amp presentations

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AcuteMedicineProgrammeobjectives

Keyobjectives:

Quality:Reducetheadmissionrateofmedicalpatientsby10%peryear

for

3

years

post

full

implementation

without

increasing

28

day

readmission,thusenhancingtheglobalpatientexperience.

Access:

EverymedicalpatientpresentingtotheAMU/AMAU/MAU*will

beseenbyaseniormedicaldoctorwithinonehourandwillbe

discharged/admittedwithin

6hours.

Cost:AchieveanationalmedicalpatientmeanALOSof5.8days,

generatingtotalbeddaysavingsover3yearsof500,000(1,300beds).

Eliminationoftrolleywaits.

(*AcuteMedicalUnit/AcuteMedicalAssessmentUnit/MedicalAssessmentUnit)

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AMPkeyfeatures

Streaming

of

acute

medical

patients

to

defined

locusofcare(AMU)

EarlyopinionfromSeniorMedicalDoctor

Earlydiagnostics(investigatetodischarge

NOT admittoinvestigate)

ExpeditedSpecialistConsultation

FasttrackOPD/procedures

Dispositiondecisionwithin6hours(admitordischarge)

Dailyward/boardrounds

Weekenddischarges

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AMPGoals

Betterpatientcare

Betterpatient/staffexperience

Betterclinicaloutcomes

Appropriateclinicalenvironment

Reducedelectivewaitingtimesforadmission/daycases,etc.

Lesstrolleywaits

Improvedefficiency

Bettervalueformoney

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AMPModelofCare

Acute Bed Pool

2nightsDecision

toadmit

Respiratory

Unit

Metabolic

Unit

Acute

Rehabilitation

Unit

Gastro

IntestinalUnit

StrokeUnit

Critical

careCardiac

Unit

EDED

GPGP

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AvLosfor2009,2010,2011

7.4

7.6

7.8

8

8.2

8.4

8.6

8.8

9

J an-

M ar 09

J an-J un

09

J an-

S ep 09

J an-

Dec 09

J an-

M ar 10

J an-J un

10

J an-

S ep 10

J an-

Dec 10

J an-

M ar 11

J an-J un

11

J an-

S ep 11

J an-

Dec 11

T im e P e r i o d

AvLOS

(days)

7.4

7.6

7.8

8

8.2

8.4

8.6

8.8

9

J an-

M ar 09

J an-J un

09

J an-

S ep 09

J an-

Dec 09

J an-

M ar 10

J an-J un

10

J an-

S ep 10

J an-

Dec 10

J an-

M ar 11

J an-J un

11

J an-

S ep 11

J an-

Dec 11

T im e P e r i o d

AvLOS

(days)

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AMPSummary

Improvesthequalityandthesafetyofcare Reducesinhospitallengthofstay Increasessamedaydischargerates

Improvesefficientuseofhospitalresources

Greaterpatient,GPandstaffsatisfaction

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IrishHospitalsNeedtoReEngineertheProcessof

caringformedicalpatients

WhyMedicine?

Onethirdofallhospitaladmissionsaremedical

Halfofallhospitalbedsareusedbymedicalpatients

How?

BenchmarkIrishpracticeagainstaverageEnglishhospitalperformance

Target:

25%ofmedicalpatientsassessedandadmissionavoided

31%stay

less

than

48

hours

in

hospital

44%staymorethan2days(average10days)

Profileandmonitoreachhospitalperformance

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MedicalAdmissionsinEnglandduring20092010year:LengthofStay

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0

500

1000

1500

2000

2500

3000

0 2 4 6 810

12

14

LoS

Numberofdischarges

0

500

1000

1500

2000

2500

3000

0 2 4 6 810

12

14

LoS

Number

ofdischarges

HospitalA:NumberofAcuteMedicalDischargesbyLengthofStay

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0

500

1000

1500

2000

2500

3000

0 3 6 9 12 >14

LoS

Numberof

discharges

0

500

1000

1500

2000

2500

3000

0 3 6 9 12 >14

LoS

Number

ofdischarges

HospitalB:NumberofAcuteMedicalDischargesbyLengthofStay

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4AreasofIntervention

Assessandavoidadmission ShortStayUnit

Efficientprocessingofordinarypatients

Appropriatecareanddischargeofcomplexpatients

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ImplementationinProgress

Goodforpatients Goodforservice

Goodfortaxpayer

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TheNationalEarlyWarningScore(NEWS)and

associated

EducationProgramme

Apatientfocused,safetyandqualityinitiative

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Introduction

Aim:Tofacilitateearlydetectionofpatientdeteriorationbycategorisinga

patientsseverityofillnessandpromptingnursingstafftorequesta

medicalreview.

This

will

occur

at

specific

trigger

points

utilising

structuredcommunicationtoolswhilstfollowingadefinitiveescalation

plan.

Thisappliestobothmedicalandsurgicalpatients.

Why:Asignificantnumberofcardiacarrestsandunplannedadmissions

to

ICUdemonstrate

deterioration

in

patients

vital

signs

up

to

24

hours

prior

tocardiacarrest.Insomecases,theremaybeafailuretorecogniseor

respondearlyenoughtothedeterioratingpatient.

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15

Patientsvitalsignsarerecordede.g.BloodPressure,Pulse

Eachvitalsignisscoredfrom0to3.

ThesescoresareaddedtogethertogivetheEarlyWarningScore

Ifthe

score

is

at

3or

above

the

escalation

protocol

or

graded

response

is

initiated


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Background

ANationalGovernanceGroupwassetupsupportedbyaNationalAdvisoryGroup

HIQArecommendedanationallyagreedEarlyWarningScore

NICEClinicalGuideline50recommendstheuseofaphysiological

track

andtrigger

systemstomonitoralladultpatientsinacutehospital

settings

IrelandwasthefirstknowncountrytoagreeaNationalEarlyWarningScore(NEWS)

Thescoringsystemissupportedbyaninterdisciplinaryeducationprogramme,COMPASS,sharedwithusbyourAustraliancolleagues

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Background(contd.)

Programmeissupportedby,amongothers:RCPI,RCSI,OfficeoftheNursingandMidwiferyServicesDirector(ONMSD),PatientsRepresentativeGroups,theIrishAssociationofDirectorsofNursingand

Midwifery(IADNAM),theClinicalIndemnityScheme(CIS)andtheIrish

Nursesand

Midwives

Organisation

(INMO),

The

Nursing

and

Midwifery

BoardgrantedCategory1approval(6credits)fortheprogramme

ItisnotedthataNEWSsystemdoesnotreplaceclinicaljudgementof

experiencedstaff,butisveryimportantinprovidinganobjectivepatient

assessmenttosupportclinicaldecisionmaking

Thefullprogrammeisavailableonthewebsiteasfollows: www.hse.ie/go/nationalearlywarningscore/

17
http://www.hse.ie/go/nationalearlywarningscore/http://www.hse.ie/go/nationalearlywarningscore/http://www.hse.ie/go/nationalearlywarningscore/


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Planfor2012

IntroducetheNationalEarlyWarningScore(NEWS)andassociatedEducationProgrammeintoeveryacutehospitalinthecountry.

Consistencyacrosstheentireacutehospitalserviceincategorising

patients severityofillnessandpromptingappropriateaction. AuditandEvaluation Progresstodate: 1300stafftrained Medicalinternsarebeingtrainedupnationallyontheprogramme (compulsorypartoftheinternsEducationandTraining

contract) Allsiteshavecommencedworkonthisandweexpectallsitesoperationalbyendofyear

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TheNationalEarlyWarningScoreisgoodNEWSforpatients

andwillsavelives


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AcuteMedicine

Programme

CorkUniversityHospital

March2012

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Cultureiscrucialandleaderswithcoreskillsforclinicaldriveandorganisationalchange

willsettheclimateforpositivetransformation

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KeyReasonsforSuccess!

Teamapproach Patientfocused Continuouspresenceofseniorcliniciansonthefloor PriorityaccesstoDiagnostics

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CUH AcuteMedicalUnitopenedJan10th

2011 TotalAdmissions,DischargesandtransfersfromJan10th toDecember2011

Admissions =2,410

Discharges =2,065

25%homewithin24hours 48%homewithin48hours

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LengthofStay TotalMedicine

AvLOS

2009 =8.97days

V

AvLOS 2011 = 7.16daysReductionoverall = 1.8days

Beddayssaved = 20,512(equivalentto56beds)

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Phase2AMAUJan11th2012

11/01/2012 12/03/2012

Numberof

Patients

Admitted

to

MSSU

406

NumberofPatientsAssessedinAMAU 528

NumberofPatientsSeeninAMUReviewClinic 269

TotalNumberofPatientsAttendancesinAMU 1,203

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AMAU Data

528

303

178

40

7

0

100

200

300

400

500

600

Assessed Discharged Same Day Admitted to MSSU Admitted to CUH Transferred to Other

Hospital

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AMAU Discharge Outcomes

57.4%

33.7%

7.6%1.3%

Discharged Same Day Admitted to MSSU Admitted to CUH Transferred to Other Hospital

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KeyChallenges

Togenerateaculturewhere wesayNO totrolleysandfindalternativesolutionsasawholehospitalworkingtogetherrather

than

as

single

silos

TointegratethehospitalservicewithGPsandthe

communityas

aseamless

service

that

is

easily

accessible

appropriateandefficient

Toprovidesufficientlongtermcarebedcapacityforpatientswhorequiresuchcare

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TheAMP

will

deliver,

provided

all

teams

worktogetherandaresupportedbyclinical

andmanagerialleadershipthathasthePatientatthecentreofthisprocess

29

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