2 – Qualitative interviews with ED clinicians and professional stakeholders. The research team has collected 20h22m of data through 44 interviews and one focus group. We want to thank the clinicians and other professionals at Westmead, Blacktown, and Mount Druitt Emergency Departments for their incredibly valuable insights and time. Analysis of this data will be completed in September 2023.

Step 1.3 – Qualitative interviews and focus groups with older people and people with a CALD background. We obtained many insights from the interviews and focus groups with people from the CALD community. We completed 14 focus groups and 3 interviews with a total of 48 people from over 5 different language groups including Arabic, Mandarin, Cantonese, Hindi and Korean. Many thanks to those who shared their ED experience with us! This data will be analysed in October 2023.

Check back to this site in 2024 for our findings.

Benefits

The proposed project will provide a rigorous approach, and an innovative and comprehensive systems perspective, to improving ED performance and patient experience, incorporating views from a diverse group of consumers and clinicians, and leveraging our cross-disciplinary research and clinical expertise, to provide solutions that are innovative and practical.

Publications

Cheek, C., Hayba, N., Richardson, L., Austin, E., Francis-Auton, E., Safi, M., Ransolin, N., Vukasovic, M., De Los Santos, A., Murphy, M., Harrison, R., Churruca, K., Long, J., Hibbert, P., Carrigan, A., Newman, B., Hutchinson, K., Mitchell, R., Cutler, H., Holt, L., Braithwaite, J., Gillies, D., Salmon, P., Walpola, R., Zurynski, Y., Ellis, L., Smith, K., Brown, A., Ali, R., Gwynne, K., & Clay-Williams, R. (2023). Experience-based codesign approach to improve care in Australian Emergency Departments for complex consumer cohorts: The MyED project protocol, Stages 1.1 – 1.3. BMJ open, 13(7), e072908. https://bmjopen.bmj.com/content/13/7/e072908

Hayba, N., Cheek, C., Austin, E., Testa, L., Richardson, L., Safi, M., Ransolin, N., Carrigan, A., Harrison, R., Francis-Auton, E., & Clay-Williams, R. (2023). Strategies to Improve Care in the Emergency Department for Culturally and Linguistically Diverse Adults: a Systematic Review. Journal of Racial and Ethnic Health Disparities, 1-21. https://doi.org/10.1007/s40615-023-01876-z

Francis-Auton, E., Cheek, C., Austin, E., Ransolin, N., Richardson, L., Safi, M., Hayba, N., Testa, L., Harrison, R., & Braithwaite, J. (2024). Exploring and Understanding the ‘Experience’ in Experience-Based Codesign: A State-of-The-Art Review. International Journal of Qualitative Methods, 23. https://doi.org/10.1177/16094069241235563

Austin, E. E., Cheek, C., Richardson, L., Dominello, A., Long, J. C., Ellis, L. A., Norman, A., & Clay-Williams, R. (2024). Improving emergency department care for adults presenting with mental illness: a systematic review of strategies and their impact on outcomes, experience, and performance. Frontiers in Psychiatry, 15, 1368129. https://doi.org/10.3389/fpsyt.2024.1368129

Austin, E. E., Blakely, B., Salmon, P., Braithwaite, J., & Clay-Williams, R. (2024). Eadem Sed Aliter. Validating an emergency department work domain analysis across three hospital configurations. Applied Ergonomics, 117, 104240. https://doi.org/10.1016/j.apergo.2024.104240

Testa, L., Richardson, L., Cheek, C., Hensel, T., Austin, E., Safi, M., Ransolin, N., Carrigan, A., Long, J., & Hutchinson, K. (2024). Strategies to improve care for older adults who present to the emergency department: a systematic review. BMC health services research, 24(1), 178. https://doi.org/10.1186/s12913-024-10576-1

Funding Acknowledgement

The Australian Institute of Health Innovation, at Macquarie University is leading this research, together with our partners Western Sydney Local Health District, the NSW Agency for Clinical Innovation, the Department of Social Services, the NDIS quality and Safeguards Commission and Health Consumers NSW. The Australian Government Medical Research Future Fund is funding the project (APP2018361).

2022 MRFF Models of Care to Improve the Efficiency and Effectiveness of Acute Care (APP2018361), 5 years