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 main form.

2. Users can’t submit the referral unless the checkbox is ticked.

3. The following is displayed once all the required info has been entered into 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 displayed in 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

GVH Patient 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 DashboardED 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