After 6 years at the helm it is time for me to say goodbye to the ECI, so I’d like to take the opportunity to say farewell and reflect on what has happened over this time.
In 2011, I was fortunate to be offered the opportunity, freedom and funding to lead the establishment of the Emergency Care Institute, located at the NSW Agency for Clinical Innovation. From the outset, the ECI was set up to support NSW EDs to deliver better emergency care and to do this collaboratively with all stakeholders (including consumers), especially those working at the coal face in ED. All of us who worked within EDs had too often had the experience of having what seemed like a good idea to another part of the system foisted upon us to implement, when unfortunately, it was not possible or practical to do so in the very demanding ED environment. There was a perception that EDs were not being listened to (and no doubt by others that we were not listening). We were familiar with increasing demand, ad-hoc access to clinical tools and resources, limited emergency care research and
translation of best practice, overcrowding and many other challenges. EDs did not have a combined voice, where the smallest level 1 and the largest level 6 department shared information and understood the others’ challenges, or engaged in common initiatives. Even more remarkably, EDs did not have a forum to embed multidisciplinary communication within their own staff at the state level, or to engage collectively with other groups.
Fast forward to June 2017, and ECI and EDs have come a long way. At the system level we’ve seen time based targets (NEAT then ETP) and despite inevitable pressure points, these have changed EDs and hospitals for the better, driving understanding of the value of senior staff in EDs and the critical role of the rest of the system in sustainable emergency care. ECI outputs have included direct and routine review of all NSW ED related incidents and RCAs and creation of a taxonomy to improve capture of relevant information to inform change; deep engagement with ED staff, professional bodies, all NSW Health pillars, other bodies and the Ministry, and other government, not for profit and private services with an impact on emergency care; the production of novel educational resources which specifically address gaps in capacity; an openly accessible, comprehensive website, linked to ED
information systems, full of fantastic clinical, process, quality and administrative resources to enable a clinician to provide evidence based care, at the bedside or running the department, at any hour in any ED anywhere; and a significantly enhanced emergency care research environment, with ECI co-leading multicentre studies, providing in-kind and other support. This has translated into a major reduction in serious critical incidents occurring in NSW EDs, reduced variability and increased efficiency of care, and enthusiasm among EDs to do more, even in the face of continually increasing demand. EDs now have a voice in what affects them, including IT, new ED builds, police processes, public health, pre-hospital, transfer and transport, models of care, policy and other clinical specialty guidance, both within the hospital system and the community.
All this progress has only been possible through the efforts of many individuals across emergency care and the broader system, and I would like to thank everyone for their support, work, feedback, and collaboration over the past six years. Special thanks go to ECI committee co-chairs over this time (Anne Hawkins, Tony Joseph, Stuart Stapleton, Jacqui Irvine, Matt Bragg, Kylie Stark, Kate Curtis, Richard Paoloni, Anna Holdgate, Amith Shetty, Alan Forrester, Liz Cloughessy), Vanessa Evans, ECI Network Manager and the wonderful ECI team (Sophie Baugh, Matthew Murray, Hatem Alkhouri, Dwight Robinson, Nick Goryl, Zafirul Hussain, John Mackenzie and the ECI Advanced Trainees) and to Sarah Marmara, Principal Policy Officer, Emergency Access at NSW MOH for her unfailing partnership in the quest for a unified voice for EDs.
It's been lots of fun!
Associate Professor Sally McCarthy