NEAT -Using Data For Your Advantage the GCH to GCUH
experience.
Emergency Department Management Conference
28-29 July 2014...
Sourcing data, interpreting data and Utilising it
Improving patient out comes.
• WHY:
• As part of the health reform acros...
Where are we
Gold Coast
Southport
70,000 presentation
Carrara
Hospital
Gold Coast Robina
55,000 presentations
DAY ONE GCUH- If you build it
they will come
Diagnostic Phase
• Data was collected (DSS, BPIO,CSIRO, Research)
• Reports were generated to monitor performance
• Foreca...
Diagnostic Phase (What we looked for in the data!)
• Presentations (Who and when)
• Performance (KPI)
• Activity vs staffi...
Understanding your data
0
10
20
30
40
50
0
50
100
150
200
250
OCCUPANCY
Y2Axis
Y1Axis
23 HospitalsInpatient Admissions (pa...
How one set of data can impact another (Current KPI)A Plan To
Address Relationships Between NEAT and NEST and Budget
NEST
...
Summary of Data (The Facts)
• There has been an increase of approximately 1400 patients a
month
• There has been a large i...
Addressing Education
Education
 What does NEAT mean for the
Emergency Department?
 See and treat all patients within two...
Put Clinicians Back at The Bed side
(The Navigator Nurse)
• The navigator role aims to help facilitate the patient journey...
Invest In Corporate Champions!
NEAT became a hospital wide issue (Executive buy in)
• How did we do this:
1. Hospital Exec...
DADs meeting (CEO)
•Monitor weekly performance and significant variance
•Identification of systemic issues and solution
•E...
How we came to conclusions
(Powerful data)
Effective Change Management
• All areas developed:
1. Response to diagnostic (What they will do)
2. Innovative staffing mo...
What we changed or added (Map changes)
Southport NEAT Time Line
Access and
Flow Unit
commence
s
Access and
flow
director
a...
What we changed in response to the data!
• New models of care (Early senior decision making)
“Streaming”
• Changed Consult...
How Emergency Data Impacts Hospital Services
• All sub-specialities were challenged to develop a surge plan to
respond to ...
Feed Back To Staff
THE
RESULTS
Thank you
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Brett Sellers & Luke Glassington, Gold Coast University Hospital - NEAT Using Data for Your Advantage

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Brett Sellers & Luke Glassington delivered the presentation at the 2014 Emergency Department Management Conference.

The 2014 Emergency Department Management Conference explored areas such as how to improve access to care, clinical redesign, NEAT compliance, patient flow, point of care testing, geriatric care, and enhance the performance of Emergency Department.

For more information about the event, please visit: http://bit.ly/edmanagement14

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Brett Sellers & Luke Glassington, Gold Coast University Hospital - NEAT Using Data for Your Advantage

  1. 1. NEAT -Using Data For Your Advantage the GCH to GCUH experience. Emergency Department Management Conference 28-29 July 2014 | Novotel on Collins Melbourne Brett Sellars: Service Director Division of medicine and Chronic Diseases. Luke Glassington: Acting Business Practice Improvement Officer (BPIO)
  2. 2. Sourcing data, interpreting data and Utilising it Improving patient out comes. • WHY: • As part of the health reform across Australia, within an ever increasing work load and a limited health budget, clinicians have to become more innovative and strategic to ensure quality patient outcomes. • Gold Coast Hospital and Health Service – the big move (GCH, now GCUH, Robina and Carrara) • Background: • In 2012-13 GCH ED had 70000presentations .(2014? 80000), Robina ED 55860 presentations • Combined in HHS 125334 last year- forecast 140000 2014 • Current NEAT 70% GCUH 82% Robina ED’s • GCUH opened 28/9/2013 since opening there has been a 23% increase in presentations at GCUH with Robina seeing same numbers. • What we did • Data set was compiled of current performance vs forecasted increases post move (August 2012) • Key stake holders met to discuss performance and quality. • Development of quality indicators (Clinical Senate)
  3. 3. Where are we Gold Coast Southport 70,000 presentation Carrara Hospital Gold Coast Robina 55,000 presentations
  4. 4. DAY ONE GCUH- If you build it they will come
  5. 5. Diagnostic Phase • Data was collected (DSS, BPIO,CSIRO, Research) • Reports were generated to monitor performance • Forecast growth • Monitor quality
  6. 6. Diagnostic Phase (What we looked for in the data!) • Presentations (Who and when) • Performance (KPI) • Activity vs staffing (Mapping vs Rostering) • Activity vs time of day and day of week • Purchased activity vs actual (QWAU) • Breaches (live investigations) • Seasonal variances • Impact of Special events • Patient journey boards
  7. 7. Understanding your data 0 10 20 30 40 50 0 50 100 150 200 250 OCCUPANCY Y2Axis Y1Axis 23 HospitalsInpatient Admissions (patients/hr) (Y1 axis) Inpatient Discharges (patients/hr) (Y1 axis) ED Presentations (patients/hr) (Y1 axis) ED Discharges (patients/hr) (Y1 axis) Inpatient Admissions from ED (patients/hr) (Y1 axis) Inpatient Length of Stay (days) (Y2 axis) ED Length of Stay (inpatients) (hours) (Y2 axis) ED Length of Stay (others) (hours) (Y2 axis) ED Access Block Cases (inpatients) (patients/hr) (Y2 axis) A B C • Keep it simple • Identify what the data is for • Understand Choke points • Understand optimal occupancy • Understand variances in data (standard deviations) • Understand what impacts the data • Quality KPI before performance • Terminology (12 midnight)
  8. 8. How one set of data can impact another (Current KPI)A Plan To Address Relationships Between NEAT and NEST and Budget NEST NEAT Budget
  9. 9. Summary of Data (The Facts) • There has been an increase of approximately 1400 patients a month • There has been a large increase in ATS category 1,2 and 3 patients • There has been a 24% increase in total presentations • There has been a 19% increase in adult presentations • There has been a 43%increase in paediatric presentations • Total % Patients seen in time by ATS have decreased about 15% • Decision Support System (Panorama) Nursing 107 FTE to 132 FTE 23% increase Medical 76 FTE to 87 FTE 15% increase. • NEAT fixed access block • Average times for the patient journey don’t = NEAT however • Streaming has reduced the impact of access block on discharged patients. • Still restrictions in streaming to MAU
  10. 10. Addressing Education Education  What does NEAT mean for the Emergency Department?  See and treat all patients within two hours of arrival.  A decision to admit or not to admit and referral to an inpatient team will be expected in this time  Patient to complete their ED stay within 4hrs from presentation.  Accurate data entry in EDIS  time seen  disposition times  Time of consultation requested for the inpatient teams should be entered into EDIS, so that causes of extended LOS can be explored.  The provisional diagnosis needs to be accurate as funding is calculated from diagnosis, triage category and disposition (admitted or discharged)
  11. 11. Put Clinicians Back at The Bed side (The Navigator Nurse) • The navigator role aims to help facilitate the patient journey through the Emergency Department (ED) to ensure that it is as efficient and timely as possible, taking action when this is not the case. The role also aims to support staff delivering care in the department. Provides a dedicated nurse to monitor time and efficiency. • Currently 16/24 at GCUH • Allow clinicians to be clinical • Surrogate benefit of having a quality monitoring system • 24/7 Education • Ensure sustainability • Not a interpretation of performance but an opportunity to identify shortfalls, and provide data which recommends where to invest.
  12. 12. Invest In Corporate Champions! NEAT became a hospital wide issue (Executive buy in) • How did we do this: 1. Hospital Executive were rostered to be in emergency for 16 hours of the day for 2 weeks. This occurred 3 times over the first year of NEAT. (Education on ED business) 2. CEO and COO invested time through meetings and forums to drive process change and identify expectations. (All specialities were asked to deliver a surge plan to address performance and staffing 24/7) 3. Development of champions and department heads to meet in these forums. 4. Daily activity (DADS) and breach meetings 5. Subscribed by all DON, ADON and Medical Directors. *or proxy
  13. 13. DADs meeting (CEO) •Monitor weekly performance and significant variance •Identification of systemic issues and solution •Establish operational principles Breech meetings (Director AFU) • Review yesterdays performance • Identify cause of breech and solutions • Report persistent issues to Dads Strategic patient flow Committee (COO) • Monitor monthly performance (NEAT, NEST and budget) • Monitor execution of strategic plan • Plan 6 months ahead especially for significant events Monthly Weekly Daily OperationalStrategicMeeting Plan- Where to present the data
  14. 14. How we came to conclusions (Powerful data)
  15. 15. Effective Change Management • All areas developed: 1. Response to diagnostic (What they will do) 2. Innovative staffing models 3. Innovative models of care (PIT, Pull models, Streaming, MAU etc) 4. Patient flow models 5. Discharge planning 6. Expected Date of Discharge (EDD) 7. 11am discharge KPI daily (% DC by 11am) 8. Long stay and cross boarder rounding 9. Documentation tools (PFM10, EMR etc.) 10. Benchmarking
  16. 16. What we changed or added (Map changes) Southport NEAT Time Line Access and Flow Unit commence s Access and flow director appointed Medical Assessmen t Unit opens Southport 24 hour CNC coverage 5 days a week BPIO commenced full time Robina and Southport ED Restructure of staffing to accommodat e early decision making in ED Business Practice Improvement officer role commenced Extra FTE in medical, nursing and admin Current management CNC to work on floor to increase coverage Reconfigure of current FTE to accommodat e new model of care Increase in Short Stay Unit capacity from 10 beds to 6 beds and 7 chairs PIT model commence d at Southport Emergency Process People ADON patient flow and extra bed managers Refinement of ward based care model Re- deployment of medical staff to clinics Rapid access clinics for medicine commence d Full time BPIO appointed New process in bed management Macro NEAT Project •Slack box process redesign •Early decision making •Education to staff on NEAT •Performance feed back •Definition on purpose and function of ED Appointment of new CE Additional nursing resources for bed management • Reconfigure bed meeting •* Additional Afternoon bed meeting •Rescheduling of ICU radiology , cardiac and HODU PT •Opening of additional HDU over winter Redesign of bed manage ment Executive rounding in ED Surge plans for all sub- specialities and new Capacity alert process Ward based porterage and refinement of bed cleaning
  17. 17. What we changed in response to the data! • New models of care (Early senior decision making) “Streaming” • Changed Consultant roster increasing cover after hours and week ends. • Geographical medical staffing, this was based on data showing presentation by time of day and ICD code. • Redesigning job descriptions to address flow and performance 24/7 • Surge plan to address patient needs 24/7 • Streaming by triage of medical patients to the Medical Assessment Unit (MAU) • Utilised the Clinical Access Redesign Unit NEAT flow chart. (Driving the escalation component with executive backing) See next slide. • Investigating individual breaches in real time. • Development of model of care for GCUH
  18. 18. How Emergency Data Impacts Hospital Services • All sub-specialities were challenged to develop a surge plan to respond to inpatient access block and ED pre-load surge. • All specialities were challenged to provide a roster to have consultations responded to in ED with in 1 hour 24/7. (work in progress) (Sub-speciality review times) • (Generalist vs Specialist ) for consultation, and care on the wards. Top 5 ICD per speciality. • Criteria based, nurse led discharge developed by sub- specialities • Improved compliance with the 11am discharge time (Transit Unit) • After hours discharge. Investment was made to address this. (pathways and care plans)
  19. 19. Feed Back To Staff
  20. 20. THE RESULTS
  21. 21. Thank you

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