REDDSoC Project - Reducing Day of Surgery Cancellations
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REDDSoC Project - Reducing Day of Surgery Cancellations

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Annie Williams, Manager Innovation & Improvement, from Goulburn Valley Health delivered this presentation at the 2012 Elective Surgery Redesign Conference. For more information about our wide range of ...

Annie Williams, Manager Innovation & Improvement, from Goulburn Valley Health delivered this presentation at the 2012 Elective Surgery Redesign Conference. For more information about our wide range of medical and health events covering a broad range of industry issues, please visit www.healthcareconferences.com.au

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    REDDSoC Project - Reducing Day of Surgery Cancellations REDDSoC Project - Reducing Day of Surgery Cancellations Presentation Transcript

    • Presented by: Annie Williams, Manager of Innovation & Improvement – Goulburn Valley Health Shepparton, Victoria REDDSoC: REDucing Day of Surgery Cancellations Project
    • Goulburn Valley Health - main campus at Shepparton, Northern Victoria - with additional campuses at Tatura and Rushworth  Innovation & Improvement Unit @ GVH: established November 2009  Multiple Surgical Services reviews [internal and external]  Project Scoping commenced Jan 2010  RHCP funding approved – scope confirmed “Review the journey of Elective and Emergency Patients, from the time of being confirmed for surgery to entering Recovery”  Branded as the REDDSoC Project Background:
    • GVH Redesign Methodology
    • What did the data say? Raw data was available… Which we followed up with process mapping, patient tracking, and extensive stakeholder communications and interviews.
    • ED patients Reasons for cancellations Wait list management Theatre Utilisation “No Beds” Staffing Issues Anecdotal evidence was provided:
    • We had a problem to solve… REDDSoC @ GVH: • Aim 1: Identify unproductive activity within OT processes – to improve capacity within existing resources • Aim 2: Reduce ED LOS for pts awaiting emergency surgical procedures • Objective 1: Reduce DOS cancellations, (planned and unplanned surgery), by 30% by 31/12/10
    • What did we ask of our stakeholders? We have people arriving everyday in our ED that will require surgery... What plans do we have in place? When the patient is confirmed for surgery, how long do they wait? What are the impacts on patients when their surgery is cancelled? What is it like for our patients to wait for a long time for their surgery?
    • Understanding the emergency demand…
    • What did we learn from the data? Period: 2 months Jul/Aug 10 Total Time [mins] Median mins [Range: mins] Average OT time Orthopaedic 14228 155 [58 – 370] 26.95 hrs/week Gen Surgery 14935 100 [15 - 350] 28.28 hrs/week Obs/Gynae 3512 84 [35 – 84] 6.65 hrs/week Vascular 1500 80 [21 – 150] 2.84 hrs/week Various 1273 2.41 hours/week Historical Allocation 4 hrs + 1 hr/day 4 hrs + 1 hr/day nil nil nil Emergency demand We did know what coming in from the Emergency Department!
    • What did our patients tell us? -3 -2 -1 0 1 2 3 4 5 6 Access to Care Respect for patients values, preferences and expressed needs Coordination and integration of care Information and education Transition and continuity Physical comfort Emotional support and alleviation of fear and anxiety Involvement of, and support for families and carers Positive Sometimes/ Mixed Negative 01/09/2010 “the staff have been good and the Doctors are great – No Problems” “About 10pm, they looked at the X ray and said I wouldn’t get to theatre tonight. It would probably be late tomorrow” He was very good with his communication, but I felt he was interrupted by the senior medical officer “She was very uncomfortable and feeling a bit faint, so I went up and asked if there was somewhere Isabelle could lie down. She said there are 3 seats there together, so lie down there. We didn’t mind waiting, but She just couldn’t sit” “Didn’t see a soul until I managed to get a nurse….. Not a good way to spend the night in this bed” “It was a long night in the ED” “The staff that looked after me were brilliant” “They kept me informed about what was going on” “A doctor came and saw me straight away. He was awesome considerate and nice”
    • Impacts of Emergency Demand… Emergency Surgical Patients Emergency Department Elective Surgical Patients ED Time to OT - Jul Aug 2010 [by specialty] 0 10 20 30 40 50 60 70 80 90 General Surgery O /& G Orthopaedic Specialty Patients ED < 8 hrs ED > 8 hrs Emergency Demand July Aug 2010 0 10 20 30 40 50 60 Monday TuesdayW ednesday Thursday Friday Saturday Sunday Day of the week patients Emergency Admissions Emergency Procedures Linear (Emergency Admissions)
    • Project Diagnostics: Capacity did not meet current, or would not meet future demand!  Limited existing physical and staff resources  Emergency activity 1/3 of all GVH OT procedures  Emergency demand was predictable  Limited existing capacity or planning for emergency demand  Current allocations process did not maximise existing limited resources  Variation in data entry and documentation  Elective surgical management meeting KPIs REDDSoC Diagnostic Summary
    • 1. Capacity based on demand, both emergency and elective 2. Allocations made to Surgical Specialities 3. Capacity for General Surgery and Orthopaedic Surgery daily [M-F] 4. Capacity created for recruitment for additional surgical specialties – including those to address areas of high elective demand e.g. ENT 5. Approved set of Business Rules for OT allocations, including regular reviews But not all changes were in response to the ‘Hard data’! Public Dental List: many patients are paediatric or have special needs – previous allocations on Friday afternoon had led to long waits and even longer fasting times; and often created challenges in patient management But Now dental sessions Monday morning Children and special needs patients are first on the list, and reports are that there is significant improvement in the processes and positive impacts on patient experience Some Features of the REDDSoC Model:
    • 4 week planner 2010 Monday Tuesday Wednesday Thursday Friday am am am am am 0830 start 0830 start 0830 start 0830 start 0900 start Theatre 1 MrHeinz Mr Kamenjarin MrHunt Mr Dalton General rotating Theatre 2 MrAbdullah Orthopaedics Dr Teale Dr Stegeman Orthopaedics rotating rotating Mr Kennedy mthly Clarnette mthly Theatre 3 Dr Ilic - Jeftic LUSCS Mr Safdar mthly MrUren mthly LUSCS Higher risk pts (Lithotripsymthly) Mr Forbes mthly Low risk MrMortensen mthly vacant 0830start 0830start 0830start 0830start 0900start Treatment FlexibleCystoscopy DrNana MrAbdullah Mr Kamenjarin MrDalton or Room TRUS Mr Heinz mthly DrSawhney pm pm pm pm pm 1300 start 1300 start 1300 start 1300 start 1300 start Emergency Theatre 1 MrHeinz Mr Kamenjarin Mr Hunt 3 wks Mr Dalton General scopes in4thwk rotating MrSafdarmthly Emergency Theatre 2 Mr Horton Orthopaedic Mr Critchley Mr Chew Orthopaedic rotating rotating MrKennedymthly MrUren mthly Theatre 3 Dr Barmare Dental Mr Mortensen Mr Mortensen Gynae Registrar 3weeks 3weeks 1300start 1300start 1300start 1300start 1300start Treatment Mr Eastman MrDalton Dr Harris M. Kamenjarin1wk Dr Sandhu2/52 Room A. Testro2wk Mr Dalton2/52 1430mthly HUNT Mr Heinz 1wk Reviewedfor5thSeptember REDDSoC VersionA.1.3.3-ProposedOT ScheduleModel THR1 THR2 THR3 T/ROOM THR1 THR2 THR3 T/ROOM THR1 THR2 THR3 T/ROOM THR1 THR2 THR3 T/ROOM 7.30 ECT ECT ECT ECT 8.00 G/S OBS/GYN DENTAL G/S ORT OBS/GYN G/S OBS/GYN DENTAL G/S ORT OBS/GYN 8.30 [HEINZ] [ILIC] URO [HEINZ] [BARMARE] [ILIC] URO [HEINZ] [ILIC] URO [HEINZ] [BARMARE] [ILIC] URO 9.00 [MORT] [MORT] [MORT] [MORT] 9.30 10.00 10.30 11.00 C/OTIME C/OTIME 11.30 ORT ORT 12.00 C/OTIME C/OTIME [BARMARE] C/OTIME C/OTIME C/OTIME C/OTIME C/OTIME C/OTIME [BARMARE] C/OTIME C/OTIME C/OTIME C/OTIME 12.30 **DOS **DOS **DOS C/OTIME **DOS 13.00 G/S C/OTIME G/S G/S G/S 13.30 EASTMAN EASTMAN EASTMAN EASTMAN 14.00 [HUNT1in8] 14.30 15.00 15.30 16.00 16.30 17.00 17.30 18.00 18.30 19.00 19.30 20.00 20.30 21.00 21.30 22.00 22.30 On-call> EMERG AFTER HOURS START TIME WEEK1 WEEK2 WEEK3 EMERG AFTER HOURS EMERG AFTER HOURS EMERG AFTER HOURS MONDAY WEEK4
    • ‘Quarantined’ Emergency Allocations  Ensure capacity every day for orthopaedic and general surgery session  All lists have emergency allocations to meet 80% of predicted demand [ Previous emergency allocations were limited to general surgery  Flexibility within the lists to treat emergency cases based on clinical need  Review of emergency cases booked after 1800hrs to see if clinically they could be moved to the next elective list  Electronic data report to capture pending OT patients Validation of predictability of Emergency demand…
    • Some Key Project Outcomes: We have seen…  Reduction in DOS Cancellations [app. 50%]  Decreased LOS for Emergency Surgical patients within the ED [improved communication, management and transition]  Electronic documentation of pending OT patients  Less after hours emergency cases = decreased overtime [$]  Greater predictability for OT medical and nursing staff  Greater planning for emergency demand allows more effective management of resources [e.g.: anaesthetic rostering, CSSD, cleaning]
    • 0 10 20 30 40 50 60 70 80 90 GS ORT GYN NumberofPatients Surgical Specialty EDSURGICALPATIENTS [EDADMISSION TO PROCEDURE] July2010 TOAug2010 ED<8 hrs ED>8 hrs 0 20 40 60 80 100 120 140 GS ORT GYN NumberofPatients Surgical Specialty EDSURGICALPATIENTS [EDADMISSION TOPROCEDURE] Sept2011toOct2011 ED<8 hrs ED>8 hrs The impact upon ED surgical patients:
    • Secrets of our success: 1. Great Executive Sponsorship 2. Clinical leadership 3. Extensive stakeholder engagement 4. Extensive consultation and planning – utilising AIM implementation approach 5. Great project support 6. Communication & branding
    • Next steps: Patient Flow Collaborative Redesign Project
    • Thank you… Contacts: Anne Williams, Manager of Innovation, GV Health, Shepparton Anne.williams@gvhealth.org.au Jenny Lia - Redesign Project Facilitator Cheryl Lancaster- Redesign Support GVH Executive, Operational management, medical officers and staff of GVH Victorian Dept of Health – RHCP NSW Health Centre for Healthcare Redesign