Presented by Dr Ruth Large

1. Clinicians Challenge
Dealing with Emergency Department demand
Presented By
Dr Ruth Large & Angela Alvarado

2. ED DEMAND - The size of the problem
• Over the past 3 years there has been an incremental
rise in National Emergency Department presentations
from 218,000 to 238,000 presentations.
• In Thames Emergency Department we see
approximately 1000 more presentations every year.

3. Trend of National Performance &
ED DEMAND – Trendof National Performance and Presentations Presentations
100%
245,000
95%
240,000
235,000
90%
230,000
225,000
85%
220,000
80%
Performance
Presentations
250,000
215,000
210,000
75%
205,000
200,000
70%
1
2
3
4
5
6
7
8
Number of Presentations
9
10
11
Performance
12
13
14
15
16

4. ED DEMAND – Future demand
But we face an even more significant
challenge
Statistics New Zealand, March 2006

5. ED DEMAND – Putting
the demand into context
• We do not see large increases in patients being
admitted into hospital.
• Emergency Department visits are costly and do not
deliver good value for money for many of our
patients.
• Emergency Department patients are more likely to
have unnecessary investigations.
• Emergency Medicine is NOT rocket science

6. ED DEMAND – Why the Increase in ED Load?
My postulation:
•
•
•
•
The public have lost the ability to correctly self triage.
There is scare-mongering in the media.
The medical fraternity has encouraged reliance.
Many of the public have the misconception that the
hospital provides the best quality health care.
• General Practice is overwhelmed
The worried well:
• An increasing number of patients self-triage to the ED with
symptoms that are not an emergency.
• We need a safe and efficient way to deal with this increasing
load to reduce the risk of overwhelming the system and to
enable the ED to perform their core business.

7. ED DEMAND – The potential Solution
• An automated system which utilises red
flags from the history and vital signs
could enable patients to effectively triage
themselves on presentation.
• Ideally this system would be integrated
with a GP booking service and the
presentation would be visible to the GP.
• The patient would receive clear guidance
as to self-management

8. HEALTH KIOSK – Screening patients to the correct care provider
BIOMETRICS
HISTORY
SYMPTOMS
ED
GP
HOME

9. HEALTH KIOSK – Features
BIOMETRIC MEASUREMENTS
•
•
•
•
•
•
•
Height
Weight
BMI
Blood Pressure
Heart Rate
Blood O2 Saturation
Temperature (IR non contact)
ADDITIONAL FEATURES
•
•
•
•
Biometric Finger reader
Phone over internet
Multi - Language Options
A4 printer

10. Health Kiosk – Patient History Module
•
Patients begin
documenting their own
history at the kiosk
•
Patients can move quickly
through the dynamic
questionnaires from an
extensive knowledgebase
•
Answers are converted
into clinical terminology
and organized by organ
system.

11. Health Kiosk – Patient Symptoms Module
A few of the questions for
Lower Back Pain
• Have you injured your back in the
past 2 days?
• Do you have new loss of feeling in
your groin or legs?
• Do you have back pain that
travels down your legs?
• Have you developed difficulty
walking?
• Are you unable to control your
bladder?
• Do you have new muscle
weakness in both legs?

12. Enabling Patient Self Management
Patients are provided with
information, pictures and
home care instructions based
on their symptoms.
• Information can be printed.
• Appointment can be made
with their GP
• They can email their visit
report to their GP.
The Health Kiosk will enable
patients to be co-producers in
the management of their own
health.

13. Health Kiosk – Best Care Option
Where to go for Care?
Best Options for Care
Recommended
Based on your responses,
It is recommend you see
Your doctor within 3 days
Use the button below to make
an appointment with your GP
BOOK APPOINTMENT
Tāpuia whakaritenga
Your GP
Recommended
Home Care
Not recommended
Emergency Department

14. Health Kiosk – Sharing Information