Jan Randall - CNC

Patient Flow Coordinator

Demand Management Unit

Concord Hospital

23rd June 2015

Transfer of Care Conference: Improving the patient journey across the

continuum of care.

The Patient Journey Everyones Business

Park Royal – Darling Harbour

Sydney : Informa Health Care

Presentation content

My Hospital Concord

The Hospital Journey – Electronic Connection

The Patient Journey

The Patient Flow Portal “Wait for What”

Delays along the way

Community Connection

Concord Repatriation General Hospital

The Hospital Journey

Electronic enhancements:

o Medications – Geriatric wards (7yrs) – Mental

Health complete, OPD and ED are in process, and

all inpatient wards on track - by March 2016

o eMR Emergency medical and nursing notes 2015

o Community Nursing referrals online to SLHD 2012

and SSWLHD 2013

o eMR for Community Nursing referrals July 2015

with the go live for My Aged Care (MAC)

o Online referrals – Specialty Services

The Patient Journey

Whole of Hospital Project February 2015: Discharge Planning – June

2015 “Patient Flow Coordinator”

Patient and Carer/Family centred care

E.g Discharge risk screen on admission

Daily monitoring of the Patient Flow Portal: EDDs and Waiting for

What (WFW) generated by the NUM

Engagement and collaboration with the Multidisciplinary Team

continue (MDT)

2013 to May 2015

0.00%

20.00%

40.00%

60.00%

80.00%

100.00%

120.00%

Ax

is T

itle

EDD Compliance by Month for the years - 2013, 2014, 2015

2015

2014

2013

EDDs by month 2015

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

90.00%

Jan Feb March April May

DCs within 3days EDD

No EDD

3days plus

Patient Flow Portal (1)

Wait for What – Definitions & Timeframes

Consults – Next working day. Except Social Work – 2

working days

Diagnostics / Treatment - AMO Review 2hours, Others

Next working day. Bone scan, MRI, Specific pathology – 2

working days

Discharge Process – Once confirmed – 24 hours. Except

Family Carer Conference – 3 working days

Patient Flow Portal (2)

Wait for What – Definitions & Timeframes

Out of Hospital Referrals – 12 hours for community

packages /nursing. 24 hour Homecare, 72 hours post

ACAT referral, Others - Next working day, TACP / TCU 2

working days, Family looking for RACF 10 working days

Transfer / Transport - 2 hours Inter-ward, 24 hours Inter-

facility accepted and waiting. Waiting for facility to accept -

Next working day. Ambulance NSW 4 hours. Others - Next

working day

0-4 Days

33%

20-49

Days 24%

5-9 Days

21%

15-19

Days 8%

10-14

Days 7%

50-99

Days 4%

Over 99

Days 3%

LOS

0

1

2

3

4

5

6

7

Waiting For What

Count

Avg No Pts

with LOS >24 Hrs &

Clinician Defined EDD

80%

Avg No Pts

with LOS >24 Hrs & No

Clinician Defined EDD

20%

Clinician Defined EDD Compliance - Week Commencing 04/06/15

(EG: 1. 2 wards closed due to norovirus)

1. High demand for single rooms due to MROs, RSV

and TB

2. High demand for Neurology beds (28 inpatients

causing access block on other wards)

3. ICU at full capacity consistently due to high acuity,

however eased now

4. Ongoing management of mental health Pts

Top 5 Patient

Access Issues

Delays to the

Pts Journey

Patients not in their HOME wards (Outlier pts) can lead to

flow obstruction. e.g No discussion between medical and

NUM re: DC plan

Follow up medical team and provide feedback - RE:

Discharge plan

Liaise with the patient and their nominated carer as

required – Community Nursing

Escalate to Senior Nurse Manager for Demand

Management Unit who will escalate further if required

Policy – Delayed Discharges...

Hospital / Patient / Community

Connection

Electronic tools/forms: all require medical signature then

print, fax.

o Medications – complete online then print

o Authority for clinical procedures

o Fax system for Other LHDs (email require encryption

code system to protect patient information – Privacy

Policy)

o Discharge Planning Manual online and updated twice

annually

2015

0

200

400

600

800

1000

1200

1400

1600

1800

Jan Feb March April May

Admissions and Discharges Jan 12th to May 31st 2015

Total - 95% DCs

DCs

Admission

Submitted by Medical Teams 2012 to 2015

0

100

200

300

400

500

600

700

800

900

2012 2013 2014 2015

886

641

829

275

Recommendation for Admission (RFAs) LOS/EDDs 2012 to March 2015

96% compliance

RFAs

Non compliant

Question Time