Making a Difference Presenter: Ross Bohm

1. Hospital Presentation HRT1014 – SAFE/Long Stay Patient Melbourne, October 2010 Making a DifferencePresenter: Ross Bohm Hospital Code Name: PORUS

2. KEY PROBLEM(1 slide) In March 2010 DO COO heard BK “no right to steal patient time” Not clear as to the exact problem 1.7% of episodes used 21.7% of bed days (2%-20%) The majority were Medical, Surgical & Rehabilitation monitor the patients continuous stay – including transfers and discharges between service and sites Focus coal face team Excel spread sheet

3. Top 5 diagnoses, as identified by the hospital, as at June 2010. Gaps in Basic care: Bowel Care Infections – UTI, Leur site, LRTI, Surgical Wound Pressure ulcers Gaps in co-ordination of care Intern and external 3. Across health teams communication 4. Gaps in post discharge care plans 5. Delays  waits Diagnosis as at June 2010

4. Presentation to HAC

7. KEY PROBLEM In October 2010 Number of episodes much the same Rehabilitation is slightly higher What we found 49% admitted initially to Medicine 30% admitted initially to Orthopaedics 48% discharged from Rehab 19% discharged from Taupo 40% discharged by 27 days 15% stay > 50 days

8. DATA… Report three Current bed days accrued for Current long stay patients (Medical, Surgical, Rehab & Taupo) >=21 days

9. A combination of factors Clinical Nurse Manager focus on any patients with a length of stay 10+ days Improved access to rehabilitation – minimal waiting Worked with Support Net agencies to improved ongoing care assessment process Cumulative Long Stay Bed Day comparison… (2009/2010 Vs 2008/2009)

10. Cumulative Long Stay Bed Day comparison… (2009/2010 Vs 2008/2009)

11. WHAT WE HAVE DONE Orthopaedic infection audit completed - recommendations being considered Value Stream Mapping - Orthopaedic patient journey Elective component Recommended improvements to pre assessment process Patient Journey Boards Reviewed all boards in current use Only some have expected date of discharge Surgical Services are setting up a project to improve the layout and use of the boards Daily Board Round Rehab – Daily focused 15 minutes MDT group meeting at boards MDT meetings Observed each of the service MDT meetings

12. KEY CHANGES IMPLEMENTED Endorsed use of Patient Journey Boards Professional development units Education Communication Handover Documentation Basic Care standards Discharge planning Falls – pressure area project To review current guidelines and identify issues Developing a clinical process to be piloted in Medical Services for clinical review at 10-14 days.

13. OUTCOMES SO FAR Over the past 7 months: Reduced the LOS Reduced bed block occasion Reduced wait times in ED – 6 hour target – 86% - 95% Raised profile of Long stay and stranded patients across the organisation Rehabilitation – review patient goals daily and update plans PJ to no PJ’s Plan the day plan the stay

14. LESSONS LEARNT(1 SLIDE) The value in a multi speciality team approach Structured activity with weekly round table meetings and weekly ward rounds Profile visibility across the organisation Power of purpose / awareness Discover what reports / information are easily available Have patient focus Right people in the room

15. Since Melbourne Townsville-SOP document Accountable organization, CAP plan HSMR structured case review Organizational metabolic Syndrome Brian Dolan rider elephant Raj Behal case mapping

16. SUSTAINING EFFORTS We will continue to use our modified register Monitor LOS at 14 days and 21 days Pilot a clinical review process at 10-14 days Standardise patient journey boards Continue value streaming mapping

17. WHERE TO Continue to use our modified register Monitor LOS Patient Profile – based on the 88 patient episodes currently in the study The long stay patient is: More like to be 75years of age or over – 59% Transfer between services – 68% 63% have had a previous admission or ED event in the past year