Denis O’Leary, Dept of Health Victoria: Using Data to Un-Wrap the Surgical Patient Pathway and Improve the Patient Experience

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Health & Medicine

Published on February 28, 2014

Author: informaoz

Source: slideshare.net

Description

Denis O’Leary, Senior Project Manager, Department of Health, Victoria delivered this presentation at the 2014 Hospital Bed Management & Patient Flow Conference, Australia's foremost patient flow improvement meeting, showcasing innovative case studies and pioneering best practice in the nation’s hospitals.

Over 150 hospitals and state and federal departments of health throughout Australia and New Zealand have attended this conference over the past years. For more information about the annual event, please visit the conference website: http://www.healthcareconferences.com.au/bedmanagement14

Using Data to Un-Wrap the Surgical Patient Pathway and Improve the Patient Experience Denis O’Leary Department of Health Victoria

“Having the debate informed by the facts unravels the prejudices”

The Perfect Surgical Pathway - Framework Well Organised Theatre Knowing how we are doing Team Working The Perfect Pathway Booking Preadmission Scheduling Sustainability Changing Culture Creating Certainty

One Common Feature “All sites were collecting data but none were not extracting data in a form meaningful for analysis”

Perhaps the Reason is………………

Surgical Patient Pathway

Elective Surgical Patient Model of Care GP Stage GP Elective Elective Stream A Few Frustrations • • • • Lost paperwork Variation in information Access issues Patients frustrations

Elective Surgical Patient Model of Care GP Stage GP Elective Elective Stream Standard Referral Forms

Elective Surgical Patient Model of Care GP OPD Stage Stage GP Specialist Outpatient Preadmission Elective Elective Stream

Elective Surgical Patient Model of Care GP OPD Stage Stage GP Specialist Outpatient Preadmission Elective Elective Stream Each individual Health Service and sites within Health Services have in place different systems, processes and paper work associated with the implementation of the Elective Surgery Access Policy

Variation Open Access Endoscopy Cat 1 –Outpatients Cat 2/3 - Outpatients Private Patients from Rooms Urology Process Request for referral Health Questionnaire Consent Inconsistent policies Standardised Practices

Frustrations • Lost paperwork • Health questionnaires not matched up • Private patients different process • Endoscopy open access different process • Patients frustrations

This form can range anywhere from 1 to 16 pages depending on the Health Service

Paper Work a Surgical Patient Gets

Pack or diary is to be handed to each patient prior to placement onto the Waiting List. The information pack will be made available for consultant rooms along with the booklet containing the request for referral, consent and health questionnaire

Up to 40% of elective patients who are given a date for surgery have their date changed

Elective Surgical Patient Model of Care GP OPD Stage Stage GP Adm Ward Specialist Outpatient Preadmission Elective Elective Stream

Elective Surgical Patient Model of Care GP OPD Stage Stage GP Adm Ward Specialist Outpatient Preadmission Elective Elective Stream Variation in Time to Surgery

Elective Surgical Patient Model of Care GP OPD Stage Stage GP Adm Ward Specialist Outpatient Preadmission Elective Elective Stream Surgical Stage Elective Sessions

Elective Surgical Patient Model of Care GP OPD Stage Stage GP Adm Ward Specialist Outpatient Surgical Stage Elective Sessions Preadmission Elective Elective Stream On the Day Cancellations can range anywhere from 1 – 16%

Week

Elective Surgical Patient Model of Care GP OPD Stage Stage GP Adm Ward Specialist Outpatient Preadmission Elective Elective Stream Emergency Emerg Stream Triage Decision to Admit Emergency Dept. Surgical Stage Elective Sessions

Elective Surgical Patient Model of Care GP OPD Stage Stage GP Adm Ward Specialist Outpatient Elective Sessions Preadmission Elective Elective Stream Emergency Emerg Stream Triage Decision to Admit Emergency Dept. Surgical Stage Ward

Hip Fracture

Elective Surgical Patient Model of Care GP OPD Stage Stage GP Adm Ward Specialist Outpatient Merged Streams Surgical Stage Elective Sessions Preadmission Elective Elective Stream Emergency Emerg Stream Triage Decision to Admit Emergency Dept. Elective & Emergency Streams Merge Elective & Emergency Sessions Ward Surgical Stage

Data Well Organised Theatre Knowing how we are doing Team Working The Perfect List Booking Scheduling Preadmission Unit of Activity Contact Hours = Anaesthesia Start Time - Surgery End Time One contact hour equivalent to one WIES

Contact Hours per week – Monday to Friday excluding Cardiology & Radiology Specialty (All) Surgery Day (All) Theatre (All) Op. Month (All) Hour Surgery Start (All) Weekly Contact Hours - Jan - 09 - May - 10 Sum of Contact Hours 350.00 300.00 250.00 200.00 150.00 100.00 k 8 W ee k 11 W ee k 14 W ee k 17 W ee k 20 W ee k 23 W ee k 26 W ee k 29 W ee k 32 W ee k 35 W ee k 38 W ee k 41 W ee k 44 W ee k 47 W ee k 50 W ee k 53 W ee k 56 W ee k 59 W ee k 62 W ee k 65 W ee k 68 W ee k 71 W ee k 74 k 5 W ee W ee W ee k 2 50.00 Week Note the increase in the contact hours – 12 week moving average would indicate that this is not a one off

Elective & Emergency Contact Hr Used Contact Hr Used Allocated Hours Emergency in or out of hours Actual Contact Hours -within allocated Elective Hours Allocated Hours 44 Weeks Contact Hours used within Normal Hours % Allocated Contact Hours used Elective Other Gen Surg Orthopaedics Obs& Gynae Plastics Vascular Urology Gastro/C.Rectal ENT 2,530 1,914 1,562 1,408 1,232 1,188 1,452 308 2,162 1,919 1,508 1,178 1,102 1,008 860 231 85.5% 100.3% 96.5% 83.7% 89.4% 84.8% 59.2% 74.9% 1,582 1,349 1,308 909 992 986 219 222 180 36 47 35 20 11 509 1 400 534 153 234 90 11 132 8 63% 70% 84% 65% 81% 83% 15% 72% Miscellaneous 1,056 550 52.1% 516 7 27 12,650 10,518 83.1% 8,083 846 1,589 Speciality Speciality % Elective in % Emergency done Emergency within allocated contact within contact Allocated Hours hours hours Emergency outside Normal Hours - Weekdays Emergency Weekends 18.5% 27.8% 10.1% 19.9% 8.2% 1.1% 15.3% 3.5% 453 429 400 226 106 66 302 597 224 406 91 19 14 2 49% 4.9% 96 80 64% 15.1% 1,790 1,721

WIES Cancellations Waiting List Beds Actual WIES Speciality Elective Emergency Cancellation Blank Wating List Increasing Beds >500 WL Cancellation Rate on DOS High/Low WL Inc/Dec Elective Emergency Other Total Beds -200 150 -100 -20 50 -50 13.8 8.2 5.9 2.1 6.7 3.4 1.6 0.8 15.3 18.0 6.7 2.2 6.6 1.8 9.9 0.6 1.3 0.3 0.3 0.1 0.3 0.0 11.1 30.3 26.5 12.9 4.4 13.6 5.2 22.6 1.4 1.9 2.9 0.1 4.9 44.2 64.0 13.5 121.7 <500 Gen Surg Orthopaedics Obs& Gynae Plastics Vascular Urology Gastro/C.Rectal ENT Speciality 2,214 2,399 932 1,242 726 149 837 180 166 71 56 56 39 10 497 1 479 440 109 9,020 Miscellaneous 2,259 1,460 1,263 940 1,018 1,002 379 220 9,119 1,005 15% 15% 5% 1% 15% 19% 358 607 179 214 310 489 7% 203 44 295 13 22 1,159 0

Points System to Highlight Specialities that should be a Focus

Prior to allocating WIES we need to agree: • emergency surgery undertaken in elective sessions should be minimised •decrease emergency surgery between 22:00 – 06:00 • long wait priority • specialty priority • how do deal with PPP < 500 i.e. Endoscopy & Plastics • decrease tension at weekend

Proposed Elective Surgical Patient Model of Care Elective Elective Stream Emergency Stream Stream Aim: To clearly separate the Preoperative Elective & Emergency patients stream

Proposed Elective Surgical Patient Model of Care Aim: To clearly separate the Preoperative Elective & Emergency patients stream GP OPD Stage Stage Surgical Stage GP Adm Ward Elective Sessions Specialist Outpatient Preadmission Elective Elective Stream Emergency Stream Stream Triage Decision to Admit Emergency Dept. Emergency Sessions • • • • Emer Beds Obstetrics General Surgery Orthopaedic Emergency Surgical Stage

2012 Operating Theatre Schedule Plastic Orthopaedic Obs&Gynae Gen. Surg. Emerg Surg.

Time when work is being Done Mid night Evening PM AM

Plastic Orthopaedic Obs&Gynae Gen. Surg.

The Need for Change Reporting Period: 1/9/2012 – 30/9/2012 Same process undertaken at another Health Service

The Result of Change Reporting Period: 1/10/2012 – 31/10/2012

Start times have improved between 2011 & 2012

Proposed Elective Surgical Patient Model of Care Aim: To clearly separate the Preoperative Elective & Emergency patients stream GP OPD Stage Stage Surgical Stage GP Adm Ward Elective Sessions Specialist Outpatient Home OPD Stage Specialist Post Op. Ward Outpatient Preadmission Elective Elective Stream Emergency Stream Stream Triage Decision to Admit Emergency Dept. Elective & Emergency Elective & Emergency Streams Merge Streams Merge Emergency Sessions • • • • 8 Emer Beds Specialist Obstetrics General Surgery Orthopaedic Emergency Surgical Stage Outpatient Post Op. Ward OPD Stage

Walking Patients & Clinicians through the Pathway Patient Walkthru’s

Walking Patients & Clinicians through the Peninsula Walking the Emergency Cholecystitis Pathway –Pathway Health Patient Walkthru’s

Consumer Participation

Walking the Pathway -

Walking the Pathway -

Hip Fracture Time to Surgery & Length of Stay

Hip Fracture

Hip Fracture Patients

# NOF Before and After July to Dec 2008 July to Dec 2011 BED DAY SAVINGS Potential 700 Actual 520 ALOS 13.2 days 36% longer than 4 exemplar 8.3 days 13% shorter than all HRT MODE LOS 9-11 days 3-5 days % D/C HOME 23% 30% % EMERG READMISSION RATE 5.8% 1.9% (ED) DOSA RATE 71% 75% RELATIVE STAY INDEX 107% 60% AVE AGE 79 76 (not transferred to campuses or other facilities) Hip Fracture project at Austin Health

Note decreasing length of Stay

In Summary

The Perfect Surgical Pathway - Framework Together we can do It Well Organised Theatre Knowing how we are doing Team Working The Perfect Pathway Booking Scheduling Preadmission Sustainability Culture Creating Certainty” “Changing

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