Your SlideShare is downloading. ×
Kim Fraser, Metro North Hospital and Health Service, Queensland - Acuity Measurement of the Post-Acute Client- Enabling Prioritisation for Service Response
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×

Introducing the official SlideShare app

Stunning, full-screen experience for iPhone and Android

Text the download link to your phone

Standard text messaging rates apply

Kim Fraser, Metro North Hospital and Health Service, Queensland - Acuity Measurement of the Post-Acute Client- Enabling Prioritisation for Service Response

266
views

Published on

Kim Fraser, Nursing Director, Post-Acute Care Service, Subacute and Ambulatory Services, Metro North Hospital and Health Service, Queensland delivered the presentation at the 2014 Discharge Planning …

Kim Fraser, Nursing Director, Post-Acute Care Service, Subacute and Ambulatory Services, Metro North Hospital and Health Service, Queensland delivered the presentation at the 2014 Discharge Planning Conference.

The 2014 Discharge Planning Conference - Assisting health services to adopt an integrated and consumer directed approach to discharge planning.

For more information about the event, please visit: http://bit.ly/dischargeplan14

Published in: Health & Medicine

0 Comments
1 Like
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total Views
266
On Slideshare
0
From Embeds
0
Number of Embeds
1
Actions
Shares
0
Downloads
9
Comments
0
Likes
1
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
No notes for slide

Transcript

  • 1. Metro North Hospital and Health Service Acuity Measurement of the Post Acute Client: Enabling Prioritisation for Service Response Kim Fraser Nursing Director Post Acute Care Service Sub Acute and Ambulatory Service Metro North Hospital and Health Service
  • 2. Metro North Hospital and Health Service Metro North Hospital and Health Service • 850,000 population • 4,157 square kilometres • Brisbane River to north of Kilcoy • Rural, regional and tertiary hospitals • Acute, post acute, subacute, rehabilitation, aged care, oncology, palliative care, psychiatric, women’s and newborn services.
  • 3. Metro North Hospital and Health Service Objectives of Presentation • Overview Post Acute Care Service • Background • Description of the Acuity Tool • Rationale for use of Acuity tool • Case study • Results of initial implementation • Recommendations
  • 4. Metro North Hospital and Health Service Brief Overview PACS • 7 day per week post acute hospital avoidance • ED or admitted patient. • Short term MD interventions to address immediate care needs • Rapid response
  • 5. Metro North Hospital and Health Service PACS • Service linkages • High risk for representation / readmission • Support acute facilities in meeting NEAT / NEST • Average 620 referrals per month
  • 6. Metro North Hospital and Health Service PACS • Average LOS 14 days • Average Age 80-89 years • 55% Female • Average will require 2.5 disciplines • Inpatient DRG: – Hip replacement with complexity – COPD – Rehabilitation – Patient > 64 years with injuries
  • 7. Metro North Hospital and Health Service Background • 2013 underwent extensive service redesign • From HACC and Chronic Disease service to a rapid response post acute service • Review of national and international literature on PAC models identified the value of acuity measures
  • 8. Metro North Hospital and Health Service Background cont… • Literature review identified: – no published evidence (Aust) – 2 published acuity tools (UK and Nth America) – UK tool lacked reliability; resource intensive; not developed for the MD team
  • 9. Metro North Hospital and Health Service Case Management Acuity Tool • Developed by Hubber, D.L. and Craig, K. (2007) for use within a telephonic chronic disease case management health service • Captures the evidence base of case management activities and measures case management outcomes
  • 10. Metro North Hospital and Health Service Acuity Tool Development • Literature review • Gap analysis • Clinical experts monitored development and testing of the tool, concepts, scores, differentials and their operating principles • Pilot phase testing (n = 3,000) – interrater reliability testing and content validity • (β) testing for content and appropriateness • Representative sampling size testing • Expert panel reviews
  • 11. Metro North Hospital and Health Service Why the Need for an Acuity Tool? • Providers of clinical services are required to demonstrate value. • What benefits are achieved beyond the traditional measurements of cost savings or cost avoidance? • How do we measure, compare and then evaluate interventions as to their effectiveness and cost?
  • 12. Metro North Hospital and Health Service Acuity Tool The Acuity Tool: • Quantifies a client’s complexity (or acuity). • Links duration, quality, quantity and volumes of health care interventions required. • Provides a quantifiable indicator of measurement which can be applied across care points in time from admission to discharge.
  • 13. Metro North Hospital and Health Service What does the CM-Acuity Tool Measure? • Dosage • Acuity
  • 14. Metro North Hospital and Health Service Dosage • Dosage – two main variables: – The activities carried out by the provider in the delivery of the intervention – The amount of time these activities take • These variables do not capture the complexity of interventions or complexity of client needs
  • 15. Metro North Hospital and Health Service Dosage cont… • The four essential elements of intervention dose are: – Amount – Frequency – Duration – Breadth (Huber et al., 2003) • Too much or too little of a dose may result in harm; inefficiency and ineffectiveness
  • 16. Metro North Hospital and Health Service Acuity • Defined as severity of illness or client condition that indicates the need for intensity of the interventions • Acuity links duration, quality, quantity and volume to key points of service delivery. • Intensity is a term related to acuity that represents the amount of care and complexity of care needed by the patient.
  • 17. Metro North Hospital and Health Service Case Management – Acuity Tool© • The Acuity Tool©: contains indicator, drivers and subdriver categories. The three indicators take the form of: • Clinical Indicators • Psychosocial indicators • Environmental indicators
  • 18. Metro North Hospital and Health Service Acuity Tool • April 2014 – permission from author to implement tool with minor modifications. • Tool within Australian context renamed: • Concise Acuity Tool for Australian Healthcare©
  • 19. Metro North Hospital and Health Service
  • 20. Metro North Hospital and Health Service
  • 21. Metro North Hospital and Health Service
  • 22. Metro North Hospital and Health Service IncreasingComplexity
  • 23. Metro North Hospital and Health Service 2 1 2 5
  • 24. Metro North Hospital and Health Service 2 1 2 5
  • 25. Metro North Hospital and Health Service Acuity Score Complexity Score Priority Score 3-4 Basic 1 5-6 Good 2 7-8 Fair 3 9-10 Moderate 4 11-12 Highest 5
  • 26. Metro North Hospital and Health Service Initial Implementation • Ease of use • Quick to use (approximately 1-3 minutes) • High clinician engagement • Ability to predict workload capacity • Ability to predict patient flow problems • High scores reflect high complexity • High scores reflect high risk for rehospitalisation • Sub-drivers not sensitive enough for some disciplines
  • 27. Metro North Hospital and Health Service Test Inter-rater Reliability • 32 inpatients (RBWH) were assessed prior to discharge • 29 patients assessed on admission to PACS • Minimal divergence of scores (from hospital to home) • Higher the score the higher the complexity and the higher the risk of representation/readmission
  • 28. Metro North Hospital and Health Service How has PACS used the Acuity Tool? The acuity tool has enabled the Service to: • Capture client acuity scores on admission and discharge • Analyse and compare acuity scores from admission and discharge In the future the tool will assist with: • Determining capacity and flow processes • Predict workload allocation accurately
  • 29. Metro North Hospital and Health Service Case Study - Molly
  • 30. Metro North Hospital and Health Service Molly • Molly 93 year old female • Presented to ED after fall – large skin tear on leg, bruising and black eye • MMSE 23/30 • History - Parkinson’s, multiple falls in past 3/12, family noticing changes and concerned • Lives alone, has no services and resistant to services • High risk of representation/readmission to ED • Referred for medication supervision, wound care, home safety assessment, mobility assessment
  • 31. Metro North Hospital and Health Service Molly cont… • Home had numerous trip hazards • Not using previously prescribed mobility aids (stick and frame) • Unsure of medications and their use - non adherence to medication regime • Family supportive – not wanting to be a burden on them • Required support with personal hygiene • MST score = 3 (irregular eating patterns)
  • 32. Metro North Hospital and Health Service
  • 33. Metro North Hospital and Health Service Clinical Indicators Psychosocial Indicators Environmental Indicators CN4 Multiple S&S requiring MD intervention PS3 Minimal adherence to care plan – does not accept advice for safety or use prescribed walking aids Q3 Substantial improvements required for safety Admission Score 4 Admission Score 3 Admission Score 3 Total Admission Acuity Score = 10 Complexity Score = Moderate Priority Score = 4
  • 34. Metro North Hospital and Health Service Molly cont… Over 2 week journey Molly had assistance with: • Showering and wound care • Medication review and education – Webster pack • OT and PT intervention – education on use of frame and stick – modifications to bathroom • Dietitian review of weight loss and education – high protein drinks • SW assisted with family and client education in relation to future care needs • Liaison with GP re Molly’s care needs and MMSE score (Molly refused referral to Memory Clinic) • Agreed to some community supports: – NGO for ongoing nursing support and personal care – Meals on Wheels
  • 35. Metro North Hospital and Health Service
  • 36. Metro North Hospital and Health Service Clinical Indicators Psychosocial Indicators Environmental Indicators CN3 Multiple S&S requiring support from one discipline (or minor interventions from other disciplines) PS2 Mostly cooperative and adhering to care plan – may occasionally forget medication Q3 Minimal modifications required for safety A = 4 D = 3 A = 3 D = 2 A = 3 D = 2 Total Admission = 10 Complexity = Moderate Priority = 4 Total Discharge = 7 Complexity = Fair Priority = 3
  • 37. Metro North Hospital and Health Service Evaluation • Data capture commenced April 1, 2014 • Only those patients who had completed their journey of care (and had a discharge acuity score recorded) by June 30, 2014 were included in sample. • Sample size = 765
  • 38. Metro North Hospital and Health Service Characteristics Number Total sample size 765 Female 445 (58%) Male 320 (42%) Age range 24 - 102 Average age 74 years Range of Acuity scores 3 - 12 Mean Acuity score on admission 6 Mean Acuity score on discharge 4 Demographics
  • 39. Metro North Hospital and Health Service Comparison of Admission and Discharge Acuity Scores. N=765 0 20 40 60 80 100 120 140 160 180 3 4 5 6 7 8 9 10 11 12 Acuity Score NumberofClients Admission Acuity Discharge Acuity
  • 40. Metro North Hospital and Health Service Grouped Acuity Scores on Admission and Discharge 472 (62%) 595 (78%) 293 (38%) 169 (22%) 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Admission Discharge NumberofClients Acuity Score 7-12 Acuity Score 3-6
  • 41. Metro North Hospital and Health Service Acuity > 7 by Age Group on Admission and Discharge 109 (63%) 152 (64%) 32 (62%) 65 (37%) 85 (36%) 20 (38%) 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 24-60 61-80 81-102 Age Group Percentage Discharge Admission
  • 42. Metro North Hospital and Health Service Lesson’s Learned • Sub drivers not always clear for all disciplines (including wound clinic) – requires further work • Repeat reliability and validity studies within the post acute setting • Engagement from staff of the process and the tool has been positive
  • 43. Metro North Hospital and Health Service Recommendations • Conduct further research on the reliability and validity of the tool • Apply the tool to E-Referral process – which will enable discharge planners to assess acuity and drive a priority response from the acute setting • Electronic solution to enable the ‘live’ display of team and discipline acuity scores (assist in resource distribution)
  • 44. Metro North Hospital and Health Service Thank You