tipping points / triggers who owns our red
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Feb 2016
SWSLHD Experience
Kim Clark
SWSLHD WoH Program Manager
Tipping points / Triggers Who Owns our RED?
What was the problem?
Falling overall NEAT
Poor admission NEAT (15-20%)
Increase activity
Poor Transfer of Care (TOC) 69%
No of Patients spending >24hrs in our ED’s – High
Average Daily 0800hrs queue = 21 adult pts
Who Owns the RED?
What was the Goal & What did we do? To improve safe and timely access to care
Governance framework ‒ Structure ‒ People ‒ Information
Data ‒ Know the data, communicate the data – transparency & ACT on
the data – trusting it ‒ Predicting capacity and demand ‒ Daily monitoring and correction
Escalation Strategies
What we did - Governance
Weekly WoHP meeting
Weekly WoH Advisory Meeting
Weekly Capacity/Workforce Planning Meeting
Weekly Emergency Department WoH Meeting
Weekly LLOS Committee
Twice daily Executive rounding in the Emergency Dept
Twice daily Access Meeting (Inpatient Wards) 5 days - patient flow and staffing
Executive PJB meetings
Executive/ED Huddles
What we did – Data Predictions/Tipping points
Inpatients with LOS > 9 days
ED Accessible Bed Occupancy
The ED Queue – yesterday’s admissions still in ED
Performance Discharge targets by Specialty/Ward
ED tipping points
20
40
60
800
1-J
an
08
-Jan
15
-Jan
22
-Jan
29
-Jan
05
-Feb
12
-Feb
19
-Feb
26
-Feb
05
-Mar
12
-Mar
19
-Mar
26
-Mar
02
-Ap
r
09
-Ap
r
16
-Ap
r
23
-Ap
r
30
-Ap
r
07
-May
14
-May
21
-May
28
-May
04
-Ju
n
11
-Ju
n
18
-Ju
n
25
-Ju
n
02
-Ju
l
09
-Ju
l
16
-Ju
l
23
-Ju
l
30
-Ju
l
06
-Au
g
13
-Au
g
20
-Au
g
27
-Au
g
03
-Sep
10
-Sep
17
-Sep
24
-Sep
01
-Oct
08
-Oct
15
-Oct
22
-Oct
29
-Oct
05
-No
v
12
-No
v
19
-No
v
26
-No
v
03
-De
c
10
-De
c
17
-De
c
24
-De
c
31
-De
c
Nu
mb
er o
f p
atie
nts
wit
h L
OS
> 9
day
s
Inpatients with LOS > 9 days (calculated daily) 2014 v 2015
2014
2015
Threshold 45 pts.
Forecasting (a storm)
What we did – LHD Wide
Quarterly LHD WOH Meetings
Project Management Templates
Weekly – Fortnightly Facility WOH Meetings
Minimum data set
10am Facility Report
Long Weekend Facility plans
Bimonthly LHD Patient Access to Care Meetings
Bed Demand Status
Outcome - LOS
Stroke and Other Cerebrovascular Disorders W/O Catastrophic or Severe CC - Was 6.5 days, now 4.1 days
Other Hip and Femur Procedures W Catastrophic CC -Was 47 days, now 19.14
Seizure W/O Catastrophic or Severe CC Was 4.1 day, now 1.71 days
Estimated Acute Overnight Bed Days saved since September 2014:
5000 bed days
Outcome - Performance
Challenges
Absolute trust & understanding of our key metrics–
knowing our business at depth where we were able to
‘see’ things tipping over that day and action ‘same day’
and normalising this approach
Executive Engagement
Clinician Engagement
Where to from here
Review Demand Escalation Plan and Triggers
Refine/ Review/Develop ED tipping points & escalation processes
Questions
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