the merry-go-round of improvements in patient flow
DESCRIPTION
Annie Williams, Manager Innovation & Improvement, Goulburn Valley Health delivered this presentation at the 6th annual Hospital Bed Management & Patient Flow conference 2013 in Melbourne. For more information on the annual event, please visit the conference website: http://bit.ly/1f3Pp03TRANSCRIPT
The Merry-Go-Round of
Improvements in Patient Flow
Annie Williams Innovation Manager
Goulburn Valley Health, Shepparton Victoria
• Patient Flow improvements – created
from a patient & organisational perspective
• Rapid transformation with a focus on workplace collaboration
• Multiple process and system changes in a rapidly changing regional hospital environment
Focus of this presentation:
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GVH Patient Flow
Where are we?
We had a problem...
Capacity
Demand
But ...
we were not managing
the FLOW!
History of successful project
initiatives, including:
Surgical Services – Reducing Day of
Surgery Cancellations
“REDDSoC Project”
Medical Ward - Reducing LOS
“RESMED Project”
Emergency Department – Achieving 4 hr
LOS targets for ED pts
“2 & 3 in 4 Project”
Background:
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GVH Patient Flow
Our approach?
• To build improvements to GVH Patient Flow from a patient and organisational perspective
This would require multiple process and system changes
in a rapidly changing regional hospital environment Resources? Senior executive leadership and project sponsorship Significant organisational ownership Limited financial resources available
Project Scope:
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GVH Patient Flow
Our executive project sponsors invited all interested operational staff to three workshops
• Process issues documented by each group
• What were the great ideas?
• Patient & Carer Interview feedback on current state of discharge planning
Our Strategy?
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GVH Patient Flow
What our patients and carers told us....
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GVH Patient Flow
www.archi.net.au
What our patients and carers told us....
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GVH Patient Flow
Today I am waiting for a
check X-Ray, which may be this afternoon [Note: orderly arrived to transport patient at conclusion of interview @ approx 11.00am].
They have told me that I can go
when I can manage my
crutches
I am not sure what has to happen next, they
will probably send me a letter. I do know that I have to come back in a couple of weeks for
something else
My only other concern is that I have had three different ways told to
me about how to manage my wound when I go home – it would be great if it
could be written down or a printed form to
make sure I get it right.
I am just waiting now for my elderly brother to come and pick me up now [..dressed, bag
packed and ready to go at 9.00am in the
morning].
I overheard a conversation earlier this morning that they want to get me transferred to my local hospital, but I don’t know when I will
go”
Summary of the current state...
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GVH Patient Flow
We found: • Variation in the documentation of
estimated date of discharge • Variation between wards and areas in
ownership of discharge planning • Variation in the format of
documentation of discharge planning • Variation in the process of “bed
management” between roles, time of the day, day of the week...
Bed Management “on the fly” – minimal capability of predicting or planning for capacity & demand Need to develop organisational approach to Patient Flow
DISCHARGE PLANNING
PATIENT FLOW
COMMUNICATION & INFORMATION
Issues Themed & Prioritised:
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GVH Patient Flow
• EDD documented - agreed policy and process
• EDD on pt journey boards and electronic entry
• Day prior planning for discharge
• Transit Lounge capacity quarantined – mixed service with Medical Day Stay [bookings process implemented]
• Patient Services [External Access] – collated
• Review of discharge times [10am] and targets [updated]
• “3 by 10” discharge strategy for each ward
• Complex Patient Discharge MDT meeting
Discharge Planning Initiatives
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GVH Patient Flow
3 by
10
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GVH Patient Flow
GVH Patient Flow Project – Play Your Part
To continue to develop improvements in the process of
discharge planning for patients of GV Health, there are
some key timeframes that have been implemented to ensure
that the relevant clinical processes are completed and reviewed
prior to patient discharge
Medical Imaging Requests: by 1000hrs day prior to discharge
Pharmacy Scripts: by 1400hrs day prior to discharge
Pathology Requests: by 1600hrs day prior to discharge
Patient awaiting services to complete discharge can be
allocated to the Transit Lounge or if appropriate can wait in a
patient lounge areas in wards or in the Glasshouse Cafe or
lounge
For further information, please
contact Penny Whelan, Project
Facilitator on 03 58323 074, or
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GVH Patient Flow
Discharges
• Review and update escalation policy for GVH
• Changes to former “Bed Management” meetings – now
multidisciplinary membership reviews Patient Flow
electronic status screen [twice daily – 9.30am and 3.30pm]
• Increased awareness and appropriate utilisation of Waranga and Tatura beds
• Increased engagement with patients and carers about their journey and discharge planning
• Information available daily on current and predicted future demand
Patient Flow
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GVH Patient Flow
Patient Flow Status to inform decision making
• Patient journey boards now a consistent
format throughout the organisation
• Implementation of electronic Patient Flow Report
• Bedside whiteboard trial in Medical Ward
for patient information & communication
Communication & Information
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GVH Patient Flow
Making our technology work for us...
Organisational Flow Patient Flow
“Patient Flow – Play Your Part”Goulburn Valley Health
Goulburn Valley Health has identified that
to meet increasing demand from the
community for services, and in order to
provide quality and timely care to all our
patients, Discharge before 10am is vital.
As well as being beneficial to patients who
come through the Emergency Department,
early discharge helps elective surgery
patients as they can be assured that we
are doing everything we can to prevent
their surgery being cancelled. This process
also streamlines and enables the transfer
of patients to and from the ICU, so these
specialised resources can be directed to
the patients who need them.
The creation of new discharge promotional
posters, together with changes to current
processes, will ensure that staff, patients
and their families will be aware of the
hospital’s updated discharge policies and
timeframes.
Discharge information will be displayed in the
wards, service areas and public areas such
as lifts and waiting areas.
This information will encourage patients, their
families and carers to take the initiative in
talking with staff, and finding out about their
discharge details from their treating team, and
to confirm discharge plans so that they can
arrive on time to take relatives and friends
home.
Further information? Contact:
Penny Whelan – Project Coordinator
phone : [O3] 58323 074
or
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GVH Patient Flow
3 by
10
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GVH Patient Flow
Discharges
This new initiative, along with other project strategies such as the updated patient journey boards and
electronic patient flow systems, will assist the hospital to achieve its discharge targets of:
a minimum of 3 patients per ward discharged before 10am, and
60 % of patient discharges finalised prior to 12noon.
Feedback on performance will be provided to operational managers
GVH Patient Flow Project – Play Your PartGOLD STAR RAPID DISCHARGE PROCESS
The “Gold Star” Rapid Discharge Process is designed to facilitate early
and efficient patient discharge, and to support continuous development of
improvements in the patient flow at GV Health.
Why? Patients and their families tell us that they want surety in the planning and
processes of discharge. They also want options on what time of the day, and the
environment in which they wait for discharge and transport.
Who does this suit? Patients who are in a stable condition, have minimal co-
morbidities and who can be actively involved and engaged in the planning process
How? There are some key timeframes that have been implemented to ensure that
the relevant clinical processes are completed and reviewed prior to patient
discharge
GOLD STAR RAPID DISCHARGE time is 9.00am
Patient awaiting services to complete discharge can be allocated
to the Transit Lounge or if appropriate can wait in a patient
lounge areas in wards or in the Glasshouse Cafe or lounge
For further
information, please
contact Penny
Whelan, Project
Facilitator on 03
58323 074, or email
penny.whelan@gvh
ealth.org.au
Play Your Part
GVH Patient
Flow
3 by
10
Play Your Part
GVH Patient Flow
Discharges
For further
information, please
contact Penny
Whelan, Project
Facilitator on 03
58323 074, or email
penny.whelan@gvh
ealth.org.au
Play Your Part
GVH Patient
Flow
3 by
10
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GVH Patient Flow
Discharges
Patient for Gold Star Discharge Process
Minimal co-morbidities Stable condition Patient involved in process and planning for discharge by 9.00am Transport available & confirmed
Patient Discharge
by 9.00am
Early identification of Gold Star Patient:Elective: information prior to admissionEmergency: information after confirmation of EDD and discharge needs
D – 1 [Day prior to discharge]
Medications Discharge Summary Follow up appointments Stable condition Patient updated Patient able to leave by 9.00am
Patient for discharge?
Yes
No
Discharge Day
Confirmation of discharge Finalise Discharge Summary Patient updated Patient discharge by 9.00am
Ongoing Clinical management +/- Routine or Gold Star Discharge Process Options for waiting :
Glasshouse CafeTransit LoungeWard Waiting Areas
GVH Patient Flow Project – Play Your PartGOLD STAR RAPID DISCHARGE PROCESS
Tools to support increased visibility of process
1. Users now have to tick the new patient consent checkbox beneath the main form.
2. Users can’t submit the referral unless the checkbox is ticked.
3. The following is displayed once all the required info has been entered into the form and the “submit” button is clicked. Users have to click the “OK” button to complete the referral submission. If the user clicks “Cancel” then the referral will not be submitted. The text displayed in the pop-up can be altered as required.
Trial of automated
referral process
•Internal referrals
•External referrals
Patient Flow – How are we tracking?
0
50
100
150
200
250
300
6-Jan 13-Jan 20-Jan 27-Jan 3-Feb 10-Feb
GVH Patient Flow DashboardED LOS
[ED Presentations compared to ED LOS]
Average presentations to ED per day
All Patients Average LOS in ED in mins
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GVH Patient Flow
0
50
100
150
200
250
300
350
400
450
500
6-Jan 13-Jan 20-Jan 27-Jan 3-Feb 10-Feb
GVH Patient Flow Dashboard[ED LOS vs. % Admit to Ward]
% Admitted to Inpatient Unit within 4 hrs
Admitted Patients Average LOS (mins)in ED
Organisational Flow Patient Flow
Elective Surgery
recommenced
Emergency Surgery + LUSCS
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GVH Patient Flow
EDD 17/12/12
Pt Flow Meetings
Pt Flow Dashboard
0
5
10
15
20
25
30
35
40
45
6-Jan 13-Jan 20-Jan 27-Jan 3-Feb 10-Feb
GVH Patient Flow Dashboard[ED LOS >12hours]
Number of Patients with LOS > 24 hours
Number of Patients with LOS > 20 hours
Number of Patients with LOS > 12 hours
Organisational Flow Patient Flow
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GVH Patient Flow
Next Steps...
• Ongoing improvements for discharge planning to continue, with a focus on time of discharge
• Patient Flow Groups meetings focus to the 3pm meeting [day prior]
• Dashboard operational reporting
• Start spreading the good news!
Acknowledgments...