Upload
buikhanh
View
213
Download
0
Embed Size (px)
Citation preview
Presentation title Presenter’s name
Department/Unit/Ward
Service line
Facility/hospital
Date
After-Hours Task Management
using portable devices.
Susan Moller, Mary Fenn, Sal Tuigamala,
Sonia Chanchlani, Julian De Looze,
Metro North ITS, Smart Devices team,
AHNM’s, RMO’s & wards of RBWH and Telstra Health.
On Evenings, Nights, Week-ends & Public Holidays
• Far fewer Doctors
• Ward RMO’s are junior & less experienced
• Possible mal-distribution of workload
• Fewer & limited support services
• No ward NUM’s or CNC’s
• 73% of MERTS occur after-hrs
• ED presentations & IHT’s do not stop
• Complex patients arrive in wards on W/E’s..
• stress/anxiety/burnout/sick leave/PTSD
RBWH - What happens after-hours?
http://qheps.health.qld.gov.au/rbwh/safety/twentyfourseven
Doctors feedback included...
• “Overwhelming workload”
• “Handovers are poorly conducted in general”
• “Important bloods are delayed, people are definitely not seen within acceptable time frames… antibiotics & meds are missed due to time pressure..”
• “You feel awful providing inadequate health care”
• 49% of nurses believed after-hours medical officers were less responsive than during the day? They felt this was related to
• drop in staffing levels,
• competing patient flows
• acuity demands and
• skill mix after-hours.
Sample of A/Hr’s staff comments..
But workloads were invisible!
RBWH – before..• Traditional desktop paging and switchboard service.
• Invisible workloads
• Inefficiencies – Phone tag between Dr’s and ward staff
• No ability to load share
• Limited ability to convey clinical information
Implementation..✓ Commenced in August 2016
✓ Procurement – Contracts and device selection
✓ Configuration of RMO roles, wards, shifts and emails.
✓ Extensive testing of devices, emails, Wi-Fi coverage
✓ Phase 1. Feb 2017– 9 wards and 6 Medical roles Go-Live
✓ Phase 2. July 2017 – to 20 wards and 10 Medical roles
Phase 3. 21st Aug 2017 – Mat/Gynae wards and O&G RMO’s.
Phase 4. 28th Aug 2017 – Mental Health services join.
The iPad storage • Within a ‘Doctors only’ area
• Keypad access
• Infection control covers
• Checked daily by AO
• ‘Feedback & Comments’ book
Week One..?
• Scrolling of screen - resolved
• Personal iPhone access – allowed
• Weekend to weekday issue – resolved
• Repeat logins, long passwords - resolved
• Configuration & routing of Med A emails - resolved
• Readmission error with tasks reappearing - resolved
• RMO’s - some wards are paging & others on are iPad – resolved
• Onsite support – for first 7 evenings/nights – supported
• Wifi access and 4G speed – ongoing
• Biggest problem……Non-pilot wards accessing system !!
Nurses feedback
▪ Transparency – “We can see that the medical staff have received and acknowledged the request”
▪ More clinical detail can be entered compared with Paging
▪ Now we enter ALL tasks – better indication of our ward needs.
▪ Fewer phone calls made trying to verify if task received
▪ No need to know which Dr to call – is assigned automatically.
▪ Easy to use – very straight forward.
▪ “I can book tasks that need to be done at a later time…”
▪ We can add extra text as needed.
Bonus’s – Apps & iBooks
• QHEPS
• The Viewer
• CIMHA
• PACSViewer
• UptoDate
• CKN
• Streamline
• IT HelpDesk
Workloads are now visible… 2,672 tasks for July
0
100
200
300
400
500
600
Medical Intern Medical RMO A Surgical Intern Surgical JHO/SHO Surgical RMO B Surgical RMO C
Number of Tasks by Role for July 2017 (9 wards only)
Sustainability?
✓After-Hours Nurse Managers are first point of call
✓Knowledge Based Articles published in ServiceNow – avail
to the 24/7 QHealth state-wide support service.
✓24/7 Support by Smart Devices team
✓PFM Support Team – for problem sorting in Business Hrs
✓Minimal recurrent costs
✓Vendor support available 24/7… if indicated.
✓Daily AO checks of all devices.
✓2018 – 4 FTE Extra Senior Registrar and 3.4 CNC for A/Hrs
✓Most importantly…End User uptake and satisfaction.
For all hospitals using Patient Flow Manager – this is now available as a Module.
“Task Manager Module”
AcknowledgementsRBWH Patient Flow Unit - Susan Moller, Sal Tuigamala, Anthony Nesbit.
RBWH Safety & Quality - Mary Fenn
Medical staff & CMORE - Sonia Chanchlani, Julian De Looze
Metro North IT - Donna Pettiford, Julie Mossler, Michael Cadogen, Damian James
Healthcare Improvement Unit
Smart Devices Team – Frank Mazzaferro et al.
Telstra Health staff - Sri Rajan
Our Carpenter
The RMO’s and wards that went first!!