Adult Retrieval Victoria Update

The year has been a productive one of team building, enhancement of retrieval procedural skill set, pre-hospital medicine placements, rapid response for delivery of patient care, strengthening of ARV coordination and implementation of workplace portfolios
 
CRITICAL CARE PROCEDURES – The number of ARV Consultant workforce took part in the Alfred Critical Care Skills training.  This included two days of high fidelity skill stations with one on one training in small groups.  The skills learnt will assist our teams to manage life and limb threatening patient conditions. The procedures have given us a foundation to write standard operational procedures acknowledging that these procedures though rare, need an approach that is standardised ensuring that the doctor, team and ultimately patient outcomes are safe.
PREHOSPITAL MEDICINE – Seven ARV Consultants were trained and orientated preparing them to participate in an AV-ARV Road MICA collaboration where they continue to be rostered once a week on shifts with Metro Road MICAs.  This has seen them increase their awareness of the pre-hospital environment, team membership and communications in assessing and managing patients.
NURSE COORDINATION – The ARV Retrieval Nurses have further developed their retrieval medicine skill set transitioning their operational experience into the coordination room.  Their role has significantly improved our ARV performance, strengthened our team and influenced the ARVs Coordination vision.
 
Quality and Safety: ARV Clinical Governance
As part of ARV’s Clinical Governance Framework, all coordinated cases are audited to determine the quality of care, maintain the impetus for continuous improvements and review safety aspects for both staff and patients
Furthermore, any variation to standard practice, formal feedback and Riskman cases trigger a formal clinical case review. Identification for systems and process improvements are then referred the ARV Internal Review Committee (IRC). In 2016/17- ARV conducted 147 case reviews. 22 cases were referred to IRC.
The main findings in IRC has led to major reviews in STEMI management, particularly in the area of failed thrombolysis in the peripheral hospital settings.
ARV has worked closely with AV in improving ARV Coordinator and AV Clinician communication to streamline patient care and transfers. Other important work has been in reviewing the despatch codes to meet the urgency of transfer required.
 
Education
 
Critical Care Retrieval Nurse Education
The education team has worked hard this year to develop new curriculum and training for a new body of staff working at ARV. The critical care retrieval nurses now working for ARV have given us a more consistent crew, particularly for metropolitan retrievals, in addition to improving our responsiveness for high acuity transfers. Whilst they are all highly skilled in the areas of critical care, and many having prior experience, ensuring they are effective and proficient in the retrieval setting, whilst challenging, has been very rewarding.
 
Registrar education
Registrars that rotate through college certified positions in ARV participate in our certificate of retrieval medicine which produces highly skilled retrieval medicine clinicians. The curriculum includes a focus on coordination, requiring consideration of not just clinical but logistical elements of retrieval also. Multidisciplinary education sessions gives opportunity for perspectives, not otherwise achieved. Training for deployment in resource limited environments, hones the skills of our registrars and affords ample opportunity for professional development in all elements of crisis resource management.
 
Consultant education
We welcomed new specialists to Adult Retrieval Victoria this year, with backgrounds in Emergency Medicine, Anaesthesia and Intensive Care Medicine. Prior experience in retrieval eased their transition into our service. Orientation alongside our new registrar groups provided both with valuable experiences.
Ongoing education for our consultant group takes many forms. Regular communication via our Retrieval Knowledge Centre, provides a web based secure platform for case base discussions and sharing of views and opinions. This year saw the introduction of Workplace, a derivative of Facebook, to Adult Retrieval Victoria. Weekly education updates are posted here along side other more general communication messages. We hold monthly meetings which include governance matters, clinical skills training, simulation, webinars and specialist guest speakers. This allow us to deliver teaching and updates that is accessible to as broad a group as possible.