28 Day Readmission Reduction Project

1. 28 Day Readmission Reduction Project Presenters Mary Hyland, Barwon Wendy Hoey, Rockhampton Michael Finn, Fremantle Fiona Whitecross, Bayside National Mental Health Benchmarking Project 27 November 2008

2. NMHBKPI Project Adult Participant Group  Rockhampton, QLD Fremantle MHS, WA   Blacktown,SWSMHS  St George, SESIMHS  Noarlunga, SA  ACT Health  Bayside Health, VIC  Barwon Health, VIC National Mental Health Benchmarking Project 27 November 2008

3. Background to 28 day readmission reduction project • Sub-project of NMHBKPI project • Team selected from interested NMHBKPI participants • Explore 28 day readmission KPI in more detail and • Develop best practice guidelines for reducing risk of readmission National Mental Health Benchmarking Project 27 November 2008

4. Methodology • Literature Review • Site visits x 4 • Opinion Pieces National Mental Health Benchmarking Project 27 November 2008

5. Usefulness: Potential key performance indicator Must be interpreted with caution The KPI is sensitive to the time period chosen. Factors that influence readmission rates: Age and gender Ethnicity Diagnosis Level of functioning Severity & persistence of symptoms Stress and psychosocial problems Psychiatric services history Other clinical factors Housing Socio-economic status Family/social support Key Findings from the Literature

6. Service based factors: Bed occupancy Length of stay Discharge planning Community follow-up and support Medication issues Strategies for reducing readmission rates Improved discharge planning Improved community follow-up and support Key Findings from the Literature (cont’d)

7. Opinion Piece Framework • Describe service model • General population and client characteristics, • Housing options, • Bed management system, • Discharge processes, • Clinical staff opinion on 28 day readmission rate, • Client opinion on 28 day readmission rate • Carer opinion on 28 day readmission rate • Staffing and skill mix, • 5 major diagnostic categories of admission and readmission. National Mental Health Benchmarking Project 27 November 2008

8. Key Findings from the Opinion Pieces • Contextual Information • Views of the KPI as useful • Factors affecting the readmission rate • Consumer-based factors • Service based factors • Strategies for reducing the readmission rates

9. 28 day readmission reduction project – site visits  Rockhampton, QLD Noarlunga, SA  St George, NSW   The Alfred, VIC National Mental Health Benchmarking Project 27 November 2008

10. Site visits interview framework and question prompts • Business rules and governance • Interface between inpatient and ambulatory services • Consumer flow decisions • Discharge planning • Purpose of admission/readmission • Length of stay, occupancy and readmission • Illness Influences National Mental Health Benchmarking Project 27 November 2008

11. Strengths and Limitations • Strengths: • Combined scientific evidence with expert opinion • Services involved were a broad representation of Australian MHS • Examined several services already moving towards best practice in action • Limitations • “Gaps” in the literature • Subjectivity and bias within opinion pieces • Selection bias in sites chosen

12. Towards 28 day readmission reduction best practice guidelines • Good governance comes with strong clinical leadership • Consumer engagement crucial • Engagement with family and carers • Seamless service delivery • Proactive resource management systems • Systematic discharge planning practices • Active and timely community follow-up National Mental Health Benchmarking Project 27 November 2008