Prepared by Susan Patterson & Darryl Mackender G Shannon, R. Devlin Orange Health Service

1. In Safe Hands Patient as Partners Prepared by Susan Patterson & Darryl MackenderG Shannon, R. DevlinOrange Health Service

2. Aim • Create an integrated care model inclusive of patient and family • Structured format for interdisciplinary bedside rounding • Integrate a shared quality and safety checklist • Focus on comprehensive care / patient-family focussed • Aim for ‘zero’ hospital associated unexpected morbidity • Reduce unexpected deaths / unexpected deterioration

3. Nature & Extent of the Problem • De coupled integration of clinicians • Medical staff rounds • Allied Health patient care • Nursing care delivery • Patient and family non engagement • Focus on key clinical criteria

4. Geographically located clinical team • Team values • Platform of accepted standard of care

5. Structural Resilience 4

6. Planning & Implementing solutions • IMET approval for geographic based teams • Team values and Ward leadership statement • EOC and IPSE • Development of scripted parameters • Bedside patient journey board • In line with Whole of Hospital & NEAT

7. Use this slide for additional for diagrams, tables, graphs or photos 6

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10. Outcomes & Evaluation Patient & Family engagement • “… have to say that the experience was far superior to any hospital experience I have ever had. While I was up there I was so well looked after, and the doctors were doing 'cyber' visits daily, where all the medical staff involved in your recovery come in and had a mini conference with you daily to assess you and make plans/goals.” • “my sisters and I felt mum was safe for the first time……………… there was just something different about this ward…………we knew what was happening”

11. Between The Flags

12. Increasing Efficiency By examining each patient that came through Ward MED-B* and following their progress: This time last year Last financial year Post SIBR (274 days) (2011/12 366 days) (273 days) Number of patients 629 791 811 ↑ (Mean average (69.0) (69.6) (68.3) Hospital Stays 716 915 922 ↑ Hospital Mortality Outcome 5.55% 5.72% 4.88% ↓ Ward Mortality Outcome 4.33% 4.37% 3.68% ↓ (n = deaths) (n = 31) (n = 40) (n = 34) Mean ward length of stay (hours) 103.68 105.36 101.28 ↓ Readmissions back to Orange Health Service within 147 183 148 ↓ 28 days of discharge (20.5%) (20%) (16%) * For Medical Ward B, Orange Health Service, excluding patients flagged as Palliative Care. Selecting patients with ward date of discharge within applicable period.

13. Outcomes

14. Towards the Triple Aim Integration with Enhanced Primary Care & Aged Care 96% Patients Med. Rec. Early ACD discussion & hospital avoidance

15. Future Scope • In Safe Hands Residential School June 2013, March 2014 • Adaptability of the model CEC Deputy Chair Peter Kennedy • “the initiative that you took with the (In Safe Hands) ward in Orange has led the whole process in NSW and will continue to lead it in NSW. “ • “if it hadn't been for the enthusiasm of the Orange team, we wouldn't have had a residential school “