Middlemore Hospital’s Emergency Care leads the way

We all strive to provide the best care for our patients, and it takes a lot of work, patience and motivation to create a culture where continuous quality improvement is expected, talked about and adhered to.

Such a culture can be found in Emergency Care with staff from a range of disciplines working together to ensure patients receive time critical treatments within the 6 hour target.

To achieve this, the team has developed a structured Quality Improvement plan using the acronym DAASHH to highlight its priority quality projects.  Vanessa Thornton, Clinical Director of EC explains what DAASHH stand for.

  • Documentation: We are currently looking at ways of improving documentation in EC.  A monthly audit tool is currently being developed and piloted
  • Airway: Improving 1st pass intubation (this means achieving an airway in an unwell patient on the first attempt). Since the introduction of an airway registry, where all EC acute intubations are logged and running teaching sessions for EC staff, rates have gone from 67.2% to 78.9%
  • Analgesia: Improving time to Analgesia. Patients often present to EC with pain and we aim to provide pain relief to all patients within 30 minutes of arrival – sooner if they are in severe pain. We monitor the provision of pain relief in patients with renal colic (kidney stones) monthly as an indicator of how the department is doing as a whole and we aim to give 95% of patients presenting with renal colic analgesia within 30mins of their arrival.  Our performance against this target continues to improve as staff become more engaged in this quality initiative.

Analgesia for Renal Colic


  • Sepsis: Our goal is that 80% of septic patients, who have an ICU review in EC will receive antibiotics within 60mins. 70% of patients presenting with signs of sepsis (who don’t have an ICU review) will receive antibiotics within 3 hours. As the graphs below show EC is improving its performance and beginning to reduce the variation in performance.

Antibiotics 60 mins  ABs - three hours

  • H is for Heart: EC is monitoring the time it takes for patients, presenting with a severe heart attack to go to the Cardiac Cath Lab to have the clot removed.  The goal is for 80% of patients, suffering from a severe heart attack to have a ‘door’ to ‘clot aspiration’ time of 90 mins. In 2011, 22% of patients had a ‘door’ to ‘clot aspiration’ time of 90mins. In 2015 this increased to 80%.
  • H is also for Hand Hygiene with compliance rates going from 20% to 79% . That’s a remarkable achievement, considering the wide range of staff that come and go from EC

It’s clear that EC is very focused on quality improvement, and this is not going unnoticed by other Emergency Departments across the country. As the national leader EC has developed a reputation for its forward thinking and innovative ideas.

While all EC staff are committed to improve patient outcomes, a shift in culture wouldn’t have happened without the drive, passion, motivation and leadership from the top and people on the shop floor. This includes Debbie Hailstone, Quality Improvement Facilitator whose passion and drive keeps everyone engaged and involved and Vanessa Thornton who helps to spread the word that everyone has a role to play in keeping our patients safe and free from preventable harm.   Anything else is unacceptable.

As a result EC has seen people take ownership of quality improvement in their day-to-day work and continuously strive to improve the care they provide.

For further information about EC’s quality projects contact Debbie Hailstone via email: Debbie.Hailstone@middlemore.co.nz



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Author: Geraint Martin

Geraint Martin was appointed Chief Executive Officer of Counties Manukau DHB in December 2006. It is one of the largest District Health Boards in New Zealand and services a population of half a million. He has significant experience over 30 years in national policy & in managing both primary and secondary care . Previously, he was Director of Health and Social Care Strategy at the Welsh Government .He authored a radical 10 year strategy of reform, including the successful “Saving 1000 lives” Campaign.Until 2004, he was CEO at Kettering General Hospital & had held senior positions in London & Birmingham.He has worked closely with clinicians in improving clinical standards,patient safety,chronic disease management & managing acute care to reduce hospital demand.In NZ, He has promoted clinical quality and leadership as central to improving patientcare. This has led to a significant increases in productivity and access, whilst maintaining financial balance. CMH has completed in 2014 a $500 m capital redevelopment programme, the largest in New Zealand. A central part of this is the establishment of Ko Awatea,the Centre for Innovation and Research which will underpin CMH as one of the the leading health systems in Australasia.In 2008, he chaired the Ministerial Review of Emergency Care in New Zealand, and in 2013 was an member of the Expert Advisory Panel on Health Sector Performance. Geraint has an MSc in Health Policy from Birmingham University .His post-graduate work has focused on health economics and Corporate Strategy . He is adjunct Professor of Healthcare Management at AUT and Victoria University, Wellington Elected in 2006 as a Companion of the Institute of Healthcare Management, previously he was an Associate Fellow at Birmingham University.He is is Chair of the Auckland Philharmonia Orchestra, a member of the Institute of Directors, on the Board of the NZ Institute of Health Management & previously the Board of The NZ Health Quality and Safety Commission.

2 thoughts on “Middlemore Hospital’s Emergency Care leads the way”

  1. This is an interesting save study. Well done to everyone involved in this initiative. Looking forward to reading 2.0 of this through your excellent continuous improvement culture. Well done team !

  2. Like reading about locally led improvement initiatives- hats off to EC- we know how difficult it is to tackle improvements in documentation- there is just so much! I would love to see an indicator about patient perception of service? Will follow with interest, as we need to have, record share and monitor more measures at all levels. Awesome!

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