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Redesign of Patient Flow Unit and Changes to Discharge Coordinator’s Role at Calvary Healthcare - ACT
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Redesign of Patient Flow Unit and Changes to Discharge Coordinator’s Role at Calvary Healthcare - ACT

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Liz Ganser, Discharge Liaison Officer, Calvary Health Care- ACT delivered this presentation as part of the 4th Annual Reducing Hospital Readmissions & Discharge Planning Conference – A conference to …

Liz Ganser, Discharge Liaison Officer, Calvary Health Care- ACT delivered this presentation as part of the 4th Annual Reducing Hospital Readmissions & Discharge Planning Conference – A conference to identify, predict and prevent unplanned readmissions and improve discharge processes. IIR Healthcare's inaugural Canadian Reducing Hospital Readmissions & Discharge Planning Conference will take place in Vancouver in late October 2013. Find out more at http://www.healthcareconferences.ca/readmissions/agenda

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  • 1. Redesign of Patient Flow Unit and Changes to Discharge Coordinator’s Role at Calvary Healthcare - ACT Little Company of Mary Health Care Limited Liz Ganser Discharge Liaison Officer Calvary Health Care -ACT
  • 2. Overview
  • 3. Calvary Hospital
  • 4. 2010 AIP (Access Improvement Program- Every patient in 4 hours Redesign Project) Highlighted issues that needed to be changed within the whole organisation – within each department. Calvary needed to be current and have a plan that would continue to meet the needs of Canberra into the future.
  • 5. Overview Overview •Where we were and where we are •Activity Management Centre •Patient Flow Unit •Where we were and where we are • Discharge Coordinators •Discharge Liaison Officers •Post discharge phone calls
  • 6. Activity Management Centre • Bed Manager 1xFTE • After Hours Hospital Manager 4x FTE • Recruitment Manager 1xFTE– am shift only • Admin Assistant 1xFTE • The ACM was not functioning well –as services out grew its effectiveness
  • 7. Patient Flow Unit • PFU Manager level 4.3 x1 FTE • Patient Flow Coordinators/After Hours Hospital Manager level 4.2 x 5.4 FTE • Discharge Liaison Officers level 2 x 2.5 FTE • Admin assistants x2 FTE ( 1 f/t and2 p/t) • The unit is more robust and dynamic
  • 8. PFU Responsibilities • DOP – Daily Operational Planning Meeting – This happens at 0900hrs Monday – Friday – Head of each department attends including hospital Executive. – All departments report staff leave planned and unplanned and identify where the shortfall will impede flow
  • 9. 0900 – 0915hrs Daily - excluding wk/ends & PHs Post Grad Seminar Room • Capacity vs Demand balance • integrated work priorities • identification of key barriers to discharge/patient flow • defined responsibilities • prioritisation of work • multidisciplinary attendance Refer to Patient Flow Unit for further information Daily Operational Planning (DOP) meeting
  • 10. PFU responsibilities • Bed management – Patient Flow • Transport bookings – Instead of every ward booking individual transport the system became centralised by e-referral – More transparent/ streamlined/ data collection tool – Taxi/ambulance ACT NSW/ PTV / destinations and what for. • Staffing of hospital – While roster shortfalls are the responsibility of the CNC the PFU Coordinator would manage the Relief Pool and Casual Pool staff and any overstaffing of units.
  • 11. PFU responsibilities • DLO -Discharge Liaison Officers – Manage and direct – Weekly meeting to discuss issues and redefine role – Oversee • daily work flow • d/c phone calls • and data entry of result • Monitoring of Red/Blue Dots- Blocks to discharge – Red/Blue dot on the PJB- patient journey Board – Indicate that patients are medically stable to be d/c social issues prevent them going home.
  • 12. Patient Journey Boards • communication tool • patient journey ‘snap shot’ • focus for planning discharge from day of admission • ‘traffic light colours’ indicate time away from discharge • PJB also indicates problems/delays for patients who are medically cleared for discharge Discharge Traffic Light System & Patient Journey Board (PBJ) White Amber Green Blue Red RED with BLUE Dot >3 days from EDD 2-3 days from EDD within 24hrs of EDD Day of D/C overstay : >EDD Discharge delayed for non-medical reasons
  • 13. Start typing Discharge Traffic Light System & Patient Journey Board (PBJ)
  • 14. Discharge Traffic Light System & Patient Journey Boards Specific DAILY PRIORITIES: Discharge planning & traffic lights – actions •AMBER DOT •GREEN DOT •BLUE DOT Doctor “Discharge Focus Time” Daily Operational Planning (DOP) Meeting KEY POINTS Note: hospital policy for patients to discharge by 1000hrs.
  • 15. Estimated Date of Discharge (EDD) •To be allocated within 24hrs of admission •Date is estimation ONLY •May be changed as clinically appropriate •EDD based on requirement for clinical care – linked to National Benchmark of average length of stay (ALOS) by DRG Discharge planning & traffic lights Handover with CNC /Team Leader at PJB Purpose: ‘handover’ meeting between team members of •Key discharge barriers •key clinical care matters for action •Prioritisation of patient care
  • 16. DISCHARGE TRAFFIC LIGHT ACTIONS – Medical Officer Responsibilities AMBER DOT ACTIONS •Ensure EDD is correct •Plan & commence discharge referrals, documentation •Inform CNC of any expected delays GREEN DOT ACTIONS •As for Amber Dot •Review pharmacy-initiated e-script for accuracy & communicate any problems •Inform CNC IMMEDIATELY of any expected delays BLUE DOT ACTIONS •Prioritise any outstanding discharge referrals, documentation •Communicate discharge instructions: Patient •Inform CNC IMMEDIATELY of any expected delays
  • 17. Discharge Coordinators X1 FTE Surgical floor X1 RTW staff member on 1 medical ward And occasionally another staff member on the second medical ward The job productivity was dependent on the person holding the role rather than a job description Discharge Liaison Officer: Where we were
  • 18. Discharge Liaison Officer:: Where we were DISADVANTAGES: No clear referral system – saw everyone on designated ward Tendency to d/c plan for every patient simple and complex Could be as busy or quiet as the allocated person wanted to be. No clear job description/ career advancement potential Not in budget!
  • 19. Discharge Liaison Officer:: Where we are now Time line:- 2011 • Mid 2011 2x .5 FTE positions advertised • August 2011 position started in PFU • Sept/Oct 2011 e-referral for complex discharges • November 2011 the .5 FTE increased to 1x FTE and one .5x1 on month by month basis.
  • 20. Reasons for a referral – must be complex 1. Is my patient likely to have self-care problems on discharge? 2. Does my patient live alone or have accommodation issues? 3. Is my patient likely to have caring responsibilities for others? 4. Has my patient needed community services before this admission and will they need to continue on discharge? DLO – Role and function
  • 21. Important things to remember! Everyone admitted is discharged. Where will they go? Home or Nursing home check address details and contact phone numbers and GP Assistance needs to be arranged Cleaning/ cooking /shopping/ complex wound care/transport/case management. Except for wound care Social Worker arranges the rest. Not everyone who lives alone needs help. But if they do make sure it is set up before d/c External services are not mind readers. Everyone who has services in place prior to admission will need these services to be reinstated prior to d/c. DLO – Role and Function
  • 22. Discharge Liaison Officer:: Where we are now Time line:- 2012 • Jan 2012 .5 position extended to 1xFTE for 6 month • Jan 2012 started d/c phone calls • April 2012 started Weekend DLO .5 FTE • June 2012 1x FTE and 1x.5 advertised • August 2012 both positions filled. • We now have 2x FTE and 1 X .5 FTE
  • 23. Discharge Liaison Officer:: Where we are now Time line:- 2013 • Feb-March Discharge phone call survey conducted • May 2013 a generic • DLO@calvary-act.com.au email address was set up • Referrals were being ‘lost ‘ in the DOP/PFU inbox • Email handovers to personal email addresses not seen when staff on unplanned leave
  • 24. Discharge Liaison Officer:: Where we are now Time line:- 2013 June 2013 designed a “discharge for DLO service” sticker which evolved into an assessment/admission form which will be filed in Medical Records once evaluated and approved by forms committee. • July 2013 2 year review in progress
  • 25. CHCACT DLO Handover Template Date: DLO: Wards: Planned Discharges: Is DLO follow up required? Such as transport bookings or completion of discharge envelope: Include Patients Ward and Name: Referrals requiring follow up: Include Patients Name and Ward:
  • 26. PT LABEL Discharge from DLO Service o Happy with current level of services this admission o Refused DLO service this admission o t/f to other facility ………………... o Other: …………………………….. o No Post Discharge Phone Call required Print Name: ………………………………… Signature: …………………………………… Designation: ……… Date: __/__/__ Ward: …………………….. Bed No: ……………… Referral Received Date: __/__/__ Review Date: __/__/__ Time: ………………………………………….. Category: ……………………………................ Admission Date and Reason: __/__/__ -------------------------------------------------------------- -------------------------------------------------------------- -------------------------------------------------------------- -------------------------------------------------------------- ---------------------------- Patient Contact Details Address: ………………….................................. …………………………………………………. Suburb: …………………….. Post Code: ....….. Contact Numbers: (H)…………………… (M)……………….. (W)……….………….. Next of Kin Name: ………………....................................................... Relationship: ………………............................................ Contact Numbers: (H)………………………………… (M)……………… (W)……….……………………….. Other: …………………………………………………… Medical / Surgical History ------------------------------------------------------------ -------------------------------------------------------------- -------------------------------------------------------------- -------------------------------------------------------------- -------------------------------------------------------------- -------------------------------------------------------------- -------------------------------------------------------------- ------------------------------------------------ Social History -------------------------------------------------------------- ------- -------------------------------------------------------------- -------------------------------------------------------------- --------------Current Services ------------------------- -------------------------------------------------------------- -------------------------------------------------------------- ----------------------------------- ACAT Yes / No Date: __/__/__ EPOA Yes / No Date: __/__/__ Advanced Care Directive Date: __/__/__ Internal Referrals (insert dates where applicable): Physiotherapy __/__/__ Social Worker __/__/__ Dietician __/__/__ Diabetic Ed. __/__/__ Psych Liaison __/__/__ Drug & Alc. __/__/__ Palliative Care __/__/__ Occ. Therapy __/__/__ RACLN __/__/__ External Referrals (insert dates where applicable): CHI __/__/__ Event Notification Yes / No : Reason: ………………………………………………….. PHSP __/__/__ CCP __/__/__ Carers ACT __/__/__ Respite __/__/__ CAPS (Provider) ______________ EACH (Provider)_____________ NHP(Facility)_________________
  • 27. Discharge Phone Calls •Why do them? •Discharge Phone Calls Deliver Quality Care, Higher Patient Satisfaction (Studer 2006) •They have multiple benefits •Engage staff •Opportunity to glean compliments and complaints Discharge Phone Calls
  • 28. Discharge Phone Calls •Reconfirm discharge instructions, •Reduce patient anxiety, •Reduce complaints and claims, •Reinforce patient perception that excellent care has been provided, and Offer an opportunity for quick service recovery. (Studer 2006) Discharge Phone Calls
  • 29. Discharge Phone Calls Jan 2012 Started –working very closely with Studer Group coach Michelle Dobe • initially called everyone we saw no matter if simple or complex •Ward/ED staff still learning the e-referral system and criteria for referral •Also called Nursing homes but stopped after 4 months receiving enough information to improve our d/c process to all facilities in the ACT and NSW area. Discharge Phone Calls
  • 30. DischargePhoneCallsToComplexPatients IntotalforFebruary2013therewereatotalof187DischargePhoneCallsmadebytheDLO’s.Thisequatesto97%ofpatientsseenbytheDLOsreceivingadischargephone call
  • 31. Survey of Post-Discharge Telephone Calls 140 surveys have been sent out with 89 returned (63%). The Survey finished at the end ofMarch.
  • 32. Highlight of D/C phone calls •Complaints/comliments about food •Complaints/compliments about staff •Hospital in general/specific ward •Noise level at night •Extended wait time to be discharged •Patient readmitted –failed d/c •Patient died **** •Recommend that patient represent to ED – readmitted d/c phone calls
  • 33. Since PFU inception The hospital overall is more transparent Communication is great Saved money but centralising the transport booking system No longer rely on Agency staff. Overall LOS has been reduced by 2 days Sumary
  • 34. Nursing Workforce Planning (Relief, Agency, Casual)
  • 35. Thank You