Wendy Tomlinson, Melbourne Health Information systems to support patient Flow, UK visit Victorian Traveling Fellowship

1. Wendy Tomlinson, Melbourne HealthInformation systems to support patient Flow, UK visit Victorian Traveling Fellowship

2. Aim • Development of Information system to support patient flow initiatives. Mixture of improvement projects and information systems

3. NHS Trusts visited NHS Trusts visited • West Middlesex University Hospital • Swindon & Marlborough Hospital, • Mayday Healthcare, Croydon • George Eliot, Nuneaton • East & West Sussex Trust (Hastings & Eastbourne)

4. West Middlesex outer west London: 80,000 ED presentations • Reducing LOS • Ward based improvement teams: • Multidisciplinary, clustered specialty teams. • Concentrating on patient discharge variation.(High Impact Change No. 3) • Predicted Discharge dates • Nurse led discharges • Medical day Unit: 13% of medical pts treated as day case.

5. Information system • not at present. • created as needed. • Similar graphs as PFC Victoria. • alternative Performance Measurement report.

6. Swindon & Marlborough NHS Trust • Previous work led through projects with strong senior clinician champion. • Plan to mainstream using operational personal as management lead. • 4 Service improvement streams: • Outpatients • Surgical Waiting list • Increase Day case activity • LOS

7. Swindon & Marlborough NHS Trust • Outpatient scheduling • Increase capacity by: • Decreasing DNA, patient agrees on appointment day. • Reduce outpatient follow ups. Criteria for follow up appointments • Relationship with GP’s for referral to consultants. • ‘One stop’ clinics • Create efficiencies by providing information on clinics in progress viewed on television screens throughout ground level.

8. Information systems • Data analyst who works with facilitator • Produces all data : graphs • Not warehoused or automated as yet.

9. Mayday Healthcare • Improvement projects and examples of systems to support day to day operational management. • Hospital wide system improvement • Strong emphasis on safety / quality • Three principles • engage clinicians in program as leads. • Dedicated project support • Executive buy in. • Discharge redesign with a focus on LOS and Bed management linking to primary and subacute.

10. Mayday cont… • Operations center • Bed manager , clerical, discharge project manger. • Bed calculator ‘excel based’ Intranet view. • Escalation status • Traffic light • Green <92% • Amber <95% • Red >95%

11. Bed calculator ‘white board’

12. Escalation policies….

13. Escalation policies….

14. Escalation policies….

15. Mayday’s discharge management information system • Development of ward view of all patients discharge date. • Supported by action sheet / checklist for each phase. • Green: from admission to 3 days before expected discharge • Amber: < 3 days to discharge • Red: day of discharge. • Linked to allied health referral

16. Mayday’s discharge management information system

17. George Eliot • Information system • Supports both operational and executive needs. • Scorecard with drill down capacity

18. Operational Information

19. Operational Information A&E

20. Operational Information: Patient Flow

21. Operational Information: Outpatient Demand

22. Operational Information: Elective Demand

23. Executive Information: Dashboard scorecards

24. Executive Information: Trend Information

25. East & West Sussex Health Trust • Information system. • Merger of two hospitals: change systems • Operational • ED: real time & summary • Waiting lists inpatient, outpatient, daypatient. • Bed occupancy, predictive & inpatient management. • Drill down

26. East & West Sussex Health Trust Underpinning all • Executive and senior operational usage of system. • Escalation policies • Validation and review summaries

27. Future • UK wide Patient Choice • Earliest appointment • GP assisted.

28. SUMMARY • Commitment at both executive, operation managers, clinical consultant and senior nursing level. • Embedded in operational management • All data > information > ACTION