improving patient flow – an integrated approach presentation.pdf · improving patient flow – an...

Improving Patient Flow – An

Integrated Approach

June 8, 2010

Trish Bergal R.N., M.N.Tbergal@wrha.mb.ca

The Problem

• ALOS > National Peers

• Large % > 30 days LOS

• No change in the proportion of Atypical

cases >30 days

• No change in avoidable patient days

The Solution

Utilization Management System• Based on validated criteria set determines the

appropriateness of admission

• Based on validated criteria set determines the

appropriateness of setting

• Is patient specific and based on the individual patient’s

severity of illness (SI) and intensity of service (IS). Thus, applies to simple and complex cases

• Captures reasons for stay related to Acute Provider reasons (Physician and Hospital); and Community

reasons

Readiness For Discharge

(RFD) Assessment

© Continuum Solutions

If RFD met,

patient considered

medically

stable for discharge.

However, patient may

not be

functionally

ready for discharge.

Assessing the Integration of

Patient Flow

Suter, E., Oelke, N.D., Adair, C.E., & Armitage, G.D. (2009). Ten Key Principles for Successful Health Systems Integration. Healthcare Quarterly, Vol. 13.

Comprehensive Service across Care Continuum

• Patient Flow Forums with Hospitals and Community Areas

• Minimum biannual meetings between hospital and geographic community partners

• Uncapped TPN Volumes

• CPTP Expansion

• Community teams as part of discharge plan

• Long Term Ventilator spaces at 1010 Sinclair

• Panel Process Review initiated

Patient Focus

• Admit according to goals of admission (not

diagnosis)

• ELOS documented

• Flight Board

• Whiteboard at patient bedside

• Transition best practices

• Dignity based care

Geographic Coverage and Rostering

• Enhancing hospital – community

partnerships

• Access algorithms for rural regions i.e. Orthopedics

• Rural – Urban Utilization Committee

• Hospitalist Model and Clinical Teaching

Units – 2 Community sites

Standardized Care Delivery through Interprofessional Teams

• Oxygen Titration protocols

• End of Life Care

• Sharing of specialized expertise

• IECPCP initiatives

• Team Training

• Care Maps

Performance Management

• Data from UM System shared monthly

with hospitals and regional program teams

• Data shared with community teams as needed

• Development of indicators to measure flow

integration

Information Systems

• Jasper Patient Flow Dashboard

• Developing Cognos Cube for UM System

data

• Link data in Cognos UM Cube with data in

Cognos DSS (ICD-10 Abstracted data)

• Data Warehousing

Organizational Culture and Leadership

• Patient Flow Forums

• Flow and Access part of Strategic

Priorities

• Commitment; Awareness;

Responsiveness; Modeling the Way;

Stewardship

Physician Integration

• Primary Care Networks; Physician

Integrated Networks

• Leadership at CMO level

• Provincial Director of Patient Access:

Catalogue of Services; BGSC; PART;

Booking Ahead

Governance Structure

• VP Clinical Services and Integration

• Clarification of Accountability Matrix

• Flow and Access part of Strategic

Priorities

Financial Management

• Regional Health plans based on current

and projected volumes

• New funding requests must be supported by strong evidence base

• The cost of institutional vs community care