Department of Human Services

Wendy Tomlinson, Melbourne Health

Information systems to support patient Flow, UK visit Victorian Traveling Fellowship

AimAim

• Development of Information system to support patient flow initiatives.

Mixture of improvement projects and information systems

NHS Trusts visitedNHS Trusts visited

NHS Trusts visited– West Middlesex University Hospital– Swindon & Marlborough Hospital,– Mayday Healthcare, Croydon– George Eliot, Nuneaton– East & West Sussex Trust (Hastings &

Eastbourne)

West MiddlesexWest Middlesex

outer west London: 80,000 ED presentations– Reducing LOS

• Ward based improvement teams:– Multidisciplinary, clustered specialty teams.– Concentrating on patient discharge variation.(High

Impact Change No. 3)– Predicted Discharge dates– Nurse led discharges

• Medical day Unit: 13% of medical pts treated as day case.

Information systemInformation system

– not at present.– created as needed.– Similar graphs as PFC Victoria.– alternative Performance Measurement

report.

Swindon & Marlborough NHS Swindon & Marlborough NHS TrustTrust

– Previous work led through projects with strong senior clinician champion.

– Plan to mainstream using operational personal as management lead.

– 4 Service improvement streams: – Outpatients– Surgical Waiting list– Increase Day case activity– LOS

Swindon & Marlborough NHS Swindon & Marlborough NHS TrustTrust

– Outpatient scheduling• Increase capacity by:

– Decreasing DNA, patient agrees on appointment day.– Reduce outpatient follow ups. Criteria for follow up

appointments– Relationship with GP’s for referral to consultants.– ‘One stop’ clinics– Create efficiencies by providing information on clinics

in progress viewed on television screens throughout ground level.

Information systemsInformation systems

– Data analyst who works with facilitator• Produces all data : graphs• Not warehoused or automated as yet.

Mayday HealthcareMayday Healthcare

– Improvement projects and examples of systems to support day to day operational management.

– Hospital wide system improvement• Strong emphasis on safety / quality • Three principles

– engage clinicians in program as leads.– Dedicated project support– Executive buy in.

• Discharge redesign with a focus on LOS and Bed management linking to primary and subacute.

Mayday cont…Mayday cont…

– Operations center• Bed manager , clerical, discharge project

manger.• Bed calculator ‘excel based’ Intranet view.• Escalation status

– Traffic light • Green <92%• Amber <95%• Red >95%

Bed calculator ‘white board’Bed calculator ‘white board’Surgical Bed

CapacityMedical Bed

Capacity#N/A #N/A

Patients in A&E Patients with D.T.A No. of electives Urgent

Accepted Urgent

On hold Urgent

CDUMale Female Total#N/A #N/AS/C S/R

#N/A #N/A CCU/CPU Coulsdon 1

Male Female Total#N/A #N/A #N/A

Total bed occupancy

Todays date08/02/2005

B.M. on duty Bleep 145Sara Riding

Time

8:00 #N/A

Hospital Escalation Status

#N/A

TraumaT.C.I

#N/A #N/A

#N/A

Medical/ Elderly care

#N/A

#N/A #N/A

SurgicalExpected discharges

100.0%

Medical

Repatriation

Clinic

HDU request

#N/A

#N/A

#N/A

#N/A

#N/A

#N/A

Delayed discharges

#N/A #N/A

#N/A

#N/A

Number of empty beds

#N/A #N/A

Purley

#N/A

I.C. Bed capacitySurgical

#N/A

Escalation policies….Escalation policies….

08:00 hrs 12:00 hrs 15:00 hrs#N/A #N/A #N/A

Actions at green statusNumber of Medical beds required @

BM to indicate predicted status at 12 and 3pm. To

call subsequent meetings if required

Bm to obtain accurate bed states throughout the day &

to update the Bed Calculator accordingly

Escalation Status available for all staff

to view on the Intranet via Bed

Calculator

At 12 midday Senior Nurses/ Matrons to

contact OPs Centre for Update

A&E co-ordinator to ensure real time info

available.

Return to bed escalation

status

Escalation policies….Escalation policies….

08:00 hrs 12:00 hrs 15:00 hrs#N/A #N/A #N/A

Actions at amber statusNumber of Surgical beds required @

Return to bed escalation

status

BM to bleep Consultants and request review of possible patients for discharge

Senior Nurse/Matron to assist in identification of patients medically fit for

discharge & to consider discharging today

Maybank Staff to ensure that patients arrive in lounge by 10am, to report

back to Ops Centre if unable. BM and Senior Nurses to support

BM to arrange a 2.15pm meeting & to inform Director of Operations & General

Managers For Surgery.

A&E co ordinator to ensure real time info available

A&E co ordinator to inform Surgical Specialties Regis & A&E reg of status &

to request their presence in A&E

BM to put repatriation of Patients from other sites on hold

Bm to carry out physical bed checksSurg Admissions staff to prioritise

urgent/longwaiters. To consider cancellation of elective patients at 2.15

meeting

Discharge Co-ordinator to assist in the utilisation of IC beds

Care Manager to expedite delayed discharges where possible

BM to liase with Transport re: extra capacity if required

Senior Nurses to identify patients awaiting diagnostics prior to discharge & to expediate

CC Matron to prioritise HDU transfers appropriately

Escalation policies….Escalation policies….

08:00 hrs 12:00 hrs 15:00 hrs#N/A #N/A #N/A

Actions at red statusNumber of Medical beds required @

Note: Amber interventions Actioned

BM with support of General Manager for Emergency Care to

page oncall consultants

A&E co-ordinator to inform A&E reg & to

consider suspending See & Treat. To identify

at early stage patients in resus who will require

specialist beds

GP liason Nurse to inform GP's & to request time delay for

admission

BM to schedule 5pm meeting & inform Director of Ops &

on call manager

Matron CC to request senior Cardiology review of patients on

D1/D2 for transfer in order to create further capacity

Director Ops to consider additional capacity in day

surgery. To liase with BM re: booking 2 trained staff if required

Care Manager & discharge co-ordinator to consider emergency

care packages for delayed discharges.

General Manager for Emergency Care to request extra ward

rounds by Consultant teams in order to produce further

discharges

Return to bed escalation

status

Mayday’s discharge Mayday’s discharge management information management information systemsystem

• Development of ward view of all patients discharge date.– Supported by action sheet / checklist for

each phase.• Green: from admission to 3 days before

expected discharge• Amber: < 3 days to discharge• Red: day of discharge.

– Linked to allied health referral

Mayday’s discharge Mayday’s discharge management information management information systemsystem

George EliotGeorge Eliot

– Information system• Supports both operational and executive needs.• Scorecard with drill down capacity

Operational InformationOperational Information

Operational Information A&EOperational Information A&E

Operational Information: Operational Information: Patient FlowPatient Flow

Operational Information: Operational Information: Outpatient DemandOutpatient Demand

Operational Information: Operational Information: Elective DemandElective Demand

Executive Information: Executive Information: Dashboard scorecardsDashboard scorecards

Executive Information: Trend Executive Information: Trend InformationInformation

East & West Sussex Health East & West Sussex Health TrustTrust

• Information system. – Merger of two hospitals: change systems

• Operational– ED: real time & summary– Waiting lists inpatient, outpatient,

daypatient.– Bed occupancy, predictive & inpatient

management. • Drill down

East & West Sussex Health East & West Sussex Health TrustTrust

Underpinning all

– Executive and senior operational usage of system.

– Escalation policies– Validation and review summaries

FutureFuture• UK wide

Patient Choice– Earliest appointment– GP assisted.

SUMMARYSUMMARY

– Commitment at both executive, operation managers, clinical consultant and senior nursing level.

– Embedded in operational management

– All data > information > ACTION