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Team Status Reports

Team Status Reports. Melbourne May 2010. Main Hospital Code Name: Antares. Current number of beds at main hospital : 520. Programme Team. Scope and boundaries of project. Acute metro – tertiary hospital (515 m/day beds, 89 same day beds) Incorporating HITH – virtual ward

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Team Status Reports

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  1. Team Status Reports Melbourne May 2010

  2. Main Hospital Code Name:Antares Current number of beds at main hospital :520 Programme Team

  3. Scope and boundaries of project Acute metro – tertiary hospital (515 m/day beds, 89 same day beds) Incorporating HITH – virtual ward + 21 beds rehab ward (off site) Does not include – 36 bed Psych unit onsite The secondary hospital that is part of SCGH group not currently in scope

  4. Report 1 and 3

  5. Data Table for Antares

  6. 765 Long-stay Medical/Surgical Episodes

  7. 24,400 Long-stay Medical/Surgical Bed Days

  8. Data Table for Antares …2

  9. Data Issues • 1. Delayed coding – 9 months behind! • 2. Lack of FTE/Clinical resource to interpret data and provide reports in a • timely manner. • Competition of priority – urgent, mandatory vs important • Quality of data • Sources of data – ailing TOPAS system, CAPLAN, other packages conflict (ie. Several reports on same patient group do not agree)

  10. The Impact on the Patient- Case Study • A long story.. • 79 yo with seizures/AF tr under Neuro, has been on dex for 4/7 • Prev CT head (07/09) frontal meningioma ~ adm under Neurosurg • Physical aggression – IV Midaz/ Haliperidol to settle • D4 - NOT FOR SURGERY • D7 – still aggressive. S/w r/v – children suggesting sale of fam home – placement of parents • D8 Psych r/v • D10 –Fam meeting – concerned about acute change in personality, not eating • D12 Anaesthetic r/v – currently not fit for surgery -likely to need ICU post op • D14 – much better team r/v for d/c

  11. D15 – Gen Med r/v re AF – suggest Cardiology r/v S/w r/v – discussed social issues, provided RCF info. Cardiology r/v re optimising AF pre op. D16 s/by psych D19 limited compliance with therapies, resistive to care, min oral intake. Waiting for dip thal results D20 – not for surgery 2* complications – fam meeting – care options limited, not suitable for rehab, fam state can’t be managed at home – for DRAC referral. D21 S/by DRAC – for TCP D26 MET call – sepsis Gen Med r/v req - ?take over care…. D30 – BP 210/109, sats 80% on r/a CRP 510 – DDX pneumonia, UTI , P.E. CTPA req D31,32,33 – 0400hrs s/by ND3 for↓u/o -blocked IDC, IV hyd D34 commenced on heparin/ IVAb’s cont. Pleural effusion not improving D35 for PICC line D36 r/v by RMO – INR 12.3, APPT 225 (INR 2.4, APPT 25.6 12 hrs later) D38 diarrhoea persists K+3 - ?needs supp. D40 –failed TOV s/by Cont CNC

  12. Diagnosis Status

  13. Issues and Observations about process to date Issues/Observations Late start Good acceptance by N/staff on wards Executive focus on long stay but compromised by lack of resources Not recognised as a problem – however, met with defensiveness in relation to established programs/processes

  14. Provisional Top 10 Diagnoses • 1. Lack of coded data • 2. Failure to see it as a problem • 3. Late start – rushed introduction • 4. Resource issues • 5. Communication • 6. Focus on volume/short stay • Current focus on 4hr rule – not linking this, seeing it as competition in resources

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