St John Urgent Care information for health professionals
St John Urgent Care centres are currently operating in Armadale, Cockburn Central and Joondalup. New centres will be opening in Cannington and Midland in early 2021, and Osborne Park and Mandurah in early 2022. Below is information for health professionals about these centres.
What is a St John Urgent Care centre?
St John Urgent Care is designed to manage acute but non-life-threatening injuries and illnesses which would otherwise present directly to an Emergency Department.
St John Urgent Care centres are large purpose-built facilities which have x-ray, casting and splinting capability on site, as well as facilities for minor procedures, IV administration and acute dental care.
These centres replicate some features of the hospital environment- namely care is delivered in a large team-based, multi-bay department, with continual nursing support. St John Urgent Care centres have specialists on call to provide orthopaedic and plastics advice throughout extended hours, rapid radiology reporting arrangements, and a review clinic to follow up results and manage non-operative fractures and injuries over time.
The first St John Urgent Care centres opened in July 2016 at Joondalup and Cockburn Central. We currently cater to 80,000 urgent care presentations annually in metropolitan Perth. As such, St John Urgent Care centres operate efficient systems tailored to the provision of Urgent Care, backed by our extensive experience in this form of healthcare. St John Urgent Care is supported by a suite of policies, procedures and robust clinical governance structures to provide consistent and high-quality care.
St John Urgent Care is NOT an Emergency Department
St John is explicit in its messaging to patients and clear in its scope- we are not an emergency department.
Any patient experiencing a potentially life-threatening event must always call triple zero (000) and proceed directly to their nearest ED. Likewise, GPs should continue to refer all life-threatening emergencies to their nearest ED.
St John Urgent Care is not an inpatient facility. Patients cannot be admitted or observed for extended periods. Instead urgent care is designed to manage those low-acuity, non-life threatening problems which currently present to local emergency departments in high volume.
The ultimate aim is to relieve the burden on metropolitan emergency departments, enabling our community’s sickest patients to access the ED, and allowing lower-acuity patients to access the most appropriate care for their problem in a timely manner.
Who is Urgent Care designed to treat?
St John Urgent Care is best suited to the needs of Australasian Triage Category 4 and 5 patients who might otherwise attend an emergency department.
These patients currently account for 51% of all Emergency Department presentations in WA, despite having a low admission rate (15%) and an extremely low mortality rate (0.002%).
Such patients typically present with acute but non-life-threatening injuries and acute infections.
This cohort requires early access to services such as:
- casting or splinting of musculoskeletal injuries
- orthopaedics, plastic surgery or ophthalmology input
- minor procedures
- intravenous antibiotics
- fracture-clinic/review-clinic type follow up
Why can’t a GP provide this care?
Individual GPs throughout WA can and do provide this type of care on a case-by-case basis in their own practice. However, patients with Australasian Triage Category 4 & 5 problems continue to present to ED in high volumes, with Urgent Care problems representing over half of the total ED activity in WA. Thus, St John has identified the need for a more systematic solution.
A recently published WA-based study by Whyatt, Vickery, Mountain et Al. concluded that 20-40% of all ED attendances could be managed in primary care, particularly when GPs operated in an environment supported by “onsite and timely radiology; speciality splinting devices for fractures; access to timely specialist advice, for example, orthopaedic, plastic surgery, dermatology and ophthalmology; and additional space and staff for observation, rehydration, etc.” This is a very apt description of a St John Urgent Care centre.
St John’s Urgent Care model is ideally staffed by GPs from practices in the local area. In our experience, many such GPs have an appetite to participate in acute/unscheduled patient care. However, the practical or commercial challenges of delivering such care on a large scale throughout extended hours are often prohibitive in the context of office-based general practice. St John Urgent Care makes it feasible for local GPs to periodically exercise their acute skillset in a well-supported environment, without affecting their day-to-day work arrangements or taking on new management challenges. Local GPs who work shifts at existing St John Urgent Care centres tend to report a high level of satisfaction with the experience. They tend to enjoy the change of setting, being up on their feet dealing with higher acuity presentations, the episodic nature of the care, and the positive team dynamics. At present, over 150 GPs throughout the Perth metropolitan area work shifts at St John Urgent Care.
To express interest in working shifts at Urgent Care, please email firstname.lastname@example.org
What DON’T we do?
Any new service justifiably generates interest, questions and concerns from both patients and health professionals. We expect that you will have questions, and we will be organising information sessions and GP engagement events in your local area in the near future to address these.
In the meantime, here is a list of things St John Urgent Care will not do:
- We will not entice your patients to change doctor.
- Urgent Care is designed to manage episodes of acute care rather than a patient’s baseline healthcare or ongoing chronic needs.
- We aim to treat episodes that would otherwise result in an avoidable ED presentation, and then return the patient to their usual GP as soon as it is safe to do so.
- We support and reinforce the existing relationship between GPs and their patients. The GP is the ultimate custodian of the patient’s ongoing healthcare.
- The first question our nurses ask every Urgent Care patient is “Who is your usual GP?”.
- This enables us to send a discharge summary to that nominated GP and to re-direct non-Urgent Care type health-care issues back to that GP
- We will not perform chronic disease management plans, mental health treatment plans, domiciliary medication management reviews or health assessments on your patients
- We will not provide long-term repeat scripts for medications to your patients
- We will not provide routine referrals to specialists for your patients
- We will not perform screening tests, health checks, skin checks, women’s/men’s health checks etc. for your patients
- We will not use emergency after-hours billing items when consulting with your patients
- We will not send patients back to you without a plan/partially treated/with incomplete workup
- We will not send patients back to you without a discharge summary
- We will not facilitate drug-seeking behaviour or prescription medication abuse
- We will not sign patients off work for extended periods following a single attendance
If you encounter any departure from the above, please contact email@example.com. We take such input very seriously.
Who are St John, and why are they operating Urgent Care centres?
St John has been serving and operating as an integral part of the Western Australian community for more than 125 years. While the look of our organisation has changed over that time, the dedication and commitment to our core purpose has remained the same. St John Urgent Care is the newest clinical service through which St John can deliver on its purpose.
We are a non-profit organisation whose purpose in Western Australia is to serve humanity and build resilient communities through the relief of sickness, distress, suffering and danger.
We do this by:
- Making first aid a part of everyone’s life.
- Delivering high quality cost-effective ambulance services to Western Australians.
- Providing appropriate, timely and equitable access into the health system for unscheduled care.
In the context of increased pressures on ambulance and emergency department services, St John Urgent Care is our effort to the provision of unscheduled care for non-life threatening problems.
- St John WA has constantly evolved and innovated to better achieve its purpose since its humble beginnings in the 19th century
- St John began teaching first aid in Perth, Western Australia on March 3rd 1892 and gradually expanded throughout rural WA in the early 1900s.
- The St John Ambulance Brigade was formed in 1904, providing urgent first aid at communal events and sporting occasions.
- As the local population grew and the need for a dedicated ambulance service became apparent, St John assumed responsibility for Perth’s ambulance service in 1922.
- By 1959 there were 72 St John sub-centres throughout WA, providing country ambulance and first aid training services to the local community.
- Due to rapid growth in demand for its services throughout the 1970s, St John undertook structural changes to enable it to reliably cater to the communities’ needs.
- St John WA transitioned from a medical charity with lay management to a non-profit organisation with professional management in 1979, combining features of a public utility, a business corporation and a voluntary association.
- During its 100yr centenary in 1992, St John opened a new branch, Community Care. This service provided by non-uniformed volunteers provided transport, outreach and a social outlet for the increasing population of lonely elderly in the community.
- In the early part of the new millennium, St John Ambulance was officially recognised by the State Government as the principle provider of ambulance transport in Western Australia.
- The Volunteer First Aid Service celebrated 100 years during 2004, acknowledging the important role volunteers play in providing first aid services at community, cultural and sporting events. You can become a volunteer for St John WA by heading to stjohnwa.com.au/changelives
- St John Ambulance Western Australia celebrated 120 years of service to the community in 2012.
- St John opened its first Urgent Care centres in Perth in 2016, reflecting its ongoing humanitarian commitment to providing high-quality first aid services and timely patient access to unscheduled care for minor injuries and illnesses.
Do Urgent Care centres work? Is there any evidence?
In designing its Urgent Care model, St John has analysed international models in the US, the UK, Ireland and New Zealand among others. The most geographically relevant model is that of New Zealand and Auckland in particular. An Urgent Care model similar to that operated by St John is well established in Auckland, having operated there for over 30 years. Auckland has 19 Urgent Care centres distributed throughout the greater metropolitan area.
In WA, patients with minor injuries and acute but non-life-threatening illnesses present in high volumes to emergency departments. By contrast, Auckland patients typically present to Urgent Care centres rather than Emergency Departments for this category of medical care. As a consequence, Auckland has the lowest per-capita ED attendance rate in the developed world at 179 attendances per 1000 of population per year. For comparison, the WA ED attendance rate is almost double this, at 322 per 1000.
St John believes that patients and frontline emergency services in WA can derive similar benefits by replicating the Auckland model, albeit in a format customised for the particular needs of WA patients- namely St John Urgent Care.
St John Urgent Care federal government pilot programme
- St John partnered with the federal government in 2019 to undertake a 4 year pilot programme to formally evaluate the St John Urgent Care model throughout the Perth metro area. This ongoing project involves a $28m commitment towards the construction of four new Urgent Care centres, and formal evaluation of their impact on the emergency healthcare system, patients, and other key stakeholders.
- The designated locations for the four Urgent Care sites are Cannington, Midland, Osborne Park and Mandurah.
- Construction of the Cannington and Midland sites is ongoing and these centres will be operational in early 2021. The Cannington site will be located at 1472 Albany Highway, while the Midland site will be located at the corner of Clayton Road and Lloyd Street.
- Locations and tenancies for Osborne Park and Mandurah sites are in the process of being finalised, with these latter facilities due to come online in early 2022.
- The programme to evaluate the effect of St John Urgent Care sites will include a stakeholder engagement process conducted by the WA Health Translation Network. A formal quantitative evaluation of Urgent Care activity, clinical case-mix, discharge outcomes and the interaction with local EDs based on matched EDIS data will be carried out by the Prehospital, Resuscitation and Emergency Care Research Unit of Curtin University. A health economics evaluation will involve a cost/benefit analysis to determine the viability, sustainability and value aspects of the Urgent Care centre model. Finally, the federal government will perform a high level analysis of local patient flow effects in the locality of new Urgent Care centres.
Is this the same as the State GP Urgent Care Network?
St John is very supportive of the state initiative as one of a number of possible measures to help prevent avoidable ED visits. In cases where local GPs have the time, physical resources and appetite to manage urgent care-type presentations in their own practice, this is clearly a good outcome for patients.
The WA GP Urgent Care Network is a recent initiative announced by the state government in partnership with WAPHA/RACGP/AMA, aimed at directing triaged category 4 and 5 patients to un-filled GP appointments.
By contrast, St John Urgent Care has been operating large purpose-built urgent care centres in WA since 2016. The St John model of service delivery is tailored specifically toward managing high-volume urgent care presentations throughout extended opening hours.
Information evenings and community conversations
St John will be organising information events for GPs in the locality of new St John Urgent Care centres in summer/autumn of 2020. These live events will provide further opportunities to ask questions and engage on the topic of Urgent Care. These events will be advertised in due course.
In addition, the Consumer and Community Health Research Network, a division of the WA Health Translation Network, will be conducting community conversations for interested stakeholders in March 2020. If you are interested in participating in these community conversation workshops please read below.
A message from the Consumer and Community Health Research Network
We are holding a Community Conversation on Tuesday 10 March for people in the Cockburn area to allow community members who have used the St John Urgent Care Cockburn Central to offer feedback and guidance for future Urgent Care centres.
A Community Conversation is an event using an abridged version of the World Café method, and is a friendly and constructive way to have open conversations around questions of importance to a specific topic. We are inviting people who have used the St John Urgent Care Centre at Cockburn Central to be involved in a conversation about their experiences and their future expectations about Urgent Care at Cockburn Central and surrounding suburbs.
The Community Conversation format will be facilitated by the WA Health Translation Network’s Consumer and Community Health Research Network (CCHRN) who will provide an independent, open and friendly environment to effectively capture discussion points and thoughts. All comments are captured by a scribe and used to develop a report about the St John Urgent Care service at Cockburn Central. This will inform St John’s provision of care relevant to the needs of the local community and the development of future urgent care sites.
For more information and registration for Tuesday 10 March event please follow the link to the CCHRN website. A small payment will be provided and refreshments will be available.
A further community conversation will be held in Midland on Wednesday 18 March. Please click here for registration details. A small payment will be provided and refreshments will be available.