The Lismore App has reported the poor performance of the Lismore Base Hospital's (LBH) Emergency Department for the last two years following the release of the Bureau of Health Information (BHI) latest quarterly statistics.

Each release would see LBH's critical benchmark data fall, and when compared to other Northern NSW Local Health District (NNSWLHD) hospitals, it would consistently sit at the bottom. It was also consistently below the NSW state average.

We can happily report that this quarter, there has been a turnaround for the LBH Emergency Department (ED). One of the key areas, Starting ED Treatment on Time, had dropped to 52%; however, this week it had risen to 65.2%, an improvement of 13.2%.

It appears as though the plans put in place by NNSWLHD CEO Tracey Maisey and her team last year are paying dividends.

It was in September 2024 when we asked Ms Maisey what was being done to turn the hospital's fortunes around. Twelve months later, the Lismore App had another conversation to discover what mechanisms had been put in place and whether they are sustainable.

"We have groups of clinicians focused on different parts of our flow system, and there's been phenomenal engagement from the teams, medical nursing, allied health, admin, management, they've all been very strongly engaged. This time last year was the beginning of the process, and then we put some things in place, which I'll talk about in a second, and then embedded them over the summer, autumn periods.

"We've just had another go at putting a new cycle of improvement initiatives in in the last two weeks. We've seen transfer of care results, which is the time it takes to move a patient from an ambulance into an ED, make material improvements, our step change and improvement, and it's all because we have our staff willing and really keen to make improvements to the system that they work in. We've empowered them to do that.

"We've given them permission, for want of a better description, and it sounds a bit old-fashioned, but we just get on with it. You guys, you know what you're doing. This is your business. You're the experts in this. What can we do to support you? And it's very pleasing.

"The treatment On Time result was exceptional. Lismore is still a very busy hospital, and we have permanently opened some more beds. But that's not the reason for this. This is all about clinical engagement."

To get a clearer understanding of the new patient flow system, we asked Ms Maisey to drill down on the details.

"We've had some expertise, international expertise. Dr Ian Sturgess, who's a renowned patient flow clinician and geriatrician, has been providing us with some clinical advice and support around our patient flow processes. He's made two visits now to Lismore, and we've created some small clinically led working groups focused on those areas that we most want to improve on. I'll give you some examples.

"We're really focused on enabling our patients who are clinically suitable to be cared for in their home virtually. It's called Hospital in the Home Service, and so there's been a big focus on that, looking at early intervention around frailty assessment. As you'd appreciate, the average age of our patients is in the older age groups, and so ensuring that we've got really comprehensive frailty assessments early on in their journey, and then education about how to stay safe in the ward and the ED and when they go home. That's the support of the allied health teams; it is pretty critical.

"We've been looking at the different flow patterns, so different patient groups have estimated lengths of stay that vary. We have an acute assessment unit for those people who just need some more observation. The clinicians aren't sure about sending them home. They want to run a few more diagnostics. That runs in our short-stay unit.

"And then we have those patients who are admitted for what we call short stay, three to five days. They need stabilising, or they need some medication, or they just need more clinical intervention.

"The third group are what I would describe as complex elderly, long stay patients that have social needs. They may be waiting for a discharge to a residential aged care facility, or they have behavioural complexities around treatment.

"I read a statistic the other day that 50% of the patients in residential aged care facilities in northern New South Wales have some level of dementia diagnosis, and yet we don't have anywhere in northern New South Wales for what's called memory-assisted beds. So, we don't have any dementia beds, specialist dementia beds. We've been talking through the Ministry of Health to the Commonwealth Government about that, because, as you'd appreciate, in order to admit people, we need free beds. We need to have beds for those patients to go into.

"When we have patients in our wards that are better elsewhere, this isn't the right care environment for them, and a busy medical ward with somebody with complex behavioural challenges who can easily get confused, and they acquire different complications. Hospital-acquired delirium or dementia would be one of those. And so we want the person to be in the right place for them, and quite often, once they're medically stable, a medical ward is not the right place for them.

"Over winter, we did open as a pilot, a ward in Byron for patients who are waiting for residential aged care placement, who aren't medically complex. They're just needing to go somewhere else. That seems to have been successful.

"We have been putting a lot of focus on what's called the Enhanced Care Program, which is a district-wide program that is working with those patients who require that additional support. It tends to be behavioural support, or it's called diversional therapy, so, to calm them, to make sure that they're feeling socially connected, that they have activity so they don't become aggressive, because we do have some of these patients, unfortunately, part of their condition is they can become aggressive, and obviously we want to keep them in a calm environment.

"So that pilot was trialled on one of the wards in Lismore, and that's been highly successful, and the executive yesterday approved for that program to roll out across the district. This isn't a one solution that's going to fix all of this. There's a whole lot of things that we need to do to continue to improve our performance, but we've had really good feedback from our patients.

Twelve months ago, Ms Maisey spoke about people staying in our hospital system for 20+ or even 28+ days. Has that number been reduced?

"Unfortunately, when I looked a couple of weeks ago, we had 104 patients across the district, not Lismore, across the district, that were medically cleared for discharge, that were waiting either for a residential aged care bed or an NDIS package. That's 104 patients, which is three wards of beds with patients that are not in the right place for them.

"Having some of those patients cohorted in Byron has absolutely made a difference, because we've also been able to centralise some of that expertise and specialist resource, and so they are moving through our processes faster. But most importantly, the environment is calm, and they're receiving sort of far more dedicated care than they would on a busy medical acute ward. It's not that those staff don't want to, but they're there for medical reasons, not necessarily social reasons. So, the right environment for them, and it's better for the staff, better for the patients, better for their families."

This pilot has worked in Byron because of the spare available ward. The other seven NNSWLHD hospitals don't have a spare ward, so the Enhanced Care Program cannot be rolled out beyond Byron Bay Hospital unless resourcing and funding can be sourced or the patient flow improvements turn up further opportunities.

As for the long-term success of the improved patient flow process, is Ms Maisey confident that the J-curve has started the upward trajectory?

"I really hope so. The clinicians are very keen and very focused on improvement, and that's why it will be successful; they want to do it, and they're determined to do it. So I'm pretty hopeful.

"I would like to say that if we could get a few more memory-assisted beds in our community, I think that would make a difference overnight. If we could have those patients in the right place, we would have more beds. We would be able to admit people quicker, they would move through our system faster, but, actually, more importantly, they would be in the right place at a certain time. So, that's something I can't influence. That's a Commonwealth funding matter.

"It will be incremental gains, but for now, we're pretty pleased with where we were at the moment."

"I did just want to take the opportunity to say thank you to our amazing staff, who really, every day, go above and beyond caring for our community and continuing to look for ways to enhance the care."

LBH BHI SUMMARY

LISMORE BASE HOSPITAL had 10,058 ED attendances during the quarter, with 2,974 patients arriving by ambulance (up 1.6 per cent or 48 arrivals).

Of all ED attendances, 65.2 per cent of patients started their ED treatment on time, an improvement of 13.2 percentage points (was 52%) on the same time last year and above the average (58.7 per cent) for NSW hospitals of a similar size or NSW 65.7%

Of those patients treated in the ED who did not require admission or transfer to another hospital, 71.1 per cent were discharged within four hours of arriving, again above the result for peer hospitals (61.4 per cent). In numerical terms, that was 3 hours 35 minutes, now it is down to 2 hours 50 minutes. The new Tweed hospital leads the way with 2hours and 8minutes)

Patients transferred from paramedics to ED staff within 30 minutes was down 1.5%, 58.8% to 57.3%. Tweed is 79.9%.

Planned surgery remained relatively stable compared with the same quarter last year, with 1,529 surgeries performed during the quarter.