Upload
informa-australia
View
818
Download
3
Embed Size (px)
DESCRIPTION
Liz Ganser, Discharge Liaison Officer, Calvary Health Care- ACT delivered this presentation as part of the 4th Annual Reducing Hospital Readmissions & Discharge Planning Conference – A conference to identify, predict and prevent unplanned readmissions and improve discharge processes. IIR Healthcare's inaugural Canadian Reducing Hospital Readmissions & Discharge Planning Conference will take place in Vancouver in late October 2013. Find out more at http://www.healthcareconferences.ca/readmissions/agenda
Citation preview
Redesign of Patient Flow Unit
and Changes to Discharge
Coordinator’s Role at
Calvary Healthcare - ACT
Little Company of Mary Health Care Limited
Liz Ganser
Discharge Liaison Officer
Calvary Health Care -ACT
Overview
Calvary Hospital
2010 AIP (Access Improvement Program-
Every patient in 4 hours Redesign Project)
Highlighted issues that needed to be
changed within the whole organisation –
within each department.
Calvary needed to be current and have a
plan that would continue to meet the needs of
Canberra into the future.
Overview
Overview •Where we were and where we are
•Activity Management Centre
•Patient Flow Unit
•Where we were and where we are
• Discharge Coordinators
•Discharge Liaison Officers
•Post discharge phone calls
Activity Management
Centre • Bed Manager 1xFTE
• After Hours Hospital Manager 4x FTE
• Recruitment Manager 1xFTE– am shift
only
• Admin Assistant 1xFTE
• The ACM was not functioning well –as
services out grew its effectiveness
Patient Flow Unit
• PFU Manager level 4.3 x1 FTE
• Patient Flow Coordinators/After Hours
Hospital Manager level 4.2 x 5.4 FTE
• Discharge Liaison Officers level 2 x 2.5
FTE
• Admin assistants x2 FTE ( 1 f/t and2 p/t)
• The unit is more robust and dynamic
PFU Responsibilities
• DOP – Daily Operational Planning Meeting – This happens at 0900hrs Monday –
Friday
– Head of each department attends including hospital Executive.
– All departments report staff leave planned and unplanned and identify where the shortfall will impede flow
0900 – 0915hrs
Daily - excluding wk/ends & PHs
Post Grad Seminar Room
• Capacity vs Demand balance
• integrated work priorities • identification of key barriers to discharge/patient flow • defined responsibilities
• prioritisation of work
• multidisciplinary attendance
Refer to Patient Flow Unit for further information
Daily Operational Planning (DOP) meeting
PFU responsibilities • Bed management
– Patient Flow
• Transport bookings – Instead of every ward booking individual transport the
system became centralised by e-referral
– More transparent/ streamlined/ data collection tool
– Taxi/ambulance ACT NSW/ PTV / destinations and what for.
• Staffing of hospital – While roster shortfalls are the responsibility of the
CNC the PFU Coordinator would manage the Relief Pool and Casual Pool staff and any overstaffing of units.
PFU responsibilities
• DLO -Discharge Liaison Officers – Manage and direct
– Weekly meeting to discuss issues and redefine role
– Oversee
• daily work flow
• d/c phone calls
• and data entry of result
• Monitoring of Red/Blue Dots- Blocks to discharge – Red/Blue dot on the PJB- patient journey Board
– Indicate that patients are medically stable to be d/c social issues prevent them going home.
Patient Journey Boards
• communication tool
• patient journey ‘snap shot’
• focus for planning discharge from day of admission
• ‘traffic light colours’ indicate time away from discharge
• PJB also indicates problems/delays for patients who are medically cleared for discharge
Discharge Traffic Light System & Patient Journey Board (PBJ)
White
Amber Green Blue Red RED with
BLUE
Dot
>3
days
from
EDD
2-3
days
from
EDD
within
24hrs
of
EDD
Day
of
D/C
overstay
: >EDD
Discharge
delayed for
non-medical
reasons
Start typing
Discharge Traffic Light System & Patient Journey Board (PBJ)
Discharge Traffic Light System & Patient Journey Boards Specific DAILY PRIORITIES: Discharge planning & traffic lights – actions
•AMBER DOT •GREEN DOT •BLUE DOT
Doctor “Discharge Focus Time” Daily Operational Planning (DOP) Meeting
KEY POINTS
Note: hospital policy for patients to discharge by 1000hrs.
Estimated Date of Discharge (EDD) •To be allocated within 24hrs of admission
•Date is estimation ONLY
•May be changed as clinically appropriate
•EDD based on requirement for clinical care – linked to
National Benchmark of average length of stay (ALOS) by DRG
Discharge planning & traffic lights
Handover with CNC /Team Leader at PJB Purpose:
‘handover’ meeting between team members of •Key discharge barriers •key clinical care matters for action •Prioritisation of patient care
DISCHARGE TRAFFIC LIGHT ACTIONS – Medical Officer Responsibilities
AMBER DOT
ACTIONS
•Ensure EDD is correct
•Plan & commence discharge referrals, documentation
•Inform CNC of any expected delays
GREEN DOT
ACTIONS
•As for Amber Dot •Review pharmacy-initiated e-script for accuracy & communicate any problems •Inform CNC IMMEDIATELY of any expected delays
BLUE DOT ACTIONS
•Prioritise any outstanding discharge referrals, documentation •Communicate discharge instructions: Patient
•Inform CNC IMMEDIATELY of any expected delays
Discharge Coordinators
X1 FTE Surgical floor
X1 RTW staff member on 1 medical ward
And occasionally another staff member on
the second medical ward
The job productivity was dependent on the
person holding the role rather than a job
description
Discharge Liaison Officer: Where we were
Discharge Liaison Officer:: Where we were
DISADVANTAGES: No clear referral system – saw everyone on
designated ward
Tendency to d/c plan for every patient simple
and complex
Could be as busy or quiet as the allocated
person wanted to be.
No clear job description/ career advancement
potential
Not in budget!
Discharge Liaison Officer:: Where we are now
Time line:- 2011 • Mid 2011 2x .5 FTE positions advertised
• August 2011 position started in PFU
• Sept/Oct 2011 e-referral for complex
discharges
• November 2011 the .5 FTE increased to
1x FTE and one .5x1 on month by month
basis.
Reasons for a referral – must be complex
1. Is my patient likely to have self-care
problems on discharge?
2. Does my patient live alone or have
accommodation issues?
3. Is my patient likely to have caring
responsibilities for others?
4. Has my patient needed community
services before this admission and will
they need to continue on discharge?
DLO – Role and function
Important things to remember! Everyone admitted is discharged. Where will they go? Home or Nursing home check address details and contact phone numbers and GP Assistance needs to be arranged Cleaning/ cooking /shopping/ complex wound care/transport/case management. Except for wound care Social Worker arranges the rest. Not everyone who lives alone needs help. But if they do make sure it is set up before d/c External services are not mind readers. Everyone who has services in place prior to admission will need these services to be reinstated prior to d/c.
DLO – Role and Function
Discharge Liaison Officer:: Where we are now
Time line:- 2012 • Jan 2012 .5 position extended to 1xFTE
for 6 month
• Jan 2012 started d/c phone calls
• April 2012 started Weekend DLO .5 FTE
• June 2012 1x FTE and 1x.5 advertised
• August 2012 both positions filled.
• We now have 2x FTE and 1 X .5 FTE
Discharge Liaison Officer:: Where we are now
Time line:- 2013
• Feb-March Discharge phone call survey
conducted
• May 2013 a generic
• [email protected] email address
was set up
• Referrals were being ‘lost ‘ in the
DOP/PFU inbox
• Email handovers to personal email
addresses not seen when staff on
unplanned leave
Discharge Liaison Officer:: Where we are now
Time line:- 2013
June 2013 designed a “discharge for
DLO service” sticker which evolved
into an assessment/admission form
which will be filed in Medical Records
once evaluated and approved by forms
committee.
• July 2013 2 year review in progress
CHCACT DLO Handover Template Date: DLO: Wards:
Planned Discharges: Is DLO follow up required? Such as transport bookings or completion
of discharge envelope: Include Patients Ward and Name:
Referrals requiring follow up: Include Patients Name and Ward:
PT LABEL Discharge from DLO Service
o Happy with current level of
services this admission
o Refused DLO service this
admission
o t/f to other facility
………………...
o Other:
……………………………..
o No Post Discharge Phone Call
required
Print Name: …………………………………
Signature: ……………………………………
Designation: ……… Date: __/__/__
Ward: …………………….. Bed No:
………………
Referral Received Date: __/__/__
Review Date: __/__/__
Time: …………………………………………..
Category: ……………………………................
Admission Date and Reason: __/__/__
--------------------------------------------------------------
--------------------------------------------------------------
--------------------------------------------------------------
--------------------------------------------------------------
----------------------------
Patient Contact Details
Address: …………………..................................
………………………………………………….
Suburb: …………………….. Post Code: ....…..
Contact Numbers: (H)……………………
(M)……………….. (W)……….…………..
Next of Kin
Name:
……………….......................................................
Relationship:
………………............................................
Contact Numbers:
(H)…………………………………
(M)………………
(W)……….………………………..
Other:
……………………………………………………
Medical / Surgical History
------------------------------------------------------------
--------------------------------------------------------------
--------------------------------------------------------------
--------------------------------------------------------------
--------------------------------------------------------------
--------------------------------------------------------------
--------------------------------------------------------------
------------------------------------------------
Social History
--------------------------------------------------------------
-------
--------------------------------------------------------------
--------------------------------------------------------------
--------------Current Services -------------------------
--------------------------------------------------------------
--------------------------------------------------------------
-----------------------------------
ACAT Yes / No Date: __/__/__
EPOA Yes / No Date: __/__/__
Advanced Care Directive Date: __/__/__
Internal Referrals (insert dates where applicable):
Physiotherapy __/__/__ Social Worker __/__/__ Dietician __/__/__
Diabetic Ed. __/__/__ Psych Liaison __/__/__ Drug & Alc. __/__/__
Palliative Care __/__/__ Occ. Therapy __/__/__ RACLN __/__/__
External Referrals (insert dates where applicable):
CHI __/__/__ Event Notification Yes / No : Reason:
…………………………………………………..
PHSP __/__/__ CCP __/__/__ Carers ACT __/__/__ Respite
__/__/__
CAPS (Provider) ______________ EACH (Provider)_____________
NHP(Facility)_________________
Discharge Phone Calls
•Why do them?
•Discharge Phone Calls Deliver Quality Care, Higher Patient Satisfaction (Studer 2006)
•They have multiple benefits
•Engage staff
•Opportunity to glean
compliments and complaints
Discharge Phone Calls
Discharge Phone Calls
•Reconfirm discharge instructions, •Reduce patient anxiety, •Reduce complaints and claims, •Reinforce patient perception that excellent care has been provided, and Offer an opportunity for quick service recovery. (Studer 2006)
Discharge Phone Calls
Discharge Phone Calls
Jan 2012 Started –working very closely with
Studer Group coach Michelle Dobe
• initially called everyone we saw no
matter if simple or complex
•Ward/ED staff still learning the e-referral
system and criteria for referral
•Also called Nursing homes but stopped
after 4 months receiving enough
information to improve our d/c process to
all facilities in the ACT and NSW area.
Discharge Phone Calls
Discharge Phone Calls To Complex Patients
In total for February 2013 there were a total of 187 Discharge Phone Calls made by the DLO’s. This equates to 97% of patients seen by the DLOs receiving a discharge phone call
Survey of Post-Discharge Telephone Calls
140 surveys have been sent out with 89 returned (63%). The Survey finished at the end of March.
Highlight of D/C phone calls
•Complaints/comliments about food
•Complaints/compliments about staff
•Hospital in general/specific ward
•Noise level at night
•Extended wait time to be discharged
•Patient readmitted –failed d/c
•Patient died ****
•Recommend that patient represent to
ED – readmitted
d/c phone calls
Since PFU inception
The hospital overall is more transparent
Communication is great
Saved money but centralising the
transport booking system
No longer rely on Agency staff.
Overall LOS has been reduced by 2 days
Sumary
Nursing Workforce Planning (Relief, Agency, Casual)
Thank You