The Merry-Go-Round
of
Improvements in Patient Flow
Annie Williams
Innovation Manager
Goulburn Valley Health, Shepparton
Vi...
• Patient Flow improvements – created
from a patient & organisational perspective
• Rapid transformation with a focus on
w...
Where are we?
We had a problem...
Capacity
Demand
But ...
we were not managing
the FLOW!
History of successful project
initiatives, including:
Surgical Services – Reducing Day of
Surgery Cancellations
“REDDSoC P...
Our approach?
• To build improvements to GVH Patient Flow from a
patient and organisational perspective
This would require multiple proc...
Our executive project sponsors invited all interested
operational staff to three workshops
• Process issues documented by ...
What our patients and carers told us....
Play Your Part
GVH Patient Flow
www.archi.net.au
What our patients and carers told us....
Play Your Part
GVH Patient Flow
Today I am waiting for a
check X-Ray, which may b...
Summary of the current state...
Play Your Part
GVH Patient Flow
We found:
• Variation in the documentation of
estimated da...
 DISCHARGE PLANNING
 PATIENT FLOW
 COMMUNICATION & INFORMATION
Issues Themed & Prioritised:
Play Your Part
GVH Patient ...
• EDD documented - agreed policy and
process
• EDD on pt journey boards and electronic
entry
• Day prior planning for disc...
3 by
10
Play Your Part
GVH Patient Flow
GVH Patient Flow Project – Play Your Part
To continue to develop improvements in t...
• Review and update escalation policy for GVH
• Changes to former “Bed Management” meetings – now
multidisciplinary member...
Patient Flow Status to inform decision making
• Patient journey boards now a consistent
format throughout the organisation
• Implementation of electronic Patient Flow
R...
Making our technology work for us...
Organisational Flow Patient Flow
“Patient Flow – Play Your Part”
Goulburn Valley Health
Goulburn Valley Health has identified that
to meet increasing deman...
Tools to support increased visibility of process
1. Users now have to tick the new patient consent checkbox beneath the ma...
Patient Flow – How are we tracking?
0
50
100
150
200
250
300
6-Jan 13-Jan 20-Jan 27-Jan 3-Feb 10-Feb
GVH Patient Flow Dash...
0
50
100
150
200
250
300
350
400
450
500
6-Jan 13-Jan 20-Jan 27-Jan 3-Feb 10-Feb
GVH Patient Flow Dashboard
[ED LOS vs. % ...
0
5
10
15
20
25
30
35
40
45
6-Jan 13-Jan 20-Jan 27-Jan 3-Feb 10-Feb
GVH Patient Flow Dashboard
[ED LOS >12hours]
Number of...
Next Steps...
• Ongoing improvements for
discharge planning to continue,
with a focus on time of discharge
• Patient Flow ...
Acknowledgments...
The Merry-Go-Round of Improvements in Patient Flow
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The Merry-Go-Round of Improvements in Patient Flow

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Annie Williams, Manager Innovation & Improvement, Goulburn Valley Health delivered this presentation at the 6th annual Hospital Bed Management & Patient Flow conference 2013 in Melbourne. For more information on the annual event, please visit the conference website: http://bit.ly/1f3Pp03

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The Merry-Go-Round of Improvements in Patient Flow

  1. 1. The Merry-Go-Round of Improvements in Patient Flow Annie Williams Innovation Manager Goulburn Valley Health, Shepparton Victoria
  2. 2. • Patient Flow improvements – created from a patient & organisational perspective • Rapid transformation with a focus on workplace collaboration • Multiple process and system changes in a rapidly changing regional hospital environment Focus of this presentation: Play Your Part GVH Patient Flow
  3. 3. Where are we?
  4. 4. We had a problem... Capacity Demand But ... we were not managing the FLOW!
  5. 5. History of successful project initiatives, including: Surgical Services – Reducing Day of Surgery Cancellations “REDDSoC Project” Medical Ward - Reducing LOS “RESMED Project” Emergency Department – Achieving 4 hr LOS targets for ED pts “2 & 3 in 4 Project” Background: Play Your Part GVH Patient Flow
  6. 6. Our approach?
  7. 7. • To build improvements to GVH Patient Flow from a patient and organisational perspective This would require multiple process and system changes in a rapidly changing regional hospital environment Resources?  Senior executive leadership and project sponsorship  Significant organisational ownership  Limited financial resources available Project Scope: Play Your Part GVH Patient Flow
  8. 8. Our executive project sponsors invited all interested operational staff to three workshops • Process issues documented by each group • What were the great ideas? • Patient & Carer Interview feedback on current state of discharge planning Our Strategy? Play Your Part GVH Patient Flow
  9. 9. What our patients and carers told us.... Play Your Part GVH Patient Flow www.archi.net.au
  10. 10. What our patients and carers told us.... Play Your Part GVH Patient Flow Today I am waiting for a check X-Ray, which may be this afternoon [Note: orderly arrived to transport patient at conclusion of interview @ approx 11.00am]. They have told me that I can go when I can manage my crutches I am not sure what has to happen next, they will probably send me a letter. I do know that I have to come back in a couple of weeks for something else My only other concern is that I have had three different ways told to me about how to manage my wound when I go home – it would be great if it could be written down or a printed form to make sure I get it right. I am just waiting now for my elderly brother to come and pick me up now [..dressed, bag packed and ready to go at 9.00am in the morning]. I overheard a conversation earlier this morning that they want to get me transferred to my local hospital, but I don’t know when I will go”
  11. 11. Summary of the current state... Play Your Part GVH Patient Flow We found: • Variation in the documentation of estimated date of discharge • Variation between wards and areas in ownership of discharge planning • Variation in the format of documentation of discharge planning • Variation in the process of “bed management” between roles, time of the day, day of the week...  Bed Management “on the fly” – minimal capability of predicting or planning for capacity & demand  Need to develop organisational approach to Patient Flow
  12. 12.  DISCHARGE PLANNING  PATIENT FLOW  COMMUNICATION & INFORMATION Issues Themed & Prioritised: Play Your Part GVH Patient Flow
  13. 13. • EDD documented - agreed policy and process • EDD on pt journey boards and electronic entry • Day prior planning for discharge • Transit Lounge capacity quarantined – mixed service with Medical Day Stay [bookings process implemented] • Patient Services [External Access] – collated • Review of discharge times [10am] and targets [updated] • “3 by 10” discharge strategy for each ward • Complex Patient Discharge MDT meeting Discharge Planning Initiatives Play Your Part GVH Patient Flow
  14. 14. 3 by 10 Play Your Part GVH Patient Flow GVH Patient Flow Project – Play Your Part To continue to develop improvements in the process of discharge planning for patients of GV Health, there are some key timeframes that have been implemented to ensure that the relevant clinical processes are completed and reviewed prior to patient discharge  Medical Imaging Requests: by 1000hrs day prior to discharge  Pharmacy Scripts: by 1400hrs day prior to discharge  Pathology Requests: by 1600hrs day prior to discharge Patient awaiting services to complete discharge can be allocated to the Transit Lounge or if appropriate can wait in a patient lounge areas in wards or in the Glasshouse Cafe or lounge For further information, please contact Penny Whelan, Project Facilitator on 03 58323 074, or email penny.whelan@gvhealth.org.au Play Your Part GVH Patient Flow Discharges
  15. 15. • Review and update escalation policy for GVH • Changes to former “Bed Management” meetings – now multidisciplinary membership reviews Patient Flow electronic status screen [twice daily – 9.30am and 3.30pm] • Increased awareness and appropriate utilisation of Waranga and Tatura beds • Increased engagement with patients and carers about their journey and discharge planning • Information available daily on current and predicted future demand Patient Flow Play Your Part GVH Patient Flow
  16. 16. Patient Flow Status to inform decision making
  17. 17. • Patient journey boards now a consistent format throughout the organisation • Implementation of electronic Patient Flow Report • Bedside whiteboard trial in Medical Ward for patient information & communication Communication & Information Play Your Part GVH Patient Flow
  18. 18. Making our technology work for us...
  19. 19. Organisational Flow Patient Flow
  20. 20. “Patient Flow – Play Your Part” Goulburn Valley Health Goulburn Valley Health has identified that to meet increasing demand from the community for services, and in order to provide quality and timely care to all our patients, Discharge before 10am is vital. As well as being beneficial to patients who come through the Emergency Department, early discharge helps elective surgery patients as they can be assured that we are doing everything we can to prevent their surgery being cancelled. This process also streamlines and enables the transfer of patients to and from the ICU, so these specialised resources can be directed to the patients who need them. The creation of new discharge promotional posters, together with changes to current processes, will ensure that staff, patients and their families will be aware of the hospital’s updated discharge policies and timeframes. Discharge information will be displayed in the wards, service areas and public areas such as lifts and waiting areas. This information will encourage patients, their families and carers to take the initiative in talking with staff, and finding out about their discharge details from their treating team, and to confirm discharge plans so that they can arrive on time to take relatives and friends home. Further information? Contact: Penny Whelan – Project Coordinator phone : [O3] 58323 074 or penny.whelan@gvhealth.org.au Play Your Part GVH Patient Flow 3 by 10 Play Your Part GVH Patient Flow Discharges This new initiative, along with other project strategies such as the updated patient journey boards and electronic patient flow systems, will assist the hospital to achieve its discharge targets of:  a minimum of 3 patients per ward discharged before 10am, and  60 % of patient discharges finalised prior to 12noon.  Feedback on performance will be provided to operational managers GVH Patient Flow Project – Play Your Part GOLD STAR RAPID DISCHARGE PROCESS The “Gold Star” Rapid Discharge Process is designed to facilitate early and efficient patient discharge, and to support continuous development of improvements in the patient flow at GV Health. Why? Patients and their families tell us that they want surety in the planning and processes of discharge. They also want options on what time of the day, and the environment in which they wait for discharge and transport. Who does this suit? Patients who are in a stable condition, have minimal co- morbidities and who can be actively involved and engaged in the planning process How? There are some key timeframes that have been implemented to ensure that the relevant clinical processes are completed and reviewed prior to patient discharge GOLD STAR RAPID DISCHARGE time is 9.00am Patient awaiting services to complete discharge can be allocated to the Transit Lounge or if appropriate can wait in a patient lounge areas in wards or in the Glasshouse Cafe or lounge For further information, please contact Penny Whelan, Project Facilitator on 03 58323 074, or email penny.whelan@gvh ealth.org.au Play Your Part GVH Patient Flow 3 by 10 Play Your Part GVH Patient Flow Discharges For further information, please contact Penny Whelan, Project Facilitator on 03 58323 074, or email penny.whelan@gvh ealth.org.au Play Your Part GVH Patient Flow 3 by 10 Play Your Part GVH Patient Flow Discharges Patient for Gold Star DischargeProcess  Minimalco-morbidities  Stable condition  Patient involved in process and planning for dischargeby 9.00am  Transport available& confirmed Patient Discharge by 9.00am Early identification of Gold Star Patient: Elective:informationprior to admission Emergency: informationafter confirmationof EDD and discharge needs D – 1 [Day prior to discharge]  Medications  Discharge Summary  Follow up appointments  Stable condition  Patient updated  Patient able to leave by 9.00am Patient for discharge? Yes No DischargeDay  Confirmation of discharge  Finalise Discharge Summary  Patient updated  Patient discharge by 9.00am Ongoing Clinical management+/- Routine or Gold Star DischargeProcess  Options for waiting : GlasshouseCafe Transit Lounge Ward Waiting Areas GVH Patient Flow Project – Play Your Part GOLD STAR RAPID DISCHARGE PROCESS
  21. 21. Tools to support increased visibility of process 1. Users now have to tick the new patient consent checkbox beneath the mainform. 2. Users can’t submit the referral unless the checkbox is ticked. 3. The followingis displayed once all the required info has been enteredinto the form and the “submit” button is clicked. Users have to click the “OK” button to complete the referral submission. If the user clicks “Cancel” then the referral will not be submitted. The text displayedin the pop-up can be altered as required. Trial of automated referral process •Internal referrals •External referrals
  22. 22. Patient Flow – How are we tracking? 0 50 100 150 200 250 300 6-Jan 13-Jan 20-Jan 27-Jan 3-Feb 10-Feb GVH Patient Flow Dashboard ED LOS [ED Presentations compared to ED LOS] Average presentations to ED per day All Patients Average LOS in ED in mins Play Your Part GVH Patient Flow
  23. 23. 0 50 100 150 200 250 300 350 400 450 500 6-Jan 13-Jan 20-Jan 27-Jan 3-Feb 10-Feb GVH Patient Flow Dashboard [ED LOS vs. % Admit to Ward] % Admitted to Inpatient Unit within 4 hrs Admitted Patients Average LOS (mins)in ED Organisational Flow Patient Flow Elective Surgery recommenced Emergency Surgery + LUSCS Play Your Part GVH Patient Flow EDD 17/12/12 Pt Flow Meetings Pt Flow Dashboard
  24. 24. 0 5 10 15 20 25 30 35 40 45 6-Jan 13-Jan 20-Jan 27-Jan 3-Feb 10-Feb GVH Patient Flow Dashboard [ED LOS >12hours] Number of Patients with LOS> 24 hours Number of Patients with LOS> 20 hours Number of Patients with LOS> 12 hours Organisational Flow Patient Flow Play Your Part GVH Patient Flow
  25. 25. Next Steps... • Ongoing improvements for discharge planning to continue, with a focus on time of discharge • Patient Flow Groups meetings focus to the 3pm meeting [day prior] • Dashboard operational reporting • Start spreading the good news!
  26. 26. Acknowledgments...

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