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Palliative Patient Journeys—providing services in a regional and rural setting


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Griffith is a multicultural city in south-western NSW, with a population of 16,972, with a greater population living in the surrounding rural and remote areas. Palliative Care & End of Life [EOL] Services, were being provided by a wide range of service providers, in both acute and community sectors. Despite Strategic Planning and Model of Care directives, variation in the integration of services and a lack of resources meant that patients and carers were subject to variations in methods of service delivery.

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Palliative Patient Journeys—providing services in a regional and rural setting

  1. 1. Annie Williams MLHD Manager of Innovation & Redesign Palliative Patient Journeys Providing Services in a Regional and Rural Setting
  2. 2. Palliative Care Service Delivery in MLHD NSW Health Palliative Care Services Plan NSW Palliative Care Strategic Framework MLHD Palliative Care Clinical Services Plan How are we delivering Palliative Care Services now? Western eastern
  3. 3. Primary Enhanced Level 1: Specialist. MLHD Palliative Care Model
  4. 4. Objective:  To provide a current state business process and patient journey analysis of the MLHD Palliative Care Patients whom access services within Griffith and the surrounding region Scope:  Documentation of current palliative patient flow, operational activities and business processes centred on Griffith, and local communities  Processes from Patient referral to EOL care
  5. 5. 160 KM 65KM 110KM 90 KM 140KM 60 KM Geographical Implications:
  6. 6. Project Methodology: Patient and Carer Interviews: De-identified interviews conducted with palliative patients, and/or carers whom have referred to or accessed the services of the Palliative Care Service.
  7. 7. Process Mapping:
  8. 8. Patient Flow - Data Analysis Outreach Sites:
  10. 10. Admissions28 %decrease   Patient Flow – Community to Acute Care:
  11. 11. MLHD: PALLIATIVE CARE Multiple Admissions & Readmissions to Griffith Base Hospital 71 % decreas e Patient Flow – Readmissions to Acute Care:
  12. 12.  A decrease in the  number of acute  Palliative Care  admissions  A consistent length of stay for Palliative Care  patients [median 4 days  from 2012 to 2015]   A significant drop in  Palliative Care patients  whom are admitted to the acute service on more than one occasion      Early identification of  patients    A proactive approach to  resourcing and delivery of  supported palliative care in  patients homes,    Provision of  after hours  services to unstable patients  only as required   Building of enhanced  relationships with outreach  sites Patient Flow – Key Findings:
  13. 13. Quantification of Patient Experience Patient and carer perceptions of the healthcare journey comprise the  “Patient Experience”. Research from the NHS & Picker Institute  provides key themes valued by both patients and carers: Access to Care Respect for Patient values, preferences, and expressed needs Coordination and integration of care Information and education Transition and continuity Physical comfort Emotional support and alleviation of fear and anxiety Involvement of family and friends
  14. 14. What our patients and carers told us: Early on, it was necessary for Lois to have a syringe driver, so that it could help to manage her pain. This worked as a partnership between myself and the Palliative Care Nurse; we worked really well together. I think that this is a great idea to investigate how to do longer term patient surveys and to talk about our experiences – it is the only way that we can improve the services to our communities and acknowledge the great services we have! We wish we knew about it sooner! … things were deteriorating; they were there whenever we needed them. …my GP who I knew very well and was caring for me well, does not have admitting rights to the hospital, so each time I went in, there was a process of transferring my case over to another doctor, I had only ever heard about Palliative Care in relation to cancer care, I didn’t realise that they could support Charley in the end stages of his illness I was told by the nurse to “get dressed you are going home”. one had told me of any plans
  15. 15. Palliative Patient Journey – Acute Palliative Care Services Palliative Patient Journey–Community Palliative Care Services Quantification of Patient Experience
  16. 16. Patient Journey Impacts GPPCT HOM E AH ED ACUTE D/C