David Fitzsimons - Estimating Resource Requirements For Cleft Care Using A Computer Programme Based Upon Clinical Care Protocols

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A presentation given by David Fitzsimons in the 'Delivering Safety & Quality: The Health Reform Agenda stream at the CHA Conference 2012, The Journey, in October.

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David Fitzsimons - Estimating Resource Requirements For Cleft Care Using A Computer Programme Based Upon Clinical Care Protocols

  1. 1. Estimating Resource Requirements Based Upon Clinical ProtocolsSMCP Palatopharyngeus Resource Requirements Estimating For Cleft Care Using A Computer Programme Based Upon Clinical Care Protocols Fitzsimons, D., Filtness, F. Fan, C. & McCullagh, C. The Childrens Hospital at Westmead, Sydney, Australia
  2. 2. Estimating Resource Requirements Based Upon Clinical ProtocolsIntroductionClinical Specialist Speech PathologistWorked on Cleft Palate Team for over 17 yearsCompleting PhD - The Faculty of Medicine, The University of Sydney
  3. 3. Estimating Resource Requirements Based Upon Clinical ProtocolsCleft Lip and Palate TeamPlastic and Reconstructive SurgeonsOral-Maxillofacial SurgeonsEar, Nose and Throat SurgeonsSpecialist OrthodontistsSpeech PathologistsAudiologistsRadiologistsSleep PhysiciansPhotographersClinical Nurse Consultant….
  4. 4. Estimating Resource Requirements Based Upon Clinical ProtocolsCleft CareChronic ConditionPrenatal - 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 - Plastics
  5. 5. Estimating Resource Requirements Based Upon Clinical ProtocolsMulticentre Outcome Comparison Studies
  6. 6. Estimating Resource Requirements Based Upon Clinical ProtocolsProvision of CareMultidisciplinary Team - Protocols of Care - Evidence-Based PracticeResource Allocation and Distribution - Equitable Financial Costs - Accountable Burden of Care for Patients - Efficient Plan
  7. 7. Estimating Resource Requirements Based Upon Clinical ProtocolsSMCP Palatopharyngeus Management / Treatment course is quite predictable
  8. 8. Estimating Resource Requirements Based Upon Clinical ProtocolsProtocols of CareStructured and Documented - Timing - Professional(s) Involved - Nature of the Intervention - Resources Required - Outcomes - CostsReviewed and Evaluated Regularly
  9. 9. Estimating Resource Requirements Based Upon Clinical ProtocolsChronic CareCleft Care is a good example of chronic careTechniques / software can be applied to any chronic care condition
  10. 10. Estimating Resource Requirements Based Upon Clinical ProtocolsReview of Protocols of Care “It would be great if we could just book all the children’s “Not so sure appointments into the about that…” system as soon as they are born !” “Well at least we would know what resources we “What a would need” FANTASTIC idea !”
  11. 11. Estimating Resource Requirements Based Upon Clinical ProtocolsReview of Protocols of Care1. Patient’s Date of Birth Database2. Patient’s Cleft Classification
  12. 12. Estimating Resource Requirements Based Upon Clinical ProtocolsReview of Protocols of Care
  13. 13. Estimating Resource Requirements Based Upon Clinical ProtocolsReview of Protocols of Care1. Patient’s Date of Birth Database2. Patient’s Cleft Classification3. Computerised Protocols of Care
  14. 14. Estimating Resource Requirements Based Upon Clinical Protocols ProtocolsPatients
  15. 15. Estimating Resource Requirements Based Upon Clinical Protocols
  16. 16. Estimating Resource Requirements Based Upon Clinical Protocols
  17. 17. Estimating Resource Requirements Based Upon Clinical Protocols
  18. 18. Estimating Resource Requirements Based Upon Clinical ProtocolsVBA Code
  19. 19. Estimating Resource Requirements Based Upon Clinical Protocols ProtocolsPatients
  20. 20. Estimating Resource Requirements Based Upon Clinical ProtocolsData Computer code generates approx. 10,000 records in 1 minute
  21. 21. Estimating Resource Requirements Based Upon Clinical Protocols
  22. 22. Estimating Resource Requirements Based Upon Clinical Protocols
  23. 23. Estimating Resource Requirements Based Upon Clinical Protocols
  24. 24. Estimating Resource Requirements Based Upon Clinical Protocols 93
  25. 25. Estimating Resource Requirements Based Upon Clinical Protocols 44% Interventions Mapped 18% Booked Out for 2024 81% !!! 12 Years Away
  26. 26. Estimating Resource Requirements Based Upon Clinical Protocols
  27. 27. Estimating Resource Requirements Based Upon Clinical ProtocolsWhat we can doShare our protocols more easily with other cleft unitsMap the effect of a protocol change on existing patients / workload interms of resource allocationEstimate the cost/benefit of changing aspects of our protocolCan map these resources 18 years into the futureDetermine the current load on the ‘cleft’ system, predict expected future loads as newpatients enter the serviceBetter plan for raw data collection as part of research projectsBetter inform the Executive of the ‘actual utilisation’ of new equipmentPrioritise interventions for patients - Better inform patients and Executive of vulnerable areas of the service, and the effects of changes (for better or worse) in funding
  28. 28. Estimating Resource Requirements Based Upon Clinical ProtocolsLimitations / ProblemsUnderestimate cost of care by generating data on cleft diagnosisBypassing the need for individualised plans for patient care
  29. 29. Estimating Resource Requirements Based Upon Clinical ProtocolsReview of Protocols of Care
  30. 30. Estimating Resource Requirements Based Upon Clinical Protocols L L A A H S
  31. 31. Estimating Resource Requirements Based Upon Clinical ProtocolsTreatment Status Code Cleft L A H S H A L Reference Uppercase = Complete Lowercase = Incomplete Treatment R G R R G R R = Repair/Revision G = Graft Uppercase = Definitely needs further surgery Lowercase = Possibly needs further surgery L A h S . * Birth R G R R . R Example 12 months age r G r r . . 7 years age . G . R . . 14 years age . . . . . .
  32. 32. Estimating Resource Requirements Based Upon Clinical Protocols . . r R G r
  33. 33. Estimating Resource Requirements Based Upon Clinical Protocols ProtocolsPatients r G r r . .
  34. 34. Estimating Resource Requirements Based Upon Clinical ProtocolsConclusionsEstimating future resource requirements is not difficultFascinating, novel way of looking at resourcesAccuracy of projected data will be improved with individualised treatmentinformationThis computer programme is primarily for use in resource allocation projects -NOT as the primary source of care plan documentationHope that this initiative will improve our access to resources and fundingenhancements for cleft services.Provide the most effective and efficient cleft palate service to patients entrusted toour care.
  35. 35. Estimating Resource Requirements Based Upon Clinical ProtocolsThe FutureModifying the software for use by chronic care teamsoutside the cleft palate fieldIn 2013, we will be adding Craniofacial Clinic protocols to system, and sharingsoftware with other cleft units
  36. 36. Estimating Resource Requirements Based Upon Clinical ProtocolsThank You

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