Patient Flow Collaborative
Action Learning Session No 3




 January 19th , 2005
 Western Hospital

 Chair for the day – J...
Welcome
Today is an opportunity for further;
• Sharing of ideas and discussion

• Networking

• Challenging yourselves and...
Housekeeping

• Phones and pagers


• Delegate packs


• Lunch will be served   (12:00 – 12:45)


• Rest rooms
Agenda

9.45 – 10.15    Western Health            Megan Bumpstead
                Scheduling elective patients

10.15 – 10...
Agenda
12.00 – 12.45   Lunch

12.45 – 13.15   Maroondah Hospital      Dominique Leyden
                Ward realignment

1...
Agenda
14.45 – 15.00   Afternoon Tea


15.00 – 16.00   Team Clusters                 PFC Leads
                - Learning ...
Western Health
Scheduling Elective Patients




 Meg Bumpstead
 Division of Surgery
 Western Health




Department of Huma...
Waiting List Scheduling
Current Issues
• Duplication of work
• No knowledge transfer
• Missed equipment/ prosthesis needs
...
Waiting List Scheduling

Interim Improvement Plan
• Microsoft Outlook Diaries

  – Off site access to schedule for Surgeon...
Waiting List Scheduling
Waiting List Scheduling

Long term solutions
• DHS secondment – Simon Jolly
• Development of IT based scheduling
  tool
Waiting List Scheduling
Improvements

• New Schedule will “talk” to PAS
• Upper level schedule for Theatres
• Individual Surgeon lists available o...
Booking Processes

Improvements to Date
• Minimal Cancellation
• No booking without unit consultation
• Development new RF...
Questions
Southern Health
Elective surgery planning




 Lesley Dwyer
 And
 Shannon Wight
 Southern Health



Department of Human Se...
QUEUING EQUITY PROJECT
ESSENTIAL CRITERIA
1.  To reduce the average waiting time for Category 2 Pt‟s on MMC,
    Clayton W...
QUEUING EQUITY PROJECT
MEASURES

1.   Access to Acute Bed
2.   Cancellation Rate (HIP)
3.   Visible reduction in average w...
Elective Theatre Access
Management – List Construction

• Problem    “living within our means”

 Emergency WIES close to t...
Elective Theatre Access
Management – List Construction

• Proposal
    • Develop Strategies that reduce WIES but still
   ...
Elective Theatre Access
Management – List Construction

• Key elements of Project
    • Resource appropriately – form a “c...
Elective Theatre Access
Management – List Construction

• Develop a rationale – quasi but
  important
 Formula:
 Emergency...
Elective Theatre Access
Management – List Construction

• What might this look like?
  – Typical list
          • Cat 1 an...
Elective Theatre Access
Management – List Construction

• Why are we “picking on” surgical units
  when they are only a sm...
Morning Tea –meet us back
here at 11am
Discussion Access Toolkits
and LOS Innovations




 Lee Martin
 Manager, CIA
 Collaborative Director




Department of Hum...
Access Toolkit

• System wide Toolkit

• LOS Innovations – access toolkit
Lunch –meet us back here at 12.45
Maroondah Hospital
Ward realignment




 Dominique Leyden
 Patient Flow Coordinator




Department of Human Services
Maroondah Hospital



                               Dominique Leyden – Project
                               Facilitator...
Background
– Why Bed
Management?
Rigorous diagnostics in phase 1 of patient flow
   collaborative identified our top three...
Methodology

• Repeat ward sample data
  collection
   Include all 5 acute ward areas
• Conduct a brainstorming session
• ...
Results:                    Ward Sample Data
  REASONS FOR DELAYS TO A PATIENT JOURNEY THROUGH WARDS

   Ward sample data ...
Results – Brainstorming
Session

Set up to look at two key areas:

• Delays caused by waiting for medical
  staff to revie...
Results;    Brainstorming

Multi disciplinary team identified
 that;

• Medicine functions independently of and
  separate...
Outcome

An identified need within the
 organisation to change the current
 bed allocation process and move
 towards devel...
Current Bed Allocation
Model

                                  1 NORTH    1 SOUTH    2 SOUTH    2 NORTH       1         3...
Projected Benefits

  • Reduced LOS

  • Reduced 12 hour stays in ED

  • Improved median discharge
    time
Proposed Model

          1 SOUTH                    1 NORTH               2 NORTH                      2 SOUTH           ...
Project Outline

• Communication and consultation
  process Nov 4 – 25 2004
• Ward moves Dec 30 – 31st 2004
Phase One
       1 SOUTH                    1 NORTH                 2 NORTH                    2 SOUTH             1 EAST ...
Phase Two

         1 SOUTH                    1 NORTH                 2 NORTH                    2 SOUTH             1 EA...
Successes

• Hospital maintained capacity
• 12 hour ED targets met
• Emergency surgery continued
• No patient/relatives co...
Questions?
Emergency Department
Data Analysis




 Lee Martin
 Director Patient Flow Collaborative
 &
 Prue Beams
 Data Consultant

D...
Clinical Streams
Triage Cat1 (Resuscitation)




    Patients presenting to this Emergency Department can expect to have a...
Clinical Streams
- Triage Cat2 (Emergency)




    Patients presenting to this Emergency Department can expect to have a j...
Clinical Streams
- Triage Cat3 (Urgent)




    Patients presenting to this Emergency Department can expect to have a jour...
Clinical Streams
- Triage Cat4 (Semi Urgent)




    Patients presenting to this Emergency Department can expect to have a...
Clinical Streams
- Triage Cat5 (Non Urgent)




    Patients presenting to this Emergency Department can expect to have a ...
Patient Journey Times in ED by Triage Cat
- Summary table
Patient Journey Times in ED by Triage Cat
- Summary table
ED Presentations by Diagnosis (Top 25)




                 * Complete list available on request
ED Presentations by Diagnosis (Top 25)
- Only patients > Upper Limit (1,007mins)




                    * Complete list a...
Time of Presentation to ED by Hour of Arrival
ED Median/Mean Length of Stay
- Admitted v Discharged streams
ED Median Length of Stay
- Admitted v Discharged streams
ED Length of Stay Summary
- Time bands
Melbourne Health
Pilot Site Update




 Marcus Kennedy
 Clinical Lead, Patient Flow Collaborative




Department of Human ...
Bed availability coordination
group

• Bed management has been organizationally
  restructured within the operational stre...
Clinician communication
coordination group

• This group has actively engaged clinical staff
  at all levels.
• Specific w...
Operating Theatre coordination
group

• This group has developed
  – an online emergency booking system, and
  – improved ...
Subacute and rehab coordination
group

• This work group has performed major work
  to redefine the model of care in subac...
Radiology coordination group

• Specific process improvements have
  occurred in this area with regard to weekend
  transp...
Emergency Flow Group

• A web based patient status tracking system
  has been developed which is viewed on
  wards and oth...
Impact of Changes at Melbourne
Health

• Through December 2004 and January 2005,
  objective evidence of impacts is starti...
0
            10
            30
            40
            50
 Ju
     l-0
Au 3




            20 11
   g-
       0
Se 3
...
Patient flow through emergency
has improved dramatically


                                              % Emergency Patie...
?Sustainability

• The improvements in these measures (over
  several measurement periods) suggest that
  the gains may be...
Melbourne Health
Improving Clinical Communication




 Dr David Smallwood




Department of Human Services
Clinical Communication Working Party
                  Background
• The rigorous diagnostics phase identified
  constraint...
Clinical Communication Working Party
              Key Actions

• Clinician communication survey



• Discharge ward rounds
Clinical Communication Working Party
         Clinical Communication Survey

    Audit of all Unit heads, Nurse Unit
    M...
Clinical Communication Working Party
          Clinical Communication Survey

• Key Findings:

- Irregular timing of ward ...
Clinical Communication Working Party
                 Recommendations
WARD ROUNDS
• Published schedule
• Additional consul...
Clinical Communication Working Party
          Recommendations

DISCHARGE PLANNING
• Educate junior doctors about day prio...
Clinical Communication Working Party
                      Recommendations
ROSTER AVAILABILITY
• An up-to-date medical ros...
Clinical Communication Working Party
            Discharge Ward Rounds
• Discharge reviews:
  – 51% (53) reviewed Monday d...
Clinical Communication Working Party
             Discharge Ward Rounds
                      Discharge times
14




12


...
Clinical Communication Working Party
              Discharge Ward Rounds
•   Weekly ward round
•   Varied wards,
•   Helpf...
Clinical Communication Working Party
              Discharge Ward Rounds
Key reasons for delays:

•   Time of notification...
Clinical Communication Working Party
           Positive Impacts

•   Increased awareness.
•   Clarification of existing p...
Clinical Communication Working Party
          Positive Impacts
14


                                                     ...
Discussion and challenges
 • Engagement of senior medical staff
 • Maintaining momentum/awareness
     •All clinicians
 • ...
Afternoon Tea –meet us back
here at 3pm
Team Clusters




 Lee Martin and PFC Leads




Department of Human Services
Clusters
• LS3 Agenda and preparation
• Involving your team
  – Who do you want to network with at LS3?
  – Who do people ...
Summary


• Registrations for LS3 due 17th January

• Keep marketing your achievements- present
  to your CEO where possib...
Have a safe trip home
Upcoming SlideShare
Loading in …5
×

als3_jan19_pres.ppt

502 views

Published on

0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
502
On SlideShare
0
From Embeds
0
Number of Embeds
2
Actions
Shares
0
Downloads
7
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

als3_jan19_pres.ppt

  1. 1. Patient Flow Collaborative Action Learning Session No 3 January 19th , 2005 Western Hospital Chair for the day – Jannie Selvidge Department of Human Services
  2. 2. Welcome Today is an opportunity for further; • Sharing of ideas and discussion • Networking • Challenging yourselves and each other • Support to keep going
  3. 3. Housekeeping • Phones and pagers • Delegate packs • Lunch will be served (12:00 – 12:45) • Rest rooms
  4. 4. Agenda 9.45 – 10.15 Western Health Megan Bumpstead Scheduling elective patients 10.15 – 10.45 Southern Health Lesley Dwyer and Elective surgery planning Shannon Wight 10.45 – 11.00 Morning Tea 11.00 – 12.00 Discussion Time Lee Martin and - Access Toolkits Rochelle Condon - LOS Hot topic calls
  5. 5. Agenda 12.00 – 12.45 Lunch 12.45 – 13.15 Maroondah Hospital Dominique Leyden Ward realignment 13.15 – 13.45 Emergency Department Lee Martin and Data analysis Prue Beams 13.45 – 14.15 Melbourne Health Marcus Kennedy Pilot site update 14.15 – 14.45 Melbourne Health David Smallwood Improving Communication
  6. 6. Agenda 14.45 – 15.00 Afternoon Tea 15.00 – 16.00 Team Clusters PFC Leads - Learning Session 3 Agenda 16.00 Close
  7. 7. Western Health Scheduling Elective Patients Meg Bumpstead Division of Surgery Western Health Department of Human Services
  8. 8. Waiting List Scheduling Current Issues • Duplication of work • No knowledge transfer • Missed equipment/ prosthesis needs • Difficult to pull pts in waiting order • Difficult to fully utilise lists • Patients booked minimal consultation
  9. 9. Waiting List Scheduling Interim Improvement Plan • Microsoft Outlook Diaries – Off site access to schedule for Surgeons – Access from NUM to theatre schedule – Still duplication
  10. 10. Waiting List Scheduling
  11. 11. Waiting List Scheduling Long term solutions • DHS secondment – Simon Jolly • Development of IT based scheduling tool
  12. 12. Waiting List Scheduling
  13. 13. Improvements • New Schedule will “talk” to PAS • Upper level schedule for Theatres • Individual Surgeon lists available off site • Ready reckoner for Equipment/ Prosthesis requirements
  14. 14. Booking Processes Improvements to Date • Minimal Cancellation • No booking without unit consultation • Development new RFA – endoscopy • Development new RFA - theatre
  15. 15. Questions
  16. 16. Southern Health Elective surgery planning Lesley Dwyer And Shannon Wight Southern Health Department of Human Services
  17. 17. QUEUING EQUITY PROJECT ESSENTIAL CRITERIA 1. To reduce the average waiting time for Category 2 Pt‟s on MMC, Clayton Waiting List. Actual 192 days KPI 173 days. 2. To treat the tail-ending patients – queuing equity. 3. In order to address a Waiting List Strategy – we need to start the ball rolling from “somewhere” PROCESS 1. Based on the volume of Theatre sessions and number of Category 2 Tail-ending patients. 2. Even distribution across Weekly Theatre Schedule. 3. Pre-Admission Clinic Collaboration 4. Clear communication with Surgical Registrars & support from Surgical Heads of Unit. 5. Awareness in Bed Bureau/Access Unit of Patient Urgency as to pt identification on Elective Admission List.
  18. 18. QUEUING EQUITY PROJECT MEASURES 1. Access to Acute Bed 2. Cancellation Rate (HIP) 3. Visible reduction in average waiting time for Category 2 Patients. 4. Patient Satisfaction 5. Sustainable change to Monash Medical Centre. 05/06 Financial Year.
  19. 19. Elective Theatre Access Management – List Construction • Problem “living within our means” Emergency WIES close to target BUT Elective WIES ahead of target in both waiting list electives and non- waiting list (other). MMC has the following profile: 70% Emergency 30% Elective 10% waiting list 20% other eg Gastroenterology
  20. 20. Elective Theatre Access Management – List Construction • Proposal • Develop Strategies that reduce WIES but still deliver waiting list targets! • Ambitious target • Start date NOW! • List Construction Project • GO LIVE FEBRUARY • What are the elements of this project?
  21. 21. Elective Theatre Access Management – List Construction • Key elements of Project • Resource appropriately – form a “can-do” group • Look for and incorporate “levers” eg ESAS non conformers, capacity at other sites. • Remain true to objective – don‟t cut across other initiatives rather use them to ensure outcomes are met eg Queuing Equity Project
  22. 22. Elective Theatre Access Management – List Construction • Develop a rationale – quasi but important Formula: Emergency WIES + Cat 1 + Maternity = X Less Target =Y Available Cat 2’s, Cat 3’s, Non W/L Z • Z is calculated and distributed equitably across surgical units cognisant of demand pressures and waiting list targets
  23. 23. Elective Theatre Access Management – List Construction • What might this look like? – Typical list • Cat 1 and/or Emergency • Long Wait Cat 2‟s – tails • Long Wait Cat 3 • How do we support clinicians? – Develop guidelines for booking – work with their special needs – Give information – Monitor progress and report back regularly
  24. 24. Elective Theatre Access Management – List Construction • Why are we “picking on” surgical units when they are only a small part of the problem? • We are not - similar strategies will be developed for “other”
  25. 25. Morning Tea –meet us back here at 11am
  26. 26. Discussion Access Toolkits and LOS Innovations Lee Martin Manager, CIA Collaborative Director Department of Human Services
  27. 27. Access Toolkit • System wide Toolkit • LOS Innovations – access toolkit
  28. 28. Lunch –meet us back here at 12.45
  29. 29. Maroondah Hospital Ward realignment Dominique Leyden Patient Flow Coordinator Department of Human Services
  30. 30. Maroondah Hospital Dominique Leyden – Project Facilitator Innovations to Improve Patient Flow in the Area of Bed Management Department of Human Services
  31. 31. Background – Why Bed Management? Rigorous diagnostics in phase 1 of patient flow collaborative identified our top three organisational constraints to be; 1. Theatre utilization - high HIP rate 2. Ward bed availability ( bed management) - Admission delays for elective surgery, - Admission delays from ED (Unable to meet 12 hour targets) 3. Acute/Sub Acute transition - Delayed access to NH and rehab beds
  32. 32. Methodology • Repeat ward sample data collection Include all 5 acute ward areas • Conduct a brainstorming session • Map a medical unit ward round • Map the bed manager for a day
  33. 33. Results: Ward Sample Data REASONS FOR DELAYS TO A PATIENT JOURNEY THROUGH WARDS Ward sample data collected August 9th to 22nd on all five acute wards at Maroondah Hospital Number of Number Reason for delay occurrences 1 Waiting for N/H or interim care bed 101 2 Waiting for Rehab bed 84 3 Waiting for medical review 75 4. Waiting for Allied Health review 32 5. Waiting for medical staff to write up 27 discharge summaries and medications 6. Waiting for ACAS 15 7. No clear plan of care 14
  34. 34. Results – Brainstorming Session Set up to look at two key areas: • Delays caused by waiting for medical staff to review patients and do discharge paperwork • Delays associated with waiting for allied health review
  35. 35. Results; Brainstorming Multi disciplinary team identified that; • Medicine functions independently of and separate to nursing and allied health, • Little consultation between disciplines
  36. 36. Outcome An identified need within the organisation to change the current bed allocation process and move towards developing a ward based medical and allied health structure
  37. 37. Current Bed Allocation Model 1 NORTH 1 SOUTH 2 SOUTH 2 NORTH 1 3 25 beds 30 beds 30 beds 25 beds EAST EAST Med 1 1 4 3 24 beds 9 30 beds o Endocrinology Med 2 1 4 4 2 8 o Oncology 1 1 4 1 o Haematology Med 3 1 2 1 2 4 o Cardiology 3 1 o Respiratory 1 2 Med 4 1 2 4 7 o Gastro o Infectious Diseases ACE Unit 1 9 1 Surg Unit 1 7 6 o Thoracic 1 Surg Unit 2 1 7 9 Orthopaedic Unit 17 6 Plastics 1 5 Urology 2 GEM 24 Estimated Medical Staff 24 22 23 16 2 14 involved in patient care (Excludes Consultants &
  38. 38. Projected Benefits • Reduced LOS • Reduced 12 hour stays in ED • Improved median discharge time
  39. 39. Proposed Model 1 SOUTH 1 NORTH 2 NORTH 2 SOUTH 1 EAST 23 3 EAST 30 24 32 30 BEDS 25 Beds Beds Beds Beds Beds Medical Unit 1 GEM Unit Medical Unit 4 Medical Unit 4 Surgical Unit Orthopaedic Unit 1 Endocrinology Gastro Medical Unit 2 Thoracic Surgery ACE Unit Medical Unit 3 Oncology Surgical Unit 2 Cardiology Haematology Plastics Respiratory Urology Estimated Medical Staff involved in patient care (Excludes Consultants & referrals) 5 2 6 7 9 5 Typical day – Current model of allocation – medical staff numbers (Excludes Consultants & referrals) 3 East 14 GEM 2 2 North 16 2 South 23 1 South 1 North 24 22
  40. 40. Project Outline • Communication and consultation process Nov 4 – 25 2004 • Ward moves Dec 30 – 31st 2004
  41. 41. Phase One 1 SOUTH 1 NORTH 2 NORTH 2 SOUTH 1 EAST 23 3 EAST 30 25 32 Beds 30 Beds BEDS 24 Beds Beds Beds Medical Unit 1 Orthopaedic Medical Unit 4 Medical Unit 4 Surgical Unit GEM Unit 1 Endocrinology Gastro Medical Unit 2 Thoracic Surgery ACE Unit Medical Unit 3 Oncology Surgical Unit 2 Cardiology Haematology Plastics Respiratory Urology Transit Lounge. Estimated Medical Staff involved in patient care (Excludes Consultants & referrals) 5 5 6 7 9 2 Typical day – Current model of allocation – medical staff numbers (Excludes Consultants & referrals) 3 East 14 1 North 24 2 North 16 2 South 23 1 South GEM - 2 22
  42. 42. Phase Two 1 SOUTH 1 NORTH 2 NORTH 2 SOUTH 1 EAST 23 3 EAST 30 24 32 Beds 30 Beds BEDS 25 Beds Beds Beds Medical Unit 1 GEM Medical Unit 4 Medical Unit 4 Surgical Unit Orthopaedic 1 Endocrinology Gastro Medical Unit 2 Thoracic Surgery ACE Unit Medical Unit 3 Oncology Surgical Unit 2 Cardiology Haematology Plastics Respiratory Urology Transit Lounge. Estimated Medical Staff involved in patient care (Excludes Consultants & referrals) 5 2 6 7 9 5 Typical day – Current model of allocation – medical staff numbers (Excludes Consultants & referrals) 3 East 14 Gem - 2 2 North 16 2 South 23 1 South 1 North 24 22
  43. 43. Successes • Hospital maintained capacity • 12 hour ED targets met • Emergency surgery continued • No patient/relatives complained!
  44. 44. Questions?
  45. 45. Emergency Department Data Analysis Lee Martin Director Patient Flow Collaborative & Prue Beams Data Consultant Department of Human Services
  46. 46. Clinical Streams Triage Cat1 (Resuscitation) Patients presenting to this Emergency Department can expect to have a journey time from arrival to departure between 0 and 1228mins with a mean of 88mins.
  47. 47. Clinical Streams - Triage Cat2 (Emergency) Patients presenting to this Emergency Department can expect to have a journey time from arrival to departure between 0 and 1122mins with a mean of 389mins.
  48. 48. Clinical Streams - Triage Cat3 (Urgent) Patients presenting to this Emergency Department can expect to have a journey time from arrival to departure between 0 and 1061mins with a mean of 366mins.
  49. 49. Clinical Streams - Triage Cat4 (Semi Urgent) Patients presenting to this Emergency Department can expect to have a journey time from arrival to departure between 0 and 930mins with a mean of 303mins.
  50. 50. Clinical Streams - Triage Cat5 (Non Urgent) Patients presenting to this Emergency Department can expect to have a journey time from arrival to departure between 0 and 552mins with a mean of 164mins.
  51. 51. Patient Journey Times in ED by Triage Cat - Summary table
  52. 52. Patient Journey Times in ED by Triage Cat - Summary table
  53. 53. ED Presentations by Diagnosis (Top 25) * Complete list available on request
  54. 54. ED Presentations by Diagnosis (Top 25) - Only patients > Upper Limit (1,007mins) * Complete list available on request
  55. 55. Time of Presentation to ED by Hour of Arrival
  56. 56. ED Median/Mean Length of Stay - Admitted v Discharged streams
  57. 57. ED Median Length of Stay - Admitted v Discharged streams
  58. 58. ED Length of Stay Summary - Time bands
  59. 59. Melbourne Health Pilot Site Update Marcus Kennedy Clinical Lead, Patient Flow Collaborative Department of Human Services
  60. 60. Bed availability coordination group • Bed management has been organizationally restructured within the operational stream, and work is advanced in development of an electronic bed management and patient tracking system. • The organizational admission and access policy has been redrafted and is under executive review. This process clarifies and streamlines access routes and their management.
  61. 61. Clinician communication coordination group • This group has actively engaged clinical staff at all levels. • Specific work has occurred in relation to: – time of day of discharge, – investigation services prioritization of access for discharge patients, – improved electronic referral and rostering systems, – weekly review and – audit of discharge practices.
  62. 62. Operating Theatre coordination group • This group has developed – an online emergency booking system, and – improved systems of flow within the OR to reduce delays in start times. – A number of recovery room strategies to minimize exit block from recovery have been implemented. • Melbourne Health has recently made available an emergency operating theatre, and • Opened day procedural facilities that increase capacity.
  63. 63. Subacute and rehab coordination group • This work group has performed major work to redefine the model of care in subacute services. • Major changes have occurred with implementation of – an improved bed management and access system, – improved relationships and patient flow systems between the acute and subacute campuses, and – improvements to patient length of stay.
  64. 64. Radiology coordination group • Specific process improvements have occurred in this area with regard to weekend transport issue for patients requiring medical imaging. This has impacted length of stay for many patients. • Improved reporting systems have meant availability of reports in a more timely fashion. • Improvement opportunities for patient access, queue management and flow systems remain in this area.
  65. 65. Emergency Flow Group • A web based patient status tracking system has been developed which is viewed on wards and other areas, to encourage pull strategies for patient movement out of ED. • This is linked to action cards and supported by the access policy (under revision). • ED processes of care have been reviewed, and innovative streaming systems are being implemented.
  66. 66. Impact of Changes at Melbourne Health • Through December 2004 and January 2005, objective evidence of impacts is starting to be realised. • Length of stay in subacute areas has decreased significantly • Elective surgery access has been maintained, and activity increased in December • Cancellations of elective work due to bed unavailable have decreased
  67. 67. 0 10 30 40 50 Ju l-0 Au 3 20 11 g- 0 Se 3 20 p- 0 9 Oc 3 t- 0 6 No 3 v- 0 De 3 c- 0 Ja 3 12 14 n- 0 4 Fe 4 b- 0 M 4 2 ar -0 7 Ap 4 r- decreased dramatically M 04 7 ay -0 5 Ju 4 n- 0 Ambulance Bypass 13 Ju 4 l-0 Ambulance bypass rates have Au 4 41 g- 0 Se 4 19 p- 0 Oc 4 40 t- 0 No 4 27 v- 0 6 De 4 c- 04 2
  68. 68. Patient flow through emergency has improved dramatically % Emergency Patients Admitted < 12 hours 100% 95% 90% Upper Control Limit (+3SD) 85% 80% Mean 75% 70% 65% Lower Control Limit (-3SD) 60% 55% 50% 3 4 04 04 05 04 4 3 4 3 3 3 4 4 4 4 4 3 4 -0 -0 -0 l-0 l-0 -0 -0 -0 -0 -0 -0 -0 -0 -0 -0 n- n- n- b- ov ov ar ec ec ug ep ug ep pr ay ct ct Ju Ju Ja Ju Ja Fe M O O A N N M D D A S A S
  69. 69. ?Sustainability • The improvements in these measures (over several measurement periods) suggest that the gains may be sustainable. • The quantum of the change in particular in the “% admitted less than 12 hours” indicator is suggestive of major and fundamental system change. – In this measure, the performance has crossed the upper control limit in the statistical process control chart for the parameter.
  70. 70. Melbourne Health Improving Clinical Communication Dr David Smallwood Department of Human Services
  71. 71. Clinical Communication Working Party Background • The rigorous diagnostics phase identified constraints in patient flow due to: – Poor communication within and between units – Inconsistent admission and discharge processes – Ward round practices (senior and junior staff) – Problematic staff rosters (updated list) – Units being unavailable for referrals
  72. 72. Clinical Communication Working Party Key Actions • Clinician communication survey • Discharge ward rounds
  73. 73. Clinical Communication Working Party Clinical Communication Survey Audit of all Unit heads, Nurse Unit Managers and Senior Registrars with the aim: • Establish an awareness of PFC • Establish an understanding of existing processes. • Identify problematic areas. • Gain feedback from participants.
  74. 74. Clinical Communication Working Party Clinical Communication Survey • Key Findings: - Irregular timing of ward rounds. - No communication process to notify timing of ward rounds. - Inconsistent after hour/weekend processes. - Varied methods of communication between senior and junior staff. - Minimal nurse & allied health attendance on ward rounds. - Varied patient decision making processes. - Lack of understanding/existence of admission policy.
  75. 75. Clinical Communication Working Party Recommendations WARD ROUNDS • Published schedule • Additional consultant input on weekend ward rounds. • Multidisciplinary attendance. • Time efficiency eg. pre-ward round debriefs. • Criteria initiated discharge. – Less reliance on consultant review. – Nurse initiated.
  76. 76. Clinical Communication Working Party Recommendations DISCHARGE PLANNING • Educate junior doctors about day prior discharge planning and re-enforce the benefits of this discharge process to senior doctors. • Prioritize patients who could potentially be discharged and assess them earlier so that discharge processes can begin as soon as possible e.g. clerical duties • Priority X-rays and bloods in am
  77. 77. Clinical Communication Working Party Recommendations ROSTER AVAILABILITY • An up-to-date medical roster which is accessible to all staff at all times. WEB BASED Registrar availability for emergency contact. REFERRAL PROCESSES • Develop project dimensions and strengthen work towards the establishment of an „e-referral‟ system.
  78. 78. Clinical Communication Working Party Discharge Ward Rounds • Discharge reviews: – 51% (53) reviewed Monday discharges out of 103 patients over two weeks. – Median discharge time of reviewed patient histories: 1500 hours – Median discharge times of all patients discharged on these two days: 1430 hours
  79. 79. Clinical Communication Working Party Discharge Ward Rounds Discharge times 14 12 10 8 6 4 2 0 1 2 3 7 9 10 11 12 13 14 15 16 17 18 19 20
  80. 80. Clinical Communication Working Party Discharge Ward Rounds • Weekly ward round • Varied wards, • Helpful „Magic Wand‟ approach • Participants include: – Senior Doctor (rotate between Gen Med, Surgery & ED) – Registrar – PFC coordinator – Bed Management – Occasional Executive representative
  81. 81. Clinical Communication Working Party Discharge Ward Rounds Key reasons for delays: • Time of notification of patient transfer. • Time of/ waiting for ward round review. • Waiting on transport. • Inadequate documentation (e.g.discharge summary). • Waiting on results. • Delay in specialist unit review. • Transit lounge- use & availability • Boarders • Discharge time entry (electronic) • Poor communication eg family
  82. 82. Clinical Communication Working Party Positive Impacts • Increased awareness. • Clarification of existing processes. • Increased Patient Flow Collaborative profile. • Encourages input from staff re improvements. • Communication between clinical staff. • More timely discharges • Nursing initiated action sheets
  83. 83. Clinical Communication Working Party Positive Impacts 14 Median discharge time for October 1300 hours 12 Median discharge time for 15th Dec 1200 Avg discharges are 50 - 60 per day 10 8 6 4 2 0 08 09 10 11 12 13 14 15 16 17 18 19 20 21 25/10/2004 08/11/2004 07/12/2004 15/12/2004
  84. 84. Discussion and challenges • Engagement of senior medical staff • Maintaining momentum/awareness •All clinicians • Creating new processes that do not rely in any one person
  85. 85. Afternoon Tea –meet us back here at 3pm
  86. 86. Team Clusters Lee Martin and PFC Leads Department of Human Services
  87. 87. Clusters • LS3 Agenda and preparation • Involving your team – Who do you want to network with at LS3? – Who do people in your team need to meet at LS3? • Communication plans – How are you using your communication strategy? • Future events- newsletter • Evaluation forms
  88. 88. Summary • Registrations for LS3 due 17th January • Keep marketing your achievements- present to your CEO where possible • Continue to engage and influence widely • Keep Going…..
  89. 89. Have a safe trip home

×