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Patient Flow Collaborative Learning Session 4

Patient Flow Collaborative Learning Session 4. Breakout session 1 Room M1 and M2 Tony Snell and Rochelle Condon. Improving care for mental health patients. Breakout session 1 Room M1 and M2 9.50 – 10.35. Maria Bubnic and Phyl Halpin Mental Health Branch Department Human Services

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Patient Flow Collaborative Learning Session 4

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  1. Patient Flow Collaborative Learning Session 4 Breakout session 1 Room M1 and M2 Tony Snell and Rochelle Condon

  2. Improving care for mental health patients Breakout session 1Room M1 and M2 9.50 – 10.35 Maria Bubnic and Phyl Halpin Mental Health Branch Department Human Services 4th May, 2005

  3. Improving Care for Mental Health Patients in the ED • Outline: • Describing the issues • Key strategies • Recent initiatives • Questions

  4. Pressures on the system • Increasing number of mental health presentations to EDs • Increasing complexity of mental health presentations • Increasing waits for mental health patients in ED

  5. Contributing factors • Greater awareness of mental health problems & willingness to seek help • Mainstreaming of mental health acute inpatient services with acute health • Greater visibility & accessibility of the ED compared to other parts of the service system • Changes to police practice under section 10 of the Mental Health Act • Co-location of CAT and ECAT services within EDs • Distribution of acute mental health beds • Decrease in availability of alternative service options

  6. Research • Who? How? Why? What happens? • 5 sites: 2 tertiary inner suburban, 2 outer suburban, 1 regional • 5 months: all mental health presentations between April & September 2004 • Retrospective medical file review immediately post presentation • Telephone follow up of a random sample post presentation

  7. ‘Mental Health Presentation’ A primary diagnosis of: • mental illness • substance abuse • crisis • injury assessed as involving ‘intentional self harm’ Assigned by the ED clinician

  8. Research Findings (1) • 36% actively managed by mental health services • 41% had prior contact with mental health services • 26% had been admitted to a mental health ward in the previous 12 months and of these 42% required admission at the current presentation

  9. Research Findings (2) • People who chose to come to ED themselves • Most considered alternatives but 54% of alternatives unavailable as people were seeking help in the evening. • When alternatives were available: • 50% referred onto ED for management • 31% preferred ED to their usual health care provider • 22% were not prepared to wait for their usual health care provider

  10. Forum • ED & mental health staff • Also input from drug & alcohol, ambulance, police, primary care, consumers • Shared view – must do better • DHS role in developing strategy • What health services can do

  11. Key issues • Most MH presentations occur after hours & involve emergency services • >50% are re-presentations to ED and known clients of mental health services • Increasing number of 24 hour+ stays for MH presentations • Layout & amenity of EDs • Provision of care within framework of MHA

  12. Responding to the issues • ‘upstream’ to reduce avoidable or inappropriate use of EDs • ‘within ED’ to improve management in the ED • ‘downstream’ to improve access to beds & continuing community care

  13. Recent initiatives • National Suicide Prevention & Intervention Strategy • NICS Mental Health Emergency Care Interface project • Victorian Hospital Demand Management (HDM) strategy and HARP • Victorian Patient Flow Collaborative – Mental Health CLIF projects

  14. Patient Flow Collaborative – Mental Health CLIF projects

  15. Mental Health CLIF Projects: Areas of focus • Improve patient flow across acute, subacute & mental health care • Link to developments in the patient flow collaborative • Involve consumers

  16. Mental Health CLIF Projects: Funded in 2004-2005 • Western Health – involves Western Hospital ED, South West AMHS & Mid West AMHS • St Vincent’s Health – involves the ED & Mental Health Program • Ballarat Health – led by Grampians Psychiatric Service

  17. Western Health CLIF project: Needs Analysis • Limited availability of mental health services & specialist support • Limited confidence & skill of ED staff to respond • Variable follow-up post-discharge from ED

  18. Western Health CLIF project: Aims & Measures • Decreased ALOS, particularly for ‘admitted’ & ‘recommended’ subgroups • Improved access to appropriate alternatives to ED • Reduction in episodes of aggression, use of seclusion & specialling • Improved on-site specialist advice, intervention & support • Improved ED staff satisfaction & responses to MH presentations

  19. Western Health CLIF project: Project Methodology • Project steering committee & coordinator • Pilot ECAT service model • Map patient pathways & audit practice • Develop guidelines, policies & procedures, & referral protocols • Staff education, training & support to implement changes

  20. Western Health CLIF project: Progress to date • ECAT model being piloted • MH & ED staff training • Collaborative assessments • Weekly team meetings • Negotiations with police & ambulance re: transport of mental health patients • IT enhancements

  21. St Vincent’s Health CLIF project: Needs Analysis • Management of information/IT • Management of communication • Identification/clarification of need • Care of patient/carer/family

  22. St Vincent’s Health CLIF project: Aims & Measures • Identify options for improving patient & information flow in the ED • Use of KPIs from NICS project to align efforts & build on learnings

  23. St Vincent’s Health CLIF project: Project Methodology • Develop IT & triage systems to support coordinated identification of need • Weekly liaison meetings • Staff training • Revise policies & procedures • Undertake feasibility study of short stay facility

  24. St Vincent’s Health CLIF project: Progress to date • Improvements to triage system • Collaborative assessment process & tool developed & to be piloted • Identification of patient streams • Exploring use of MH identified beds in ED to fast track responses

  25. Ballarat Health CLIF project:Needs analysis • Review of feedback/complaints data • Further consultation with stakeholders, to be led by an Advisory Committee • Review of triage data • Process mapping triage responses across inpatient & community interfaces

  26. Ballarat Health CLIF project:Aims & Measures • Improve access to inpatient and community mental health services • Use of KPIs for: • triage responses • timeliness of access to inpatient & community services • referrer, consumer & carer satisfaction

  27. Ballarat Health CLIF project:Project Methodology • Possible target areas to improve pathways to service access: • Policies & procedures, practice guidelines & referral protocols • Coordination of information & communication systems • Staff education & training • Triage redevelopment

  28. Ballarat Health CLIF project:Progress to date • Delayed start - March 2005 • Appointment of project officer • Establishing Advisory Committee • Data analysis commenced

  29. Questions ?

  30. Morning Tea Meet us back here for Intranet theatre booking system at 10.55

  31. Intranet theatre booking system Breakout session 2Room M1 and M2 10.55 – 11.45 Robyn Gillies Consultant Anaesthesetist Emergency Bookings Project Coordinator Clinical Innovations Funded Program Melbourne Health 5th May, 2005

  32. Emergency Theatre Booking System (ETBS) Development of an intranet based emergency booking system for the Operating Suite at the RMH

  33. Intranet based Emergency Theatre booking system • Why? • How? • What did we get? • Did we get what we wanted? • What will we need to develop further?

  34. Intranet based Emergency Theatre booking system • Why? • How? • What did we get? • Did we get what we wanted? • What will we need to develop further?

  35. Why Pursue such a project? • Identification of need

  36. The booking system prior to February 2005 – 1 piece of messy paper! Sometimes these were all that Were filled in Often data not recorded, lost in translation, viewed by only the OR in-charge, etc.

  37. Why Pursue such a project? • Dissatisfaction with the original system • Inadequate data collection and lack of ability to monitor emergency operations • Lack of transparency in the original system • Lack of guidelines for Emergency bookings

  38. What were we missing? • Data: • Timeliness of emergency theatre provision • Times of greatest need for emergency OR • Impact of changes in the emergency access • Reliable data on delays and problems in the system • Guidelines • Any ideas on the rules?

  39. Intranet based Emergency Theatre booking system • Why? • How? • What did we get? • Did we get what we wanted? • What will we need to develop further?

  40. The ETBS:How did we start? • Identification of Personnel – for discussion and implementation • Project outline with approximate budget • Application for funding

  41. The Next Steps • Project Plan • including goals and key areas of focus • Development of Guidelines for Emergency Bookings • OR executive approved • Development of Standardised list of priorities • For each surgical specialty

  42. Goals for the Project • Collect data for continuous quality assurance • Introduce transparency into the theatre booking • Streamline the process of emergency booking • Qualify, quantify and improve the current system organisation for nursing, equipment etc. • Develop a reproducible system for use in other institutions • Optimum utilisation of theatre time

  43. Guidelines for Emergency Bookings This also included discussion on: • Communication Issues • Guidelines for emergency surgery access • when there is no emergency theatre available. • A time critical (life or limb threatening) emergency • Access to emergency theatre • Super-specialty or Complex Surgery • Dispute Resolution

  44. Development of Standardised list of priorities • Surgeons asked to give “optimum time frames” for emergency access • Asked to estimate times for operations • Not entered onto the system but available for comparison with data collected

  45. The Next Steps – Information Technology • Plan for IT development • Recruitment of IT specialist • Purchase of server • Process of development allowing review of critical areas • Hardware Decisions • Mobile hardware for “running the floor”

  46. How is this being Implemented? • 4 Planned Phases • Education • Data Collection • System modification based feedback and quality of data collected • Data Distribution to “close the loop” • 5th Phase • Modifications based on learnings

  47. Intranet based Emergency Theatre booking system • Why? • How? • What did we get? • Did we get what we wanted? • What will we need to develop further?

  48. A visual of the ETBS as it exists in its not quite final form What does it look like??

  49. The Actual System • ETBS • Adding a booking • Priority of booking • Organising the bookings • Confirmation/completion and cancellation of bookings • Data collection

  50. This is the site looked up on internet explorer Users click here to add a booking This is what can be seen on networked computers after a password has been entered

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