David Fitzsimons - Building Redundnacies into a Clinical Databse for Monitoring Patient Care

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Presented by Mr David Fitzsimons, Clinical Specialist Speech Pathologist from the Children's Hospital at Westmead, at the CHA Conference on 24 October 2012

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David Fitzsimons - Building Redundnacies into a Clinical Databse for Monitoring Patient Care

  1. 1. Clinical Database Redundancies: Monitoring Patient Care Building Redundancies into a Clinical Database for Monitoring Patient Care Mr David Fitzsimons Clinical Specialist Speech Pathologist The Cleft Palate Clinic, The Children’s Hospital at Westmead Sydney, AustraliaSlide: 1 Wednesday 24 October 2012 Copyright © Fitzsimons 2012
  2. 2. Clinical Database Redundancies: Monitoring Patient Care Cleft Lip and Palate Team Plastic and Reconstructive Surgeons Oral-Maxillofacial Surgeons Ear, Nose and Throat Surgeons Specialist Orthodontists Speech Pathologists Audiologists Radiologists Sleep Physicians Photographers Clinical Nurse Consultant ….Slide: 2 Wednesday 24 October 2012 Copyright © Fitzsimons 2012
  3. 3. Clinical Database Redundancies: Monitoring Patient Care Cleft Care Chronic Condition Prenatal - End of Growth (~ 18-20 years of age) Stages of Treatment - Prenatal Management - Management of Newborn - Initial Surgery - Plastics & ENT - Speech Intervention - Secondary Surgery (Speech Surgery) - Plastics - Alveolar Bone Graft Surgery - Plastics - Orthodontics - Nose Surgery - Plastics & ENT - Jaw Surgery - PlasticsSlide: 3 Wednesday 24 October 2012 Copyright © Fitzsimons 2012
  4. 4. Clinical Database Redundancies: Monitoring Patient CareCleft and Craniofacial CareComplexRequires multiple strategies for teams to achieve goalsInvolves a large number of - Disciplines - Appointments - Interventions - Longitudinal Vulnerable to breakdownSlide: 4 Wednesday 24 October 2012 Copyright © Fitzsimons 2012
  5. 5. Clinical Database Redundancies: Monitoring Patient CareQuality Improvement “…The more steps / components that exist in a process, the higher the chance that something will go wrong…”Slide: 5 Wednesday 24 October 2012 Copyright © Fitzsimons 2012
  6. 6. Clinical Database Redundancies: Monitoring Patient CareCleft and Craniofacial Care Archiving Ordering Speech Report Database Additional Samples Writing Entries Tests Post- Collecting Speech Operative Audit Therapy Follow-up Data Referral to Surgery Local Services Quality Improvement Programme Clinical CareSlide: 6 Wednesday 24 October 2012 Copyright © Fitzsimons 2012
  7. 7. Clinical Database Redundancies: Monitoring Patient CareQuality Improvement ProgrammeLargely people dependentUsually a single team member that does it all in our own teams If anyone can do it...... and someone should do it….. then no one will do it. Put systems in place to prevent and/or minimise disruptions to clinical careSlide: 7 Wednesday 24 October 2012 Copyright © Fitzsimons 2012
  8. 8. Clinical Database Redundancies: Monitoring Patient CareTools to Help Manage and Monitor CareClinical Database - Research Tool - Quality Improvement Tool Great Potential - Failsafe - Add layers of redundancySlide: 8 Wednesday 24 October 2012 Copyright © Fitzsimons 2012
  9. 9. Clinical Database Redundancies: Monitoring Patient CareAim Brief illustration of the way in which our clinical database helps us manage and monitor patient care in our institutionSlide: 9 Wednesday 24 October 2012 Copyright © Fitzsimons 2012
  10. 10. Clinical Database Redundancies: Monitoring Patient CareTake Home Messages 1. Value in identifying patients, or groups of patients at risk of „falling through the cracks‟ 2. We can learn from „near miss‟ incidents in our Clinic 3. Build systems that look for these near-miss incidents 4. Improve our level of clinical careSlide: 10 Wednesday 24 October 2012 Copyright © Fitzsimons 2012
  11. 11. Clinical Database Redundancies: Monitoring Patient CareClinical DatabaseSlide: 11 Wednesday 24 October 2012 Copyright © Fitzsimons 2012
  12. 12. Clinical Database Redundancies: Monitoring Patient CareCruxPresented (in part): 2003 – ACLAPA Meeting: Sydney 2005 – World Congress: Durban 2009 – ACPA Meeting: Arizona 2011 – ACLAPA Meeting: PerthSlide: 12 Wednesday 24 October 2012 Copyright © Fitzsimons 2012
  13. 13. Clinical Database Redundancies: Monitoring Patient CareCruxSlide: 13 Wednesday 24 October 2012 Copyright © Fitzsimons 2012
  14. 14. Clinical Database Redundancies: Monitoring Patient CareCruxSlide: 14 Wednesday 24 October 2012 Copyright © Fitzsimons 2012
  15. 15. Clinical Database Redundancies: Monitoring Patient CareCruxSlide: 15 Wednesday 24 October 2012 Copyright © Fitzsimons 2012
  16. 16. Clinical Database Redundancies: Monitoring Patient CareCruxSlide: 16 Wednesday 24 October 2012 Copyright © Fitzsimons 2012
  17. 17. Clinical Database Redundancies: Monitoring Patient CareCruxSlide: 17 Wednesday 24 October 2012 Copyright © Fitzsimons 2012
  18. 18. Clinical Database Redundancies: Monitoring Patient CareCruxSlide: 18 Wednesday 24 October 2012 Copyright © Fitzsimons 2012
  19. 19. Clinical Database Redundancies: Monitoring Patient CareProcessSlide: 19 Wednesday 24 October 2012 Copyright © Fitzsimons 2012
  20. 20. Clinical Database Redundancies: Monitoring Patient CareProcess Database Search Tables Criteria Data Entry ResultsSlide: 20 Wednesday 24 October 2012 Copyright © Fitzsimons 2012
  21. 21. Clinical Database Redundancies: Monitoring Patient Care“Live” ReportingSlide: 21 Wednesday 24 October 2012 Copyright © Fitzsimons 2012
  22. 22. Clinical Database Redundancies: Monitoring Patient CareReports for Monitoring Patient Care• Children with repaired or unrepaired cleft palate aged over 6 months, who have not seen a Speech Pathologist in the last 2 months and do not have an appointment in the next 2 months (4-8 months target for early speech and language)• Children aged 15 months of age who had reduced phonetic inventory and probable glue ear at their 12 month review (? Lower threshold for ENT intervention)• Children aged 18 months of age who were demonstrating „backing patterns‟ at their last Clinic visit• Children aged under 5 who had documented evidence of compensatory speech characteristics, and I have not had contact with their local SLP in the last 6 months NOTE: These are NOT research reportsSlide: 22 Wednesday 24 October 2012 Copyright © Fitzsimons 2012
  23. 23. Clinical Database Redundancies: Monitoring Patient CareReports for Monitoring Patient Care• List of patients with upcoming appointments who have confirmed syndromic conditions NOTE: These are NOT research reportsSlide: 23 Wednesday 24 October 2012 Copyright © Fitzsimons 2012
  24. 24. Clinical Database Redundancies: Monitoring Patient Care NOTE: These are NOT research reportsSlide: 24 Wednesday 24 October 2012 Copyright © Fitzsimons 2012
  25. 25. Clinical Database Redundancies: Monitoring Patient Care“Live” ReportingSlide: 25 Wednesday 24 October 2012 Copyright © Fitzsimons 2012
  26. 26. Clinical Database Redundancies: Monitoring Patient CareTriggering ReportsComputer codeDesign your own triggers:Slide: 26 Wednesday 24 October 2012 Copyright © Fitzsimons 2012
  27. 27. Clinical Database Redundancies: Monitoring Patient CareTake Home Messages 1. Value in identifying patients, or groups of patients at risk of „falling through the cracks‟ 2. We can learn from „near miss‟ incidents in our Clinic 3. Build systems that look for these near-miss incidents 4. Improve our level of clinical careSlide: 27 Wednesday 24 October 2012 Copyright © Fitzsimons 2012
  28. 28. Clinical Database Redundancies: Monitoring Patient CareThank YouSlide: 28 Wednesday 24 October 2012 Copyright © Fitzsimons 2012

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