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Melinda Pascoe, Principal Policy Analyst - Patient Flow Portal & Damian Miners, Principal Policy Analyst - Patient Flow Portal, NSW Ministry of Health delivered this presentation at the 6th annual Hospital Bed Management & Patient Flow conference 2013 in Melbourne. For more information on the annual event, please visit the conference website: http://bit.ly/1f3Pp03
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Prepared by Melinda Pascoe and Damian Miners
Principal Policy Analysts
System Relationships and Frameworks Branch
NSW Ministry of Health
February 2013
Patient Flow Systems and the Patient Flow Portal
Agenda
Patient Flow Systems
Patient Flow Portal Capability Demonstration
Patient Flow Portal Testimonial
Future Vision
Questions
Navigating patients
through the health
system to prevent
delays
Care Coordination
Navigating patients
through the health
system to prevent
delays
Find it, Fix it, Log it, Escalate it
Transparent
accountable
leadership
Action Orientated
Governance
Transparent
accountable
leadership
Action Orientated Demand &
Capacity Planning
Organising your
service to build
Reduce the Chaos
Variation
smoothing the peaks
and troughs to
distribute the load
No Surprises
Variation
Management
Smoothing the peaks
and troughs to distribute
the load
No Surprises
Demand
Act early to preserve
capacity
Don ’
Demand
Escalation
Act early to
preserve capacity
Don’t wait till its too late
Practice
Promote best
practice to lock in
expected outcomes
Standardised
Practice
Promote best
practice to lock in
expected
outcomes
Express, Model, Reinforce
PATIENT FLOW
SYSTEMS
Quality
Structuring systems
around an expected
outcome
Patient Centric
Quality
Structuring systems
around an expected
outcome
Quality
Structuring systems
around an expected
outcome
Patient Centric
Supporting Policies
• Care Coordination:
Planning from
Admission to Transfer
of Care in NSW Public
Hospitals (PD
2011_015)
• Inter-facility Transfer
Process for Adults
Requiring Specialist
Care (PD 2011_ 031)
• Emergency
Department-Direct
Admission to Inpatient
Wards (PD2009_055)
Approach to Sustainable Change
Capability
Education and Training
Tools
Patient Flow Portal
• National Emergency Access Target (NEAT)
• National Elective Surgery Target (NEST)
• Activity Based Funding (ABF)
Current Context
1700000
1800000
1900000
2000000
2100000
2200000
2300000
2400000
2500000
2600000
2002-03 2003-04 2004-05 2005-06 2006-07 2007-08 2008-09 2010-11 2011-12
Source is NSW Health Annual Report: Total ED Attendances by Year 2002-03 to 2011-12
ED Attendances are increasing in NSW
~ 25% increase in ED
Attendances over 7 years
• Navigating the patient through the journey
• Identify, avoid and reduce and delays
• Involve all relevant staff in planning of care
from admission
• Commence at entry to the service and
progress through to discharge and beyond
Care Coordination
Key Requirements
Transfer of Care Risk Screen
Multidisciplinary Team reviews
Estimated Date of Discharge
Transfer of Care Checklist
Referrals, appointments and follow up
• First step to reduce variation is identify sources in existing practices that create
unnecessary peaks and troughs:
Variation in patient admission or discharge processes
Variation in clinical management
Variation in booking tests or transport
Variation in pathology processing
• Flattening variation within a complex system can lead to smoother outputs and
better outcomes
Variation Management
• Clinical practice
Align with Evidence Based Practice
Early identification of deterioration
• Work process practices
Communication
Referrals
Booking procedures
Escalating delays
Multi disciplinary Team meetings
Utilisation of Transit / Discharge Lounges
Standardised Practice in Action
Presentations are
predictable
Admissions are
predictable
Demand & Capacity Planning
Predictability of Emergency Department Trends
0
1,000
2,000
3,000
4,000
5,000
6,000
7,000
12
/31
/200
7
3/1
0/2
008
5/1
9/2
008
7/2
8/2
008
10
/06
/200
8
12
/15
/200
8
2/2
3/2
009
5/0
4/2
009
7/1
3/2
009
9/2
1/2
009
11
/30
/200
9
2/0
8/2
010
4/1
9/2
010
6/2
8/2
010
To
tal sep
ara
tio
ns f
or
su
rgic
al
pro
ced
ure
s
Emergency vs. non-Emergency Surgical Admissions
emergency other
Emergency
Surgery is
predictable
Predictability of Emergency Trends
Planned
Surgery is
not
Predictive Tool collates
information about
• Patients coming into the
hospital
• Patients exiting
• Capacity to fit demand
Data is used to inform short and
long term capacity planning:
• Calculate tipping points
• Analyse daily demand for each
ward – deliver a plan for required
discharges each day
• Analyse demand over the long
term (e.g. identifying frequent
outliers – does this service require
extra capacity?)
• Manage predicted events –
medical term change / public
holidays / events
Demand & Capacity Planning What is Predictive Tool
used for:
• Historical data
• Current Emergency
Department status
• Expected overnight
Surgical and Medical
booked admissions
• Direct admissions
• Projected discharges /
EDD
Tipping Points
• Emergency demand
• Patient with LOS > 9 days
• Staff shortages
• Patients waiting RACF
• Isolation Patients
• Inpatients waiting for surgery
Demand Escalation
Structure format to escalate response to
demand
•Capacity Action Plan (CAP) A strategic plan
to manage expected demand
•Escalate before the problem occurs
•Short Term Escalation Plan (STEP) for
short term unforseen and immediate
mismatches
•Unpredicted demand managed through
short term solutions
Aim:
• PFS approach is to improve quality of service, therefore quality outcomes need to
drive the evaluation of the systems performance
Quantitative Data
• Falls, medication errors, wrong surgical site, deteriorating patients, etc
Qualitative Data
• Patient Experience, Patient Survey, Co-Design, feedback loop to staff?
• Staff Experience
Quality –
Performance and Quality need to co-exist
• Robust - in structure to lock in process and behavioural change
• Defined with accountabilities at all levels
• Transparent with processes and accountabilities
• Action orientated to make decisions and solve issues
• Maintained and committed – throughout the project and beyond
• Focussed on the patient and staff experience
Governance
Agenda
Patient Flow Systems
Patient Flow Portal Capability Demonstration
Patient Flow Portal Testimonial
Future Vision
Questions
Agenda
Patient Flow Systems
Patient Flow Portal Capability Demonstration
Patient Flow Portal Testimonial
Future Vision
Questions
Agenda
Patient Flow Systems
Patient Flow Portal Capability Demonstration
Patient Flow Portal Testimonial
Future Vision
Questions
2013
• Increased functionality and Redesign
• Working Party of NSW Local Health District Representatives
• Releases planned for May and November
2014
• Tablet application
Future Vision
Select a Waiting for What Reason
Edit a Waiting for What Reason
Default User Preferences
Colour Coded EDD and Ward Profile
Reports Module – Download Reports
Reports Module – Schedule Emailing Reports
Hospital Dashboard Login
Agenda
Patient Flow Systems
Patient Flow Portal Capability Demonstration
Patient Flow Portal Testimonial
Future Vision
Questions
NSW Ministry of Health
Melinda Pascoe
Damian Miners
patientflow@moh.health.nsw.gov.au
Phone: 02 9391 9368
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