fiona butler, metro south health: improving the entire system

ADDRESSING LONG STAY PATIENTS

IMPROVE ENTIRE SYSTEM Ms Fiona Butler

Nursing Director Patient Flow

Logan Beaudesert Hospital

Sub-Stream Leader, Patient Flow

Ambulatory Care & Hospital Avoidance Stream

Metro South Health Services

OVERVIEW

• Metro South HHS

• Patient flow strategy

• Logan Hospital

• The drivers

• Innovation and redesign

• Long stay and stranded strategy

• Outcomes

• Future vision

Metro South HHS Metro South is the most populated Hospital and Health Service in Queensland. In 2011, there are 991,961 residents in Metro South, equal to 23 per cent of Queensland’s population. By 2016, this is expected to grow to 1,126,304 residents.

Metro South Health covers 3,856 square kilometres from the Brisbane River south to the Redland City Council in the east, and to the Scenic Rim Shire down to the border of New South Wales in the south-west.

Through these facilities we deliver a full suite of specialties from eight clinical streams including:

•Aged Care and Rehabilitation Services

•Cancer Services

•Emergency and Clinical Support Services

•Medicine and Chronic Disease Services

•Mental Health Services

•Patient Flow, Ambulatory Care and Hospital Avoidance

•Surgical Services

•Women’s and Children’s Services

Metro South at a glance 2011-2012 •279,562 weighted activity units •175,886 hospital admissions •242,281 emergency department presentations •10,980 staff members •$1.618 billion expenditure

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ED Presentations 2012/13

Metro North HHS 235,839

Metro South HHS 220,504

Gold Coast HHS 125,731

QLD 26 top Hospital ED Presentations

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MEDAI

Admissions from the Emergency Department

Key focus areas for Logan Hospital

Logan Patient Flow Redesign and

Innovation Program

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Governance

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Communications

Project 2

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Software )

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Highlighted Projects to date

• Full bed platform redesign

• New models of care

• Standardisation

• Visual management tools (PFM)

• DRG LOS

• OBD specifically business areas utilising excusive OBD

• Medical bed management

• Medical LOS changing the utilisation

• Embedding acute bed management

Project Vision

Change Process Bed platform management

• How did we do it?

• Know the strategic direction

• Metric Total Admitted Volume: Day, Week, Month

Bed Platform

Acute/SNAP

All Patients LOS <10 days (Now 7 days)

LOS Stranded above <21 days (Now 15 days)

Frequent attenders

*HBCIS drops off the initial LOS when a patient SNAP’d

To get Truth of Total LOS for an admission we had to develop Krystal report

Change Process How Did We Do It

• Bed Platform

• Know Your Cohort Acute

Non Acute

SNAP

Daily Admitted

• Visual Tools - standardisation Electronic Journey Boards

Patient Flow Manager (PFM)

EDD

• Team Senior Clinicians Medical & Nursing

Senior Allied & Senior Community Interface

• Communication Plan Daily Morning Meeting 0800 advise our position

Daily Multidisciplinary Meeting at the Journey Board 0915

Weekly Complex Multidisciplinary LOS & Stranded Complex Senior Ex Team/Family Meetings

Individual Doctors: Discuss their Cohort, Complex Issues & LOS

Winter strategy

Change Process How Did We Do It?

Average Length of Stay - Medicine

Result

Actual / prior

year Change Change %

Average Length of Stay (ALOS) - Month 3.53 4.20 -0.67 -16.1%

Average Length of Stay (ALOS) - YTD 3.72 4.53 -0.81 -17.8%

ALOS - Medicine

OBD - Medicine Occupied Bed Days - Medicine, excluding Nephrology

Result

Actual/ prior

year Change Change %

Occupied Bed Days (OBD) - Month 2,518 2,987 -469 -15.7%

Occupied Bed Days (OBD) - YTD 18,344 22,491 -4147 -18.4%

Average Daily Occupied Beds - Month 81.2 96.4 -15 -15.7%

Average Daily Occupied Beds - YTD 85.3 104.6 -19 -18.4%

NEAT into the future

• Target 90% NEAT discharge home

• Target 90% NEAT short stay

• Target 50% NEAT inpatient admission

• Interim Care Direct Admit

• CDU/APU

Set Realistic Goals Celebrate Success

Along The Way

“Excellence is never an accident. It is always the result of high intention,

sincere effort, and intelligent execution; it represents the wise choice of

many alternatives - and its choice, not chance, that determines your future”.

Aristotle

Ms Fiona Butler

Nursing Director Patient Flow

Logan Beaudesert Hospital

Sub-Stream Leader, Patient Flow

Ambulatory Care & Hospital Avoidance Stream

Metro South Health Services

Ph: 3299 8065

fiona.butler@health.qld.gov.au