Point of Care Admission Royal Victorian Eye & Ear Hospital Elective Surgery Redesign Conference 12-13th Nov 2012 Mitchell Wilson [email protected]
Jun 30, 2015
Point of Care Admission Royal Victorian Eye & Ear Hospital
Elective Surgery Redesign Conference 12-13th Nov 2012
Mitchell Wilson [email protected]
RVEEH Clinical Services
• 180,000 occasions of service in
outpatient clinics
• 46,000 occasions of service in
Emergency
• 13,000 theatre cases per year
• 50% of public eye including most
Special Eye and 10% of public ENT
services in Victoria
• Theatre access: 80% eye & 20% ENT
workload
RVEEH Surgical Services Day Surgery Department (DSF)– 3 Theatres (Level 3 Peter
Howson Wing) Operating Theatre Suite (OTS) – 5 Theatres (Basement
Peter Howson Wing)
Short Stay Care Centre (SSCC) – 21 recliner bays (Level 4 Peter Howson Wing)
SSCC provides admission and discharge services for patients whose theatre allocation is for the basement OTS
Operating Theatre Suite & SPC
Day Surgery
Short Stay Care Centre
Pre-admission
Medihotel
Ward 8 / Bed Management
Admissions GF
3rd
4th
6th
7th
8th
Basement Entrance
Smorgon Family Wing
RVEEH Surgical Service Location
Peter Howson Wing
• Operates 7am to 7pm Mon – Fri
• Two shifts
o0700 to 1530 – 4 nursing staff
o1030 to 1900 – 3 Nursing Staff
• Approx 6000 admissions annually
RVEEH Short Stay Care Centre
Centralised Admissions
• Crowded admission waiting area – DSF & SSCC
patients in the one area waiting for admission
• There has been both formal and informal patient
complaints about the waiting time and environment
• Delays in prepping patient for theatre & delays in
theatre start time - 6% of incident reports for SSCC
• Staff disquiet - rework in data entry in PiMS and
clerical work taken on by nursing staff
Point of Care Project May - August 2012
Background
• Issues
– Patient & staff disquiet
– Delays in admission and theatre start time
– As part of the enabling works for redevelopment
• The admission process was reviewed and the Point of
Care Project established
Methodology and Staging
• The methodology adopted for the project was
Process Redesign
• Phases:
– Defining the scope of work
– Diagnosing the issues
– Developing appropriate interventions
– Implementation
– Evaluation of outcomes
User Group • Project Executive Sponsor
• Project Manager: Staff from Planning & Innovation
• Project Leads: NUM SSCC & DSF
• NUM Inpatient Ward & Preadmission
• Perioperative Services Manager
• Manager Health Information Services
• Admissions Clerk
• Accounts Manager
Scope
• Inclusions are all admission during the hours of 7am
to 7pm Monday to Friday – core business hours
• Exclusions are admissions that occur out of hours
and weekends – these are managed via the
Emergency Department
Diagnosing the Issues
• The User Group mapped the current admission
process.
• The mapping process provided an:
– understanding of patient flow
– bottlenecks and
– constraints
Developing appropriate interventions
• A future state for the admission process was then
created which mitigated constraints.
• Principles used to guide the development of a future
state focused on changing the way patients waited
and travelled before their surgery.
• The aim was to create a future state which was
patient centred and reduced delays.
Prerequisites for Future State
• Space available on the SSCC and DSF
• Wireless access for data entry and printing of
admission registration form
• PiMS availability on mobile computer units
Trial Period
• One month before Go Live implementation a series of
trial dates were identified.
• Theatre bookings were reviewed to identify lowest
activity for alternating morning and afternoon
sessions
• Staff feed back was recorded immediately after
patients had been admitted and debriefing meetings
discussed resolution for identified issues
• As the trial period progressed and issues were
resolved busier and full days were trialled
Implementation
• Go live was 20th August 2012
• Modifications to the Future State were made for Point
of Care due to limitations of PiMs & patient privacy
issues
o Unable to have 2 patients assigned to the one
patient recliner bay
o Patient demographics required to be checked on
admission, difficult to maintain privacy in a
shared room.
Evaluation
The project realised three key objectives:
• Improved patient experience
• Reduced delays in prepping patients for theatre
• Streamlined patient admission process by removing
rework and delays
Benefits realised as a result of the project are:
• Released space on ground floor for enabling works
• Improved communication between admission and
inpatient staff
Evaluation • No RiskMan entries for delays in patient admission since Go
Live
6:54
6:57
7:00
7:03
7:06
7:09
7:12
20/08/2012
21/08/2012
22/08/2012
23/08/2012
24/08/2012
25/08/2012
26/08/2012
27/08/2012
28/08/2012
29/08/2012
30/08/2012
31/08/2012
1/09/2012
2/09/2012
3/09/2012
4/09/2012
5/09/2012
6/09/2012
7/09/2012
8/09/2012
9/09/2012
10/09/2012
11/09/2012
12/09/2012
13/09/2012
14/09/2012
15/09/2012
16/09/2012
17/09/2012
18/09/2012
Time of first Patients presentation at Nurses Station (SSU Specific)
User group Review
• Composition of the project team
• Communication breakdown in private rooms
• Resistance to change
• Increased patient involvement
• Involve IT earlier
• Limited baseline data to compare with post go-live
data
Patient Feedback
• It is good to go straight to an area where there are
nurses and doctors
• I’ve been here before and this time it was much
better, I had to stand last time as there were not
enough chairs
• The new waiting room is very comfortable and warm
and it is good to have the big TV to watch
• There is plenty of staff around to answer your
questions