20,000 days campaign storyboard learning session 3, 11-12 march 2013 –nurses –pharmacists...
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Aim
To increase the number of patients enrolled into the Very High Intensive User programme (VHIU) from 120 cases to 600* cases by July 2013.
This will result in a reduction in unplanned presentation and admission to Middlemore Hospital.
*Goal of 600 includes:» GP Referrals: 200 cases» 5 Flag referrals: 400 cases
Driver Diagram
- Include Collaborative Driver Diagram
5 Flag Process Change Packages
Secondary Drivers
(Theory of change)
Change Ideas Tested
Describe Process
Screening and Triage
.
Process has been standardise to ensure consistent assessment and review of all patients
Risk Assessment Guide (RAG)
Improved the existing RAG form to include information relating to language and health literacy to enable more comprehensive and thorough assessment.
Streamline Data Collection
Improved the existing data sets enable process measures that facilitate the monitoring and assessment of the change ideas.
5 Flag Process Change Packages
Secondary Drivers
(Theory of change)
Change Ideas Tested
Describe Process
Patient Quality of Life Assessment
To demonstrate VHIU’s benefit to the patient.
Standardise Information to GP’s
To enable and ensure that GP’s receive clear and consistent information about what VHIU does and how they work with practices.
GP Process Change Packages
Secondary Drivers
(Theory of change)
Change Ideas Tested
Describe Process
GP referral, use of triage tool.
To enable GP to review their patients to identify those most likely to benefit from the VHIU programme.
Partnering with GP Practices
Working with Franklin, Otara & Mangere Practices, sharing expertise and information, sharing home and follow up visits. Developing a joint care plan.
Most Successful PDSA Cycles?
- Include PDSA Tree diagram
Most Successful PDSA Cycles?
Pt identification by GP
using PARR (Any score)
GP Heart sink
Patients (list)
Pt identification
by GP using
PARR(with High
score)
PARR & 5 Flag
comparison
5 flag generation
for GP
Test of 5 flag+PAR
R+Heart
sink pts
Trigger tool
GP identificatio
n/Referral
Our prediction before the PDSA:
GP’s can correctly identify the appropriate VHIU patients using the PARR tool.
PDSA data revealed that on its own the PARR tool did not correctly identify patients for the VHIU team
This PDSA led to the embedding of the trigger tool as part of patient identification
Measures Summary
• Outcome measures– Patients enrolled from 5 flags, Primary care & Secondary care– Reduction in unplanned presentations & admissions– Bed days saved– Patient outcome measure (pre and post VHIU programme)
• Process Measures– Number of patients completing the VHIU Programme– Number of times patients complete the VHIU Programme– Time between presentations at EC & time to next unplanned
presentation.
• Balancing Measures– Numbers of re- presenting patients to the programme
VHIU Dashboard
- Include Collaborative Dashboard
Version: 1.0Dated: 28/02/2013
Project Manager : Alison Howitt Clinical Leader: Harry ReaImprovement Advisor: Prem Kumar
ContactsVHIU DashboardFebruary 2013
Run Chart - Total No of Cases Referred to VHIU
461
477
460
500 500
453
498
518511
496
505
520
455
527
400
420
440
460
480
500
520
540
Month/Year
Co
un
t o
f R
efe
rra
ls
Data 1
Median
Run Chart of 5 Flag Referrals to VHIU
458 460
447
500 499
453
493
503498
470 468
513
444
519
400
420
440
460
480
500
520
540
Month/Year
Co
un
t o
f R
efe
rra
ls
Data 1
Median
Run Chart of GP Referrals to VHIU
2
17
13
0 0 0
4 4
15
10
14
28
0
7
0
5
10
15
20
25
30
35
40
45
50
Month/Year
Co
un
t o
f R
efe
rra
ls
Data 1
Median
Run Chart of No of Patients Enrolled into VHIU
14
9
14
2325
34
46
28
49
41
38
35 35
40
0
5
10
15
20
25
30
35
40
45
50
Month/Year
Co
un
t o
f C
as
es
Data 1
Median
Run Chart of Enrolments from 5 Flag Referrals
12
910
2324
34
41
20
41
33
19
22
28
37
0
5
10
15
20
25
30
35
40
45
50
Month/Year
Co
un
t o
f C
as
es
Data 1
Median
Run Chart of Enrolments from GP Referrals
1
0
4
0 0 0
4 4
8
5
9
5
0 00
2
4
6
8
10
Month/Year
Co
un
t o
f C
as
es
Data 1
Median
Run Chart of Total Number of Patients Discharged from VHIU
13 4
8
19
32
16
34
39
29 30
1614
0
5
10
15
20
25
30
35
40
45
50
Month/Year
Co
un
t o
f C
as
es
Data 1
Median
Run Chart of Average Time in days on VHIU Programme
1215
18
34
42
5862
81
62 63
72
58
73
55
0
10
20
30
40
50
60
70
80
90
100
Month/Year
Av
era
ge
Tim
e i
n D
ay
s
Data 1
Median
Average days between sending to LOC/Team Member and First Home Visit
17
8
13 13
22
1314
6
10
14
4 4
75
0
5
10
15
20
25
30
35
40
45
50
Month/Year
Av
era
ge
Da
ys
Data 1
Median
Implementation
Implementation Areas
Changes to Support Implementation
PDSA cycles
Standardisation Screening and Triage Process
Documentation Process Map
Training Developing training materials to support new staff.
Job Descriptions
Measurement Develop regular reports for outcome and process measures
Resourcing Review of Job Descriptions for new Staff recruited
Adapted from “The Improvement Guide. A Practical Approach to Enhancing Organizational Performance” Gerald Langley et al., 2009, p180.
Highlights and Lowlights
Highlights- The collaborative support from 20,000 days bringing focus and
drive that has provided a catalyst for change and increased momentum
- The mutual respect within the VHIU team of our interdisciplinary skill set
- Recognition of the importance of a Model of Care which includes home visit and an holistic approach
Lowlights- Confusion due to multiple agendas within Primary and
Secondary care- Resistance and misunderstanding about integrated care- Difficulty in breaking down silos of care
Achievements to date- Do you have a change package, measurement plan?
- Multiple PDSA have resulted in standardised data capturing and reporting which includes monthly VHIU dashboard.
- What has changed and what difference have the changes made? - The data has allowed us to focus on areas that make a
difference and abandon those that don’t.- Triage process improved to identify the patient acuity enabling
the timely intervention- Referral Process leading to identification of patients from across
the health sector- Patient identification: Increase the appropriateness of referrals
received
- Improvements for patient and family experiences- Right service by the right professional to the right patient
and at right time
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