The Curious Case of…
Model 3&2
(adapted from Curious Case of Benjamin Button)
Avilene Casey
SDU Liaison Officer
Hon Presid...
Background -Hospital Models
O Government redesign of acute hospital system –
Future Health 2012 – 2015, Small Hospital Fra...
Rationale for Establishment of
Hospital Groups
O Large range acute hospitals operating in relative
isolation
O Duplication...
Objectives
O Improve the quality of patient care
O Improve access to appropriate services
O Improve cost effectiveness
O I...
The Importance of being a
Model 3 or 2
“Now produce your explanation and pray make it
improbable.”
― Oscar Wilde, The Impo...
Model ‘s
O 9 Model 2
O 26 Model 3
O 8 Model 4
(reference DoH, AMP, NSP and SDU)
ED Attendances and Admissions
YTD All Hospitals ED
Attendances
166,414
YTD All Hospitals ED
Admissions
45,252
Model 4 ED A...
Importance of Model 3-2
O Improve patient flow across the continuum of
care
O They will act as the hub in an integrated
sy...
Emerging Focus
- Leading care across the Continuum
O Preventing avoidable
patient
admissions/readmission
s
O Equipping Pat...
Role of Model 2 Hospitals
O Change in health trend showing an increasing
use of day case procedures in all specialities
O ...
Service Opportunities
O Day Surgery – & 2S – fit but need stay
O Ambulatory Care – Chronic Disease management,
assessment ...
Service opportunities continued
O Collaborative working
O Development of common standards of care
O Flexible movement of c...
Nursing opportunities
O Working across sites/boundaries -Nursing can
become the integration
O Nurse led OPD clinics – pre ...
Challenges
O Politics – Professional, government
O Culture
O Emotion – societal role
O Education
O Physical/Technical
O St...
Challenges continued
O How do you use the experience wisdom and talent
that currently exist in your service in a different...
Intervention Area Metric National
target
2010 2013 Trend
1
Assess and avoid admission
% of patients with LOS=0 25% 11.54% ...
Medical AvLOS for 2009, 2010, 2011, 2012, 2013
7
7.2
7.4
7.6
7.8
8
8.2
8.4
8.6
8.8
9
Jan
10
Jan
11
Jan
12
Jan-
13
Time Per...
What now
O Exploration and agreement
 Locally – front line staff with service intelligence
 Regionally DON’s within Grou...
For what it's worth: it's never too late or, in my case, too early to
be whoever you want to be.
There's no time limit, st...
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Aveline Casey, Director of Nursing National Acute Medicine Programme

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The curious case of models 2 & 3

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Aveline Casey, Director of Nursing National Acute Medicine Programme

  1. 1. The Curious Case of… Model 3&2 (adapted from Curious Case of Benjamin Button) Avilene Casey SDU Liaison Officer Hon President of IADNAM
  2. 2. Background -Hospital Models O Government redesign of acute hospital system – Future Health 2012 – 2015, Small Hospital Framework 2013, Establishment of Hospital Groups 2013 O Health Service Reform programme – move from hospital centric model of care O Clinical Care Programmes AMP, NSP etc. O National Standards for Safer Better Healthcare – towards Licencing O HIQA reports O EU Directive
  3. 3. Rationale for Establishment of Hospital Groups O Large range acute hospitals operating in relative isolation O Duplication and fragmentation of resources O Difficulty in recruitment and retention of key clinical staff O Non compliance with EU Directives O Inequitable distribution of workload and resources. (Adapted from Professor John R. Higgins May 2013)
  4. 4. Objectives O Improve the quality of patient care O Improve access to appropriate services O Improve cost effectiveness O Improved health outcomes and satisfaction for patients Need to create a paradigm shift in the way acute care is managed. Right staff, Right Skills in the Right Place
  5. 5. The Importance of being a Model 3 or 2 “Now produce your explanation and pray make it improbable.” ― Oscar Wilde, The Importance of Being Earnest
  6. 6. Model ‘s O 9 Model 2 O 26 Model 3 O 8 Model 4 (reference DoH, AMP, NSP and SDU)
  7. 7. ED Attendances and Admissions YTD All Hospitals ED Attendances 166,414 YTD All Hospitals ED Admissions 45,252 Model 4 ED Attendances 70, 557 Model 2&3 ED Attendances 95, 587 Model 4 ED Admissions 19,005 (26.9%) Model 2&3 ED Admissions 26,247 (27.4%)
  8. 8. Importance of Model 3-2 O Improve patient flow across the continuum of care O They will act as the hub in an integrated system of primary and hospital care O Deliver faster access increasing volume of elective services in selected specialities O Treat patients at lowest level of complexity safely, timely, efficient and as close to home as possible
  9. 9. Emerging Focus - Leading care across the Continuum O Preventing avoidable patient admissions/readmission s O Equipping Patients for long term self management O Building readmission prevention strategy O Improving discharge instruction O Enabling safe transition home or to other sites O Creating bi-directional patient flow streams
  10. 10. Role of Model 2 Hospitals O Change in health trend showing an increasing use of day case procedures in all specialities O Enable GP and Primary Care teams to support patients in their own community O Rehabilitation is a major role of small hospitals O Health promotion- prevention and management O Care for differentiated low risk medical/surgical patients O Elevating the patient & family experience
  11. 11. Service Opportunities O Day Surgery – & 2S – fit but need stay O Ambulatory Care – Chronic Disease management, assessment of older persons O Medical Services – Clinics e.g. cardiac failure, Rehab, COPD O Diagnostics Bloods X-Ray endoscopy, bronchoscopy etc. O Palliative Care O Patient centred care – decision making, needs, experience
  12. 12. Service opportunities continued O Collaborative working O Development of common standards of care O Flexible movement of clinical staff O Robust patient transfer arrangements based on clinical need O Ambulance bypass, transfer & repatriation protocols O Entire group expertise and resource realised O Building a competent engaged workforce
  13. 13. Nursing opportunities O Working across sites/boundaries -Nursing can become the integration O Nurse led OPD clinics – pre surgery assessment O Advanced roles - Reframe redesign O Specialist roles O Engaging the nursing workforce O Preparing graduates for service
  14. 14. Challenges O Politics – Professional, government O Culture O Emotion – societal role O Education O Physical/Technical O Structure “You can be as mad as a mad dog at the way things went. You could swear, curse the fates, but when it comes to the end, you have to let go.” – Benjamin Button
  15. 15. Challenges continued O How do you use the experience wisdom and talent that currently exist in your service in a different way ? O Development of Competency Frameworks to meet the new service delivery O Robust assessment skills, O Patient flow requiring a high level of efficiency and coordination, data interpretation O Discharging – nurse led O Leadership accountability for performance
  16. 16. Intervention Area Metric National target 2010 2013 Trend 1 Assess and avoid admission % of patients with LOS=0 25% 11.54% 23% 2 Short Stay Unit % of patients with LOS 1-2 days 31% 25.36% 24% 3 Efficient Processing of ordinary patients % of patients with LOS > 2 days 44% 63.10% 53% 4 Complex discharges. % of patients with LOS >14 days 11% 13.12% 10.8% Area 4 % BDU of patients with LOS > 30 33% 34.82% Areas 3 and 4 AvLOS for those staying > 2days 6 -10 days 12.87 12.4 Overall AvLOS for medical patient 5.8 days 8.48 6.94 Acute Medicine KPI Results Data Source: HIPE, ESRI © Acute Medicine Programme HSE Ireland
  17. 17. Medical AvLOS for 2009, 2010, 2011, 2012, 2013 7 7.2 7.4 7.6 7.8 8 8.2 8.4 8.6 8.8 9 Jan 10 Jan 11 Jan 12 Jan- 13 Time Period AvLOS(days) Data Source: HIPE, ESRI © Acute Medicine Programme HSE Ireland
  18. 18. What now O Exploration and agreement  Locally – front line staff with service intelligence  Regionally DON’s within Group/network of Model 2 & 3 DON’s  Hospital Group Governance Structures  IADNAM  Clinical colleagues - Colleges  National – ONMSD, DoH, 3rd level Institutes, NMBI  Create a unified national vision and strategy
  19. 19. For what it's worth: it's never too late or, in my case, too early to be whoever you want to be. There's no time limit, stop whenever you want. You can change or stay the same, there are no rules to this thing. We can make the best or the worst of it. I hope you make the best of it. Benjamin Button looking back on his life says: Thank you.

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