the merry-go-round of improvements in patient flow

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:

Play Your Part

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

http://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

email

[email protected]

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GVH Patient Flow

Discharges

mailto:[email protected]

• 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

[email protected]

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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

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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


GVH Patient Flow Dashboard[ED LOS vs. % Admit to Ward]

% Admitted to Inpatient Unit within 4 hrs

Admitted Patients Average LOS (mins)in ED


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


GVH Patient Flow Dashboard[ED LOS >12hours]

Number of Patients with LOS > 24 hours




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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...

the merry-go-round of improvements in patient flow

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