Annie Williams, GV Health, Shepparton, Victoria - Redesigning Discharge - “Turning on the Tap”

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Annie Williams, Manager of Innovation and Improvement, GV Health, Shepparton, Victoria delivered the presentation at the 2014 Discharge Planning Conference.

The 2014 Discharge Planning Conference - Assisting health services to adopt an integrated and consumer directed approach to discharge planning.

For more information about the event, please visit: http://bit.ly/dischargeplan14
Download Annie Williams, GV Health, Shepparton, Victoria - Redesigning Discharge - “Turning on the Tap”


  • REDESIGNING DISCHARGE: AN ORGANISATIONAL PERSPECTIVE Annie Williams Manager of Innovation & Improvement GV Health, Victoria
  • Focus of this presentation  Growing the service capacity of the organisation – to meet the demands and expectations of our patients and consumers  The approach to development and implementation of a new patient flow system, utilising a systemic Redesign approach  Reinventing the Wheel – or alternatively, Whose “wheel” can we borrow?
  • Setting the scene...
  • Capacity Demand But ... we were not managing the FLOW! We had a problem....
  • Historical systems and approach ED Acute Wards Discharge Planning Sub Acute Wards Surgical Services Community Services Regional Health Services Lack of organisational vision
  • Our Approach...
  • Summary of the current state... We found: • Variation in the documentation of estimated date of discharge • Variation between wards and areas in ownership of discharge planning • Variation in the format of documentation of discharge planning • Variation in the process of “bed management” between roles, time of the day, day of the week...  Bed Management “on the fly” – minimal capability of predicting or planning for capacity & demand  Need to develop organisational approach to Patient Flow Play Your Part GVH Patient Flow
  • Organisational Background... History of successful project initiatives, including: Surgical Services – Reducing Day of Surgery Cancellations “REDDSoC Project” Medical Ward - Reducing LOS “RESMED Project” Emergency Department – Achieving 4 hr LOS targets for ED pts “2 & 3 in 4 Project” “To build improvements to GVH Patient Flow from a patient and organisational perspective”
  • Our strategy... Executive project sponsors invited all interested operational staff to three workshops • Process issues documented by each group • What were the great ideas? • Patient & Carer Interview feedback on current state of discharge planning
  • Patient & Carer Experience Patient and staff perspective valuable lever for change Alignment with National Standards Tools, training & templates available at: www.archi.net.au Stand alone or project focus
  • Play Your Part GVH Patient Flow They have told me that I can go when I can manage my crutches I am not sure what has to happen next, they will probably send me a letter. I do know that I have to come back in a couple of weeks for something else My only other concern is that I have had three different ways told to me about how to manage my wound when I go home – it would be great if it could be written down or a printed form to make sure I get it right. I am just waiting now for my elderly brother to come and pick me up now [..dressed, bag packed and ready to go at 9.00am in the morning]. I overheard a conversation earlier this morning that they want to get me transferred to my local hospital, but I don’t know when I will go” What our patients and carers told us.... Today I am waiting for a check X-Ray, which may be this afternoon [Note: orderly arrived to transport patient at conclusion of interview @ approx 11.00am].
  • • EDD documented - agreed policy and process • EDD on pt journey boards and electronic entry • Day prior planning for discharge • Transit Lounge capacity quarantined – mixed service with Medical Day Stay [bookings process implemented] • Patient Services [External Access] – collated • Review of discharge times [10am] and targets [updated] • “3 by 10” discharge strategy for each ward • Complex Patient Discharge MDT meeting Discharge Planning Initiatives
  • Patients with Complex Discharge Requirements
  • Patient Flow Our Approach• Review and update escalation policy for GVH • Changes to former “Bed Management” meetings – now multidisciplinary membership reviews Patient Flow electronic status screen [twice daily – 9.30am and 3.30pm] • Increased awareness and appropriate utilisation of Waranga and Tatura [external campus] beds • Increased engagement with patients and carers about their journey and discharge planning • Information available daily on current and predicted future demand
  • Patient Flow Status to inform decision making
  • Organisational Patient Flow
  • 1. Users now have to tick the new patient consent checkbox beneath the mainform. 2. Users can’t submit the referral unless the checkbox is ticked. 3. The followingis displayed once all the required info has been enteredinto the form and the “submit” button is clicked. Users have to click the “OK” button to complete the referral submission. If the user clicks “Cancel” then the referral will not be submitted. The text displayedin the pop-up can be altered as required. Trial of automated referral process •Internal referrals •External referrals Electronic Patient Flow – Electronic Referrals
  • Communications & Marketing  Targeted and tailored to meet needs of the audience  Logos, branding and colour to cut through the “wallpaper of health”  Multiple channels – avoidance of email only  Keeping it fresh and refreshed  Building and supporting relevant computer skills to deliver effective communications  Confidence building in redesign approach
  • Ambulance Arrives Is there a cubicle available ? Pt unloaded into cubicle Yes No Can the pt go to the waiting room? ED ANUM & AO:  Assess which pts can go to EMU  Assess pts for admission  Assess pts to go to waiting room  Ensure ambulance pt transfer to cubicle •Pt transferred to waiting room •Triage Nurse to complete keystroke Yes No Review @ 20 minutes ED ANUM +/ AHHM:  Contact ward that have admissions waiting in ED and expedite Assess which pts can go to EMU  Assess pts for admission Review @ 30 minutes ED Play Your Part GVHPatient Flow
  • “Patient Flow – Play Your Part” Goulburn Valley Health Goulburn Valley Health has identified that to meet increasing demand from the community for services, and in order to provide quality and timely care to all our patients, Discharge before 10am is vital. As well as being beneficial to patients who come through the Emergency Department, early discharge helps elective surgery patients as they can be assured that we are doing everything we can to prevent their surgery being cancelled. This process also streamlines and enables the transfer of patients to and from the ICU, so these specialised resources can be directed to the patients who need them. The creation of new discharge promotional posters, together with changes to current processes, will ensure that staff, patients and their families will be aware of the hospital’s updated discharge policies and timeframes. Discharge information will be displayed in the wards, service areas and public areas such as lifts and waiting areas. This information will encourage patients, their families and carers to take the initiative in talking with staff, and finding out about their discharge details from their treating team, and to confirm discharge plans so that they can arrive on time to take relatives and friends home. Further information? Contact: Penny Whelan – Project Coordinator phone : [O3] 58323 074 or penny.whelan@gvhealth.org.au Play Your Part GVH Patient Flow 3 by 10 Play Your Part GVH Patient Flow Discharges This new initiative, along with other project strategies such as the updated patient journey boards and electronic patient flow systems, will assist the hospital to achieve its discharge targets of:  a minimum of 3 patients per ward discharged before 10am, and  60 % of patient discharges finalised prior to 12noon.  Feedback on performance will be provided to operational managers
  • 0 50 100 150 200 250 300 6-Jan 13-Jan 20-Jan 27-Jan 3-Feb 10-Feb GVH Patient Flow Dashboard ED LOS [ED Presentations compared to ED LOS] Average presentations to ED per day All Patients Average LOS in ED in mins Play Your Part GVH Patient Flow Patient Flow – Rapid Transformation
  • 0 50 100 150 200 250 300 350 400 450 500 6-Jan 13-Jan 20-Jan 27-Jan 3-Feb 10-Feb GVH Patient Flow Dashboard [ED LOS vs. % Admit to Ward] % Admitted to Inpatient Unit within 4 hrs Admitted Patients Average LOS (mins)in ED Elective Surgery recommenced Emergency Surgery + LUSCS Play Your Part GVH Patient Flow EDD 17/12/12 Pt Flow Meetings Pt Flow Dashboard Patient Flow – Rapid Transformation
  • 0 5 10 15 20 25 30 35 40 45 6-Jan 13-Jan 20-Jan 27-Jan 3-Feb 10-Feb GVH Patient Flow Dashboard [ED LOS >12hours] Number of Patients with LOS > 24 hours Number of Patients with LOS > 20 hours Number of Patients with LOS > 12 hours Elective Surgery recommenced Emergency Surgery + LUSCS Play Your Part GVH Patient Flow Patient Flow – Rapid Transformation
  • Our Approach I would like to sincerely thank Informa Australia conferences and the organising committee for the opportunity for their kind invitation to be with you today , and welcome any questions or comments Thankyou
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