dr jennifer carroll, consultant physician, cork university hospital
Post on 27-Jun-2015
1.201 Views
Preview:
DESCRIPTION
TRANSCRIPT
Primary Care- Hospital Interface
“acute unselected medical admissions”
Is there a better way ?
? Help for HSE 374 million budget overrun
• National Policy and Reconfiguration
• Year on Year ED – Trolley crisis
• Numbers of older more complex acute medical illness presenting to hosp
• Renewed focus on Acute Medical Care
• 6hr Emergency access targets
LEVERS FOR CHANGE
Cork University Hospital
Irelands only level 1 trauma centre 850 bed hospital 40 + specialties 250,000 patient episodes annually 9,000 births per year 180,000 out-patient attendances per year 3,250 multi-professional staff €250m capital development programme Large change programme being implemented
AMU - Cork University Hospital January 2011 opened with 23 acute medical
beds Direct GP referrals from February 2011 Direct transfers from ED / Trolleys Consultant Physician continuous presence on
the unit Up skilling of nursing staff Culture shared team approach promoting high
quality care with proactive rapid assessment and discharge planning
Key Elements:
48 hour Length of Stay Same day Diagnostics Senior decision maker on the floor Daily specialist in each service CIT daily to facilitate discharge and
handover in the community
Improve access for patients to prompt medical assessment by a senior clinical decision maker
Uncouple the necessity for overnight admission for a procedure or investigation is a key paradigm shift
Improve patient flow and reduce wait for in-patient bed.
AIM:
Total Admissions, Discharges and transfers from Jan 10th to December 2011
2400 acute medical patients admitted 2,065 medical patient discharges 48% discharged in 48 hours 25% in 24 hours Average length of stay 61.29 hrs Length of Stay for General Acute Medicine
in hospital reduced from 10.4 - 6.5 days for first 6 months 2011
Additional resources ??
1.5 WTE Consultant Physician Weekly rotation NCHD team 3 . WTE Nursing Staff 1 . WTE Care Assistant – Radiology Reconfiguration of General Ward 35 beds
to 23 short stay unit
Capital Infra structure rebuild 1.5 millionincluding equipment
Length of Stay – Total Medicine
AvLOS 2010 = 9.07 daysV
AvLOS 2011 = 7.07 days
Reduction overall = 2 days
Bed days Saved = 20,512 (equivalent to 56 beds)
Cost savings significant if allow 1100 euros per bed
Phase 2 AMAU Jan 11th2012
Initially phased opening Mon-Fri (0800hrs-2000hrs)
Continuous Consultant Physician presence
Same – Day Diagnostics
AMU review Clinics to support same day discharge strategy
Aim for 25% - 30% same day discharge
Additional Resources?
2 further WTE Consultant Physician posts
3 NCHD posts ( Transfers 1 ED –CUH 2 - SIVUH )
Transfer Nursing Staff from ED /MSSU
8 trolleys for 13 bay assessment area.
Activity:
Impact of Service Changes
Transfer of Cardiology services end Nov ’11 Closure ED SIVUH 8pm – 8am end Nov ’11 Change in pathway for trauma rehabilitation to
SIVUH – Dec ’11 Increased acute General Medical Activity 13% Full closure of SIVUH ED – July ’12 Transfer emergency surgery ex SIVUH - July ’12 Not a steady state at any stage in
2012
AMU Patient Throughput
Number of Patients Admitted to MSSU ( other sources)
676
Number of Patients Assessed in AMAU ( 981 MSSU)
3726
Number of Patients Assessed in AMU Review Clinic
1158
Total Number of Patients Assessed in AMU 5560
AMAU Discharge Outcomes
94
150
199
188
238
185 182187
177
234
58
90
104
93
115
90
107 107103
79
11
23 24
60
8880
98
8388
173
04 6
1 5 2 40 1 10
50
100
150
200
250
J an-12 Feb-12 Mar-
12
Apr-12 May-
12
J un-
12
J ul-12 Aug-12 Sep-12 Oct-12
Number of Patients
Month Discharged Same Day
Admitted to MSSU
Admitted to CUH
Transferred to Other Hospital
Length of Stay – ALL Medicine
AvLOS 2011 = 7.07 day
V
AvLOS 2012 = 6.2 days
Reduction overall = approx 3 days (24+beds)
CUH Trolley Count –12th October
Outcome:
Better patient care Better patient/staff experience Improved access for primary care Better clinical outcomes Appropriate clinical environment Reduced elective waiting times for
admission/day cases, etc. Less trolley waits Improved efficiency Better value for money
Key Reasons for Success!
Team approach - Patient focused
Continuous presence of senior clinicians on the floor
Priority access to Diagnostics
Partnership with Primary Care with improved access /communication
Work Practices:
Daily Consultant ward rounds 8am, 5pm and “Hot “ review Mid-day
AMU Physician continual presence, no other fixed commitments
AMU Physician for unit provides phone advice for primary care
Summary:
AMU’S improve the quality and the safety of care
Reduce in-hospital length of stay Increased direct discharge rates Improved efficiency of hospital resources Greater patient and staff satisfaction
Conclusion :
Good for patients
Good for service
Good for tax payer
Success is not final, failure is not fatal: It is the courage to continue that counts. Winston Churchill
top related