View
25
Download
0
Category
Preview:
DESCRIPTION
A Balanced Set of Clinical Measures and the discussions they have provoked. Bruce George Executive Director (Operations) Quality, Improvement and Patient Safety Capital & Coast DHB. SITUATION (September 2013). Lots and lots of bar graphs Many providers of “data” and “charts” - PowerPoint PPT Presentation
Citation preview
A Balanced Set of Clinical Measures
and the discussions they have provoked
Bruce GeorgeExecutive Director (Operations)
Quality, Improvement and Patient SafetyCapital & Coast DHB
SITUATION (September 2013)• Lots and lots of bar graphs• Many providers of “data” and “charts”• Multiple systems from which data is extracted• Some data extracted and turned into charts without
any internal oversight
0100200300400500600700800900
Num
ber E
vent
s
Month
Events Reported by Month/Year
2009
2010
2011
2012
2013
SITUATION (September 2013)• Inconsistent definitions• Some very complex denominators to “enable”
comparisons• Multiple (connected?) committees where insight from
data or charts is discussed
CURRENT STATE (April 2014)• Standard Balanced Set of Clinical and Quality Measures• Clear definitions of “counts” to drive improvement• Discussion, agreement and action at Clinical
Governance meetings
70
75
80
85
90
95
100
01Ap
r13
15Ap
r13
29Ap
r13
13M
ay13
27M
ay13
10Ju
n13
24Ju
n13
08Ju
l13
22Ju
l13
05A
ug13
19Au
g13
02Se
p13
16S
ep13
30Se
p13
14O
ct13
28O
ct13
11N
ov13
25N
ov13
09D
ec13
23D
ec13
06Ja
n14
20Ja
n14
03Fe
b14
17Fe
b14
03M
ar14
17M
ar14
31M
ar14
14Ap
r14
28Ap
r14
12M
ay14
26M
ay14
09Ju
n14
23Ju
n14
Cou
nt
Week ending
ED 6hr target
Green Amber Red
Value X Center Line Natural Process Limits
CURRENT STATE (April 2014)• Balanced Set includes:
• Patients Discharged Deceased (monthly)• SAC 1 & 2 events (monthly)• Placements to Aged Residential Care (monthly)• ED 6 hour target (weekly)• Hospital Occupancy at 4pm (daily)• All Reported Events (weekly)• Readmissions (monthly)• Complaints (weekly)• Falls (monthly)• Medication / Fluids errors (monthly)• Pressure Sores / Ulcers (monthly)• Peri-operative Harm (quarterly)• Restraints / supportive Devices (monthly)• Safe Staffing (monthly)
INVESTIGATIONS (April 2014)• Investigations into signals
• Readmissions• Safe Staffing• Peri-operative Care
050
100150200250300350400450500
01Ja
n11
01M
ar11
01M
ay11
01Ju
l11
01S
ep11
01N
ov11
01Ja
n12
01M
ar12
01M
ay12
01Ju
l12
01Se
p12
01N
ov12
01Ja
n13
01M
ar13
01M
ay13
01Ju
l13
01S
ep13
01N
ov13
01Ja
n14
01M
ar14
01M
ay14
Cou
nt
Month and Year
CCDHB Readmissions (within 28 days)
Red Amber Green
Value X Center Line Natural Process Limits
Signal – run of 8 above the mean (bad)
INVESTIGATIONS (April 2014)• Investigations into signals
• Readmissions• Safe Staffing• Peri-operative Care
1
5 1
2
2
6
2
2
2
2
2
Mean CL: 350.47
293.69
407.26
270.00
280.00
290.00
300.00
310.00
320.00
330.00
340.00
350.00
360.00
370.00
380.00
390.00
400.00
410.00
Indi
vidu
als:
Val
ue
INVESTIGATIONS (April 2014)• Initial analysis using existing tools
• Unforeseen readmission – new problem• Unforeseen readmission – existing problem
Vasc
ular
Urolo
gyPa
in Mg
mts
Paed
Sur
gPa
ed O
ncolo
gyPa
edea
trics
Orth
opae
dics
Opth
amolo
gyOb
stetri
csNe
uros
urg
Neon
atal
Gyna
ecolo
gyGe
nera
l Sur
gery
ENT
Dent
alCa
rdiot
hora
cicRe
spira
tory
Rena
lAT
ROn
colog
yNe
urolo
gyIm
muno
logy
Olde
r Adu
ltsHa
emot
ology
Gene
ral M
edici
neGa
stro
Endo
Emer
geng
yDS
SCa
rdiol
ogy
50.0%
40.0%
30.0%
20.0%
10.0%
0.0%
Read
mis
sion
Rat
e
Readmit Rate per month by Specialty
• Haematology (24%)
• Oncology (22%)
• Renal (19%)
• General Medicine (14%)
• Older Adults (14%)
• ATR (13%)
• General Surgery (12%)
• Paed Oncology (15%)
24%
22%
13%
19%
14%14% 12%
15%
Avg readmit rate
By Specialty: Monthly Readmit Rates (Jan12 to Jan14)
• Three specialties highlighted as higher rates – understandable as likely to be complex cases
By original visit LOS
• Distributions of LOS resulting in a readmission are in synch with those of all admissions
Readmissions All Admissions
60
45
30
15
02824201612840
2824201612840
60
45
30
15
02824201612840
General Medicine
Days
Perc
ent
General Surgery Haematology
Oncology Renal Medicine
Histogram of LengthOfStay60
45
30
15
02824201612840
2824201612840
60
45
30
15
02824201612840
General Medicine
Days
Perc
ent
General Surgery Haematology
Oncology Renal Medicine
Index LOS
By Clinician: General Medicine
Readmisisons 50 49 48 47 45 42 32 31 29 2391 22 9386 69 60 60 56 56 55Percent 5 5 5 5 4 4 3 3 3 29 2 98 7 6 6 5 5 5
Other
Marion
Leigh
ton
Nicola
Smith
Adel E
kladio
us
Consu
ltant
Emerg
ency
Colin
Feek
Sinead
Donn
elly
Christi
na Ca
meron
Phil ip
pa Sh
irtcliff
e
Kyle P
er rin
Ange
la Sote
riou
Darren
Bowle
s
Luatup
u Ioan
e-Clev
erley
Rupa
l i Shar
ma
Nigel
Raym
ond
Ketna
Parek
h
John M
urray
Wilson
Dorot
hy Din
esh
Peter
Robe
r ts
Elaine
Barr i
ngton-
Ward
120
90
60
30
0
Read
mis
ison
s
IP Admissions 354 354 301 300 287 274 273 219 189 173523 124 111 658510 465 436 433 432 417 398Percent 5 5 4 4 4 4 4 3 3 27 2 2 97 6 6 6 6 6 6
Other
Marion
Leigh
ton
Mark
Weathe
rall
Nicola
Smith
Consu
ltant
Emer g
ency
Colin
Feek
Kyle P
errin
Dar ren
Bowles
Christi
na Ca
meron
Ange
la Sote
riou
Sinead
Donn
el ly
Luatup
u Ioa
ne-Cl
everle
y
Adel E
kladio
us
Rupa
l i Shar
ma
Ketna
Par ek
h
Phil ip
pa Sh
irtcli ff
e
J ohn M
urray
Wil son
Nigel R
aymon
d
Dorot
hy Din
esh
Peter
Robe
rts
Elaine
Barri
ngton-
Ward
600
450
300
150
0
IP A
dmis
sion
s
Readmissions
All Admissions
• Readmit rates largely in synch with the overall admission rates per clinician
Doctors names
Doctors names
By DRG: General Medicine
Count 68 66 63 63 56 56 55 51 51 49183 47 46 44 44 43 1164165141 134103 96 77 69Percent 2 2 2 2 2 2 2 2 2 26 2 2 1 1 1 406 5 5 4 3 3 2Cum % 35 38 40 42 44 46 48 49 51 536 54 56 57 59 60 10012 17 21 25 28 31 33
indexdrg3Othe
rF60X60Q61E75I68B76L64G66K60F73E69T60J64G67G70F76B77L63F74E62F62X62E65
3000
2500
2000
1500
1000
500
0
100
80
60
40
20
0
Coun
t
Perc
ent
Pareto Chart of indexdrg3 by IndexSpecialtyIndexSpecialty = General Medicine
Count 102 96 78 75 74 70 66 62 62 58287 56 54 53 53 1483231164 156 156 125111 103Percent 3 3 2 2 2 2 2 2 2 28 1 1 1 1 396 4 4 4 3 3 3Cum % 38 41 43 45 47 48 50 52 53 558 56 58 59 61 10014 18 22 26 30 33 35
DRG3Othe
rT63I71B76B81D63Q61F76F63G47G70E69K60F74G67E75J64T60L63F62F73E65E62
3500
3000
2500
2000
1500
1000
500
0
100
80
60
40
20
0
Coun
t
Perc
ent
Pareto Chart of DRG3 by HealthSpecialtyNameHealthSpecialtyName = General Medicine
• Readmission DRG’s in synch with total IP admission DRG’s, except X62 & G70
Readmissions All Admissions
Outcomes of Readmissions analysis• Has driven development and deployment of new
charts, insight from data and discussion at Clinical Governance
• No clear single reason for increase but two DRGs to investigate further
• Progress with internal clinical audit• Include Primary Care in investigations
Visibility of data and analysis of signals has driven• Greater use of Central Dashboard• Planning for Operations Centre to optimise flow & safety
CURRENT STATE (April 2014)
CURRENT STATE (April 2014)Visibility of data and analysis of signals has driven• Greater use of Central Dashboard• Planning for Operations Centre to optimise flow & safety
FUTURE STATE (December 2014)• Standard Balanced Set of Clinical and Quality Measures• Clear definitions of “counts” to drive improvement• Discussion, agreement and action at Clinical
Governance meetings
6
6
6
2Mean CL: 94.09
88.77
99.41
78.00
80.00
82.00
84.00
86.00
88.00
90.00
92.00
94.00
96.00
98.00
100.00
Indi
vidu
als:
Val
ue b
y Ph
ase
FUTURE STATE (tbc)• Charts (Statistical Process Control) accessed via intranet
dashboard.• Proactive not reactive - act upon early warning from
signals not trends.• Analysis for improvement (count) and comparison (rate).• Full DHB perspective not just Hospital.• Integrated Operations Centre
Monthly Balanced Scorecard Month & YTD vs targetsMonth YTD Month YTD
Patient Experience Process EfficiencyED Target 94 94 Length of Stay 2.8 3.2Complaints 65 564 Acute vs Elective 74 68
Clinical Measures DOSA 71 73Falls 72 641 Bed utilisation 89 93SAC 1-2 2 88 Theatre utilisation 77 87Reported Events 342 4536 Outpatient DNA 6 7Peri Operative 54 345 Value For MoneyMedication 32 432 Caseweight 6533 6565
Healthy Workplace Acute vs Elective 678 765Staff Turnover 1.3 0.9 FTE costs 45999 654336Engagement 4.3 4.1 Operating Costs 34555 665458
Recommended