Specialist CASE STUDY: Improvements at the Royal Victorian Eye & Ear Hospital

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Mitchell Wilson, Nurse Unit Manager Short Stay care Centre from the Royal Victorian Eye & Ear Hospital delivered this presentation at the 2012 Elective Surgery Redesign Conference. For more information about our wide range of medical and health events covering a broad range of industry issues, please visit www.healthcareconferences.com.au

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Specialist CASE STUDY: Improvements at the Royal Victorian Eye & Ear Hospital

  1. 1. Point of Care Admission Royal Victorian Eye & Ear Hospital Elective Surgery Redesign Conference 12-13th Nov 2012 Mitchell Wilson mitchell.wilson@eyeandear.org.au
  2. 2. RVEEH Clinical Services • 180,000 occasions of service in outpatient clinics • 46,000 occasions of service in Emergency • 13,000 theatre cases per year • 50% of public eye including most Special Eye and 10% of public ENT services in Victoria • Theatre access: 80% eye & 20% ENT workload
  3. 3. RVEEH Surgical Services  Day Surgery Department (DSF)– 3 Theatres (Level 3 Peter Howson Wing)  Operating Theatre Suite (OTS) – 5 Theatres (Basement Peter Howson Wing)  Short Stay Care Centre (SSCC) – 21 recliner bays (Level 4 Peter Howson Wing)  SSCC provides admission and discharge services for patients whose theatre allocation is for the basement OTS
  4. 4. Operating Theatre Suite & SPC Day Surgery Short Stay Care Centre Pre-admission Medihotel Ward 8 / Bed Management Admissions GF 3rd 4th 6th 7th 8th Basement Entrance Smorgon Family Wing RVEEH Surgical Service Location Peter Howson Wing
  5. 5. • Operates 7am to 7pm Mon – Fri • Two shifts o0700 to 1530 – 4 nursing staff o1030 to 1900 – 3 Nursing Staff • Approx 6000 admissions annually RVEEH Short Stay Care Centre
  6. 6. Centralised Admissions • Crowded admission waiting area – DSF & SSCC patients in the one area waiting for admission • There has been both formal and informal patient complaints about the waiting time and environment • Delays in prepping patient for theatre & delays in theatre start time - 6% of incident reports for SSCC • Staff disquiet - rework in data entry in PiMS and clerical work taken on by nursing staff
  7. 7. Point of Care Project May - August 2012 Background • Issues – Patient & staff disquiet – Delays in admission and theatre start time – As part of the enabling works for redevelopment • The admission process was reviewed and the Point of Care Project established
  8. 8. Methodology and Staging • The methodology adopted for the project was Process Redesign • Phases: – Defining the scope of work – Diagnosing the issues – Developing appropriate interventions – Implementation – Evaluation of outcomes
  9. 9. User Group • Project Executive Sponsor • Project Manager: Staff from Planning & Innovation • Project Leads: NUM SSCC & DSF • NUM Inpatient Ward & Preadmission • Perioperative Services Manager • Manager Health Information Services • Admissions Clerk • Accounts Manager
  10. 10. Scope • Inclusions are all admission during the hours of 7am to 7pm Monday to Friday – core business hours • Exclusions are admissions that occur out of hours and weekends – these are managed via the Emergency Department
  11. 11. Diagnosing the Issues • The User Group mapped the current admission process. • The mapping process provided an: – understanding of patient flow – bottlenecks and – constraints
  12. 12. Current State - Admission
  13. 13. Developing appropriate interventions • A future state for the admission process was then created which mitigated constraints. • Principles used to guide the development of a future state focused on changing the way patients waited and travelled before their surgery. • The aim was to create a future state which was patient centred and reduced delays.
  14. 14. Future State - Admission
  15. 15. Prerequisites for Future State • Space available on the SSCC and DSF • Wireless access for data entry and printing of admission registration form • PiMS availability on mobile computer units
  16. 16. Trial Period • One month before Go Live implementation a series of trial dates were identified. • Theatre bookings were reviewed to identify lowest activity for alternating morning and afternoon sessions • Staff feed back was recorded immediately after patients had been admitted and debriefing meetings discussed resolution for identified issues • As the trial period progressed and issues were resolved busier and full days were trialled
  17. 17. Implementation • Go live was 20th August 2012 • Modifications to the Future State were made for Point of Care due to limitations of PiMs & patient privacy issues o Unable to have 2 patients assigned to the one patient recliner bay o Patient demographics required to be checked on admission, difficult to maintain privacy in a shared room.
  18. 18. Implementation Model
  19. 19. Evaluation The project realised three key objectives: • Improved patient experience • Reduced delays in prepping patients for theatre • Streamlined patient admission process by removing rework and delays Benefits realised as a result of the project are: • Released space on ground floor for enabling works • Improved communication between admission and inpatient staff
  20. 20. Evaluation • No RiskMan entries for delays in patient admission since Go Live 6:54 6:57 7:00 7:03 7:06 7:09 7:12 20/08/2012 21/08/2012 22/08/2012 23/08/2012 24/08/2012 25/08/2012 26/08/2012 27/08/2012 28/08/2012 29/08/2012 30/08/2012 31/08/2012 1/09/2012 2/09/2012 3/09/2012 4/09/2012 5/09/2012 6/09/2012 7/09/2012 8/09/2012 9/09/2012 10/09/2012 11/09/2012 12/09/2012 13/09/2012 14/09/2012 15/09/2012 16/09/2012 17/09/2012 18/09/2012 Time of first Patients presentation at Nurses Station (SSU Specific)
  21. 21. User group Review • Composition of the project team • Communication breakdown in private rooms • Resistance to change • Increased patient involvement • Involve IT earlier • Limited baseline data to compare with post go-live data
  22. 22. Patient Feedback • It is good to go straight to an area where there are nurses and doctors • I’ve been here before and this time it was much better, I had to stand last time as there were not enough chairs • The new waiting room is very comfortable and warm and it is good to have the big TV to watch • There is plenty of staff around to answer your questions
  23. 23. Thank You mitchell.wilson@eyeandear.org.au

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