REDESIGNING DISCHARGE: AN ORGANISATIONAL PERSPECTIVE Annie Williams Manager of Innovation & Improvement GV Health, Victoria
Aug 22, 2014
REDESIGNING DISCHARGE: AN ORGANISATIONAL PERSPECTIVE
Annie Williams
Manager of Innovation & Improvement
GV Health, Victoria
Focus of this presentation
Growing the service capacity of the organisation – to
meet the demands and expectations of our patients and
consumers
The approach to development and implementation of a
new patient flow system, utilising a systemic Redesign
approach
Reinventing the Wheel – or alternatively,
Whose “wheel” can we borrow?
Setting the scene...
Capacity
Demand
But ...
we were not managing
the FLOW!
We had a problem....
Historical systems and approach
ED
Acute Wards
Discharge
Planning
Sub Acute Wards
Surgical Services
Community Services
Regional Health Services
Lack of organisational
vision
Our Approach...
Summary of the current state...
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
Play Your Part
GVH Patient Flow
Organisational Background...
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”
“To build improvements to
GVH Patient Flow from a
patient and organisational
perspective”
Our strategy...
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
Patient & Carer Experience
Patient and
staff
perspective
valuable lever
for change
Alignment
with
National
Standards
Tools, training & templates available at: www.archi.net.au
Stand
alone or
project
focus
Play Your Part
GVH Patient Flow
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”
What our patients and carers told us....
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].
• 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
Patients with Complex Discharge Requirements
Patient Flow
Our Approach • 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 [external campus] beds
• Increased engagement with patients and carers about
their journey and discharge planning
• Information available daily on current and predicted
future demand
Patient Flow Status to inform decision making
Organisational Patient Flow
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
Electronic Patient Flow – Electronic Referrals
Communications & Marketing Targeted and tailored to meet needs of the audience
Logos, branding and colour to cut through the
“wallpaper of health”
Multiple channels – avoidance of email only
Keeping it fresh and refreshed
Building and supporting relevant computer skills to
deliver effective communications
Confidence building in redesign approach
Ambulance
Arrives
Is there a
cubicle
available
?
Pt unloaded into
cubicle
Yes
No Can the
pt go to
the
waiting
room?
ED ANUM & AO:
Assess which pts can
go to EMU
Assess pts for
admission
Assess pts to go to
waiting room
Ensure ambulance pt
transfer to cubicle
•Pt transferred to
waiting room
•Triage Nurse to
complete keystroke
Yes
No
Review @ 20 minutes
ED ANUM +/ AHHM:
Contact ward that
have admissions
waiting in ED and
expedite
Assess which pts can
go to EMU
Assess pts for
admission
Review @ 30 minutes
ED
Play Your Part
GVH 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
Play Your Part
GVH Patient Flow
3 by
10
Play Your Part
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
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
Play Your Part
GVH Patient Flow
Patient Flow – Rapid Transformation
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
Elective
Surgery
recommenced
Emergency
Surgery
+ LUSCS
Play Your Part
GVH Patient Flow
EDD
17/12/12
Pt Flow
Meetings
Pt Flow
Dashboard
Patient Flow – Rapid Transformation
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
Elective
Surgery
recommenced
Emergency
Surgery
+ LUSCS Play Your Part
GVH Patient Flow
Patient Flow – Rapid Transformation
Our Approach
I would like to sincerely thank
Informa Australia conferences and
the organising committee for the
opportunity for their kind
invitation to be with you today ,
and welcome any questions or
comments
Thankyou