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Jan Maree Marsh, Royal Children's Hospital Brisbane: ‘Y and the I Generation’- Patient Flow More than Child’s Play at Children’s Health Queensland
 

Jan Maree Marsh, Royal Children's Hospital Brisbane: ‘Y and the I Generation’- Patient Flow More than Child’s Play at Children’s Health Queensland

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Nicole Close, Nurse Manager Patient Flow and Jan Maree Marsh, Clinical Lead, Little Feet Big Steps Project, Royal Children's Hospital Brisbane ...

Nicole Close, Nurse Manager Patient Flow and Jan Maree Marsh, Clinical Lead, Little Feet Big Steps Project, Royal Children's Hospital Brisbane
delivered this presentation at the 2014 Hospital Bed Management & Patient Flow Conference, Australia's foremost patient flow improvement meeting, showcasing innovative case studies and pioneering best practice in the nation’s hospitals.

Over 150 hospitals and state and federal departments of health throughout Australia and New Zealand have attended this conference over the past years. For more information about the annual event, please visit the conference website: http://www.healthcareconferences.com.au/bedmanagement14

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    Jan Maree Marsh, Royal Children's Hospital Brisbane: ‘Y and the I Generation’- Patient Flow More than Child’s Play at Children’s Health Queensland Jan Maree Marsh, Royal Children's Hospital Brisbane: ‘Y and the I Generation’- Patient Flow More than Child’s Play at Children’s Health Queensland Presentation Transcript

    • Y & i generation Patient Flow more than Child’s Play Children’s Health Queensland Presented by: Nicole Close & Jan Marsh Date: 28 /2 /2014
    • Tech-Savvy - Generation Y is plugged-in 24 /7. This generation prefers to communicate through e-mail and txt messaging rather than face-to-face contact. Make up 90% workforce Driving force for change
    • Little feet BIG steps and MacroNEAT projects have integrated and transformed communication culture improving our Patient Flow Journey.
    • In 2011 the project identified five focus areas that impact on a patients journey 1. Triage redesign 2. DEM admission process 3. ORS Efficiency 4. ORS pre-admission and clinical preparation 5. Bed Management redesign
    • Diagnostic report • • • • • Communication strategies unclear and inefficient Multiple phones calls for same patient or issue Frustration, delays and often conflict Multiple contact points for Patient Flow created confusion Technology pagers at the time
    • The redesign! Simulation undertaken to determine fit for purpose device selection to enhance process - mobile phone Communication standardised Clear procedural guidelines where suggested.
    • What changed? iPhone arrived 2012 Mobile email access Mobile access to Emergency Department Information Systems Inter Hospital Transfer referrals – Health Department Directive iPad arrived Oct 2013
    • Mobile phone technology improved the communication processes, reduce duplication. Direct communication assists real time flow and information sharing across the complex. Documented information transfer – ability to audit, provides real time data and assists operational patient flow management and decision making processes
    • • Admitted patient cohort – Admission Facilitation Process – DEM processes – Inpatient processes – 2012 our admission facilitation for inpatient cohort was 30% – 2013 we achieved >60% – Since the start 2014 80-100% most days • Discharge Planning 40% by 11am KPI 2012 9-11% 2013 15-16% 2014 TBC
    • Process for obtaining a bed for a patient – PFSU, DEM and Ward Nursing Staff DEM Nursing Shift Co-ordinator (S/C) texts PFSU re the need for a bed including the following information: Diagnosis of the child Age of the child Whether a bed or cot is required Infectious status of the child IV - NGT etc if relevant • • PFSU NM forwards this text to the accepting ward PFSU NM notifies DEM S/C of accepting ward name • Accepting ward advises DEM S/C of predicted collection time by text • Accepting ward contact Operational services to assist with transfer of the patient • Accepting ward nurse to obtain designated phone to accompany transfer along with any pre-arranged equipment necessary DEM notifies parents of ETA in ward •
    • The same can not be said for everyone involved
    • Baby Boomers what the??
    • BED REQUEST via TEXT message DEM Team Leader sends bed request via text to PFSU PFSU NM recieves bed requests via text. Copies & pastes request to recieving ward once bed allocated. Confirmation is requested The ward team leader receives text , then confirms bed availability to PFSU via text & contacts DEM team leader directly to negotiate time to pull patient to ward. PFSU allocate inpatient bed communicate to Ward via text
    • Y texting It’s a Language of its own – or is it? SWALK – used in early 1900’s by soldiers in war time “Sealed with a loving kiss”
    • Financial Benefits • Total cost of the iphone annually is $10, 456.20 around $400.00 to $500.00 per month. No modifications made to iphone • The time delays in real time decision making equated to 14% of the Patient Flow Manager’s working time. Over 12 months it worked out to be 988 hours and equates to $51376 pa. (based on $52.00 per hour) 2.7 hrs of process inefficiency per day • This figure would increase significantly when multiplied across WARD/Unit Shift Coordinators, NUMs and Medical Officers. • $51,000 multiplied X 10 equates to $510,000 plus
    • How the use of mobile phones and texting rather than calling has improved Patient Flow Communication audit results Questionnaire, Leader Rounding and staff survey n =50 MAIN Findings 1. Mobiles effective = 100% 2. iPhone saved time =100% 3. It improved patient journey = 100%
    • Other comments:Attached to a yellow shift coordinator lanyard assists in identification of team leader Changed behaviour and culture Can track communication
    • Other comments on the survey • Used to MMS medical staff and Visiting Medical Officers • Used to locate equipment • NUMs or shift coordinators fill roster deficits or emergent leave with multiple contact texts rather than cold calling • • • • Disadvantages Noisy at night – advised to switch to mute Pocket dialling When they are broken without backup – chaos! We now have back ups. • Concerns over looking unprofessional to parents and carer • Interruptions whilst giving patient care or support
    • How Ward Access to EDIS has enabled improved Patient Flow • Workload management • Staffing demands • Improved patient journey • A pilot study was commenced and embraced by everyone – it is now standard practice
    • Standardised use of Clinical comments in EDIS
    • Clinical comments on EDIS INP Opin • • • • • Medical (not referred /not ready /isolation) Ortho (referred 11.15am /ready) ENT (seen) etc INP – The consultant/fellow believes this patient will be admitted under the team listed Opinion – A consultant from an inpatient team (listed) regarding patient management is needed Not Ready – tasks remaining for DEM should be documented at the end of the comment including times of expiry to ensure flow Ready – all tasks from the emergency department perspective are completed Isolation – the consultant believes an isolation bed will be required.
    • Where to from here? • • • Face time for immediate review of patients? Extending iPhone access to medical teams Do we need iPad? • Face time during paediatric retrievals – ‘Shetal Patel MD’: completed a pilot study evaluating the use of the apple face time video conferencing application during paediatric transport – the study did prove the feasibility of the ipad/phone in the use of paediatric transports and warranted further evaluation. 100% found video conferencing easy to use; 92% reported difficulty determining patient disposition based on phone report alone 75% felt that video conferencing provided a better understanding of the patients condition with 66% assisted determination of patients disposition and 75% believe that it should be routinely used for transport. • •
    • Acknowledgements Jennifer Ashton project manager – Little Feet Big Steps Therese Oates project manager – MACROneat The Nursing Staff in photos.
    • References: Dec 2013 Maureen Farrell and Katy Weare: Use of iPhone by nurses in acute care settings to improve communication and decision making processes Cam Lincoln in Health and Safety:- Nurses will get iPhone to communicate and manage work at a major Boston-area hospital October 2013 Shetal Patel MD – A prospective Study evaluating the use of apple facetime videoconferencing during paediatric transport/