TRANSITION  CARE  QUALITY  SERVICE  REVIEW  IN  THE  LODDON  MALLEE  REGION  

CONDUCTING    A  QUALITY  SERVICE  REVIEW  

Sharan  Ermel  Carol  Parker  Collabora@ve  Health  Educa@on  and  Research  Centre  

Introduc@on  

Service  review  

•  Performance  •  Quality  •  Understanding  •  Improvement  •  Con@nua@on  •  Replica@on  

Processes  

•  Nego@a@on  of  evalua@on  plan  

•  Data/evidence  collec@on  &  analysis  

•  Dissemina@on  of  results  •  Inform  decisions  •  Increased  understanding    

Introduc@on  -­‐  con@nued  

Products  of  review  •  Evidence  •  Conclusions  •  Recommenda@ons  

Transi@on  Care  Program  -­‐  Background  Transi@on  Care  Program  (TCP)  •  Joint  Commonwealth/State  funded  na@onal  program  aimed  at:  

•  Minimising  the  number  of  older  people  experiencing  inappropriate  extended  hospital  lengths  of  stay  and/or    

•  Being  prematurely  admiVed  to  residen@al  care  •  Program  for  the  provision  of  flexible  care  under  the  Aged  Care  Act  (1997)  

•  Established  2004-­‐05  •  Na@onally  -­‐  599  flexible  care  places  allocated  

•  In  Victoria    •  2009  -­‐  674  places    →  837  in  2011          

•  Currently:    •  4000  places  na@onally,    •  1000  opera@onal  in  Victoria    

•  364  regional  •  636  metropolitan  based  

•  NOT  a  subs@tute  for  hospital  based  care,  nor  a  subs@tute  for  ongoing  community-­‐based  aged  care.  

Transi@on  Care  Program  –  Background(2)  Bendigo  Health  •  2007  –  10  places  •  2008  –  27  places  •  2010  –  58  places  

•  Bendigo  –  32  places  •  Swan  Hill  –  8  places  •  Echuca  –  10  places  •  Maryborough  –  4  places  •  Kyabram  –  4  places  •  Castlemaine  –  4  places  (Sept)    

•  2013  –  85  places    Mildura  –  July  2010  •  12  places  

 Loddon  Mallee  Region  Popula@on  •  308,  782  (2011)  

•  359,  206  (2021)  

65yrs  +    •  17%  (Victoria  =    14%)  2011  

•  20.8%  (Vic  =    16.7%)  2021  

Need  for  assistance  core  ac@vity:    •  5.8%  (Victoria    5%)  

Residen@al  aged  care  availability:  •  High  level:  37.6(Vic  42.2)  per  1000  eligible  •  Low  level:  49.2  (Vic  45.7%)  per  1000  eligible    

NEGOTIATION  OF  EVALUATION  PLAN    

Ques@ons  to  consider  Key  stakeholders  ?  Availability?    

Funding  ?  

What  evidence  is  required?  

What  measures  are  available?    

Who  is  going  to  conduct  the  review/evalua@on?    

What  is  the  purpose  of  the  evalua@on?    

Project  aim  

•  Review  and  evaluate  Loddon  Mallee  TCP  service  delivery  

•  Formulate  recommenda@ons  to  assist  the  provision  of  best  prac@ce  clinical  care  and  to  best  enable  applicable  Transi@on  Care  standards  to  be  met  

Governance  structure  

  Steering  CommiVee  established  

Project  Objec@ves  1.  Review  and  evaluate:  

–  Exis@ng  client  service  delivery  of  Loddon  Mallee  TCP  services  against:  •  Transi@on  Care  Program  Guidelines  2011  -­‐  Quality  Standards  

•  Contracts  for  the  Provision  of  Transi@on  Care  Program  Services  

• Na@onal  Safety  and  Quality  Health  Service  Standards    2011  –  Regional  administra@ve    &  repor@ng  processes  

2.  Make  recommendaFons  to  assist  TCP  services  

3.  Provide  informaFon  and  advice  to  Bendigo  Health  regarding:    •  Addi@onal  support  and  systems  that  may  be  required  in  its  role  as  

Regional  Manager  of  the  TCP  Service  

4.  Benchmark  

Collec@on  of  evidence  Mixed  method  approach  

•  Interviews  of  key  stakeholders  and  TCP  staff  •  Focus  groups  •  Compliance  with  TCP  Standards,  Bendigo  Health  contract,  

NSQHSS  

•  Compliance  with  repor@ng  and  administra@ve  requirements  

•  Benchmarking  –    Staffing  

–    Occupancy  –    Discharge  des@na@on  and  length  of  stay  

Interviews  and  focus  groups  Open  ended  quesFons  –  exploraFon  of  themes  

•  Service  strengths  and  weaknesses  •  Training  opportuni@es  •  Resource  requirements  •  Staffing  requirements  

•  Impediments  to  service  delivery  

•  ICT  deficits  and  technical  support  requirements  •  Unmet  need  

Evidence  -­‐  standards  

•  Transi@on  Care  Program  Guidelines  2011  -­‐  Quality  Standards  

•  Contracts  for  the  Provision  of  Transi@on  Care  Program  Services  

•  Na@onal  Safety  and  Quality  Health  Service  Standards    2011  

DATA  COLLECTION  AND  ANALYSIS  

Interviews  and  focus  groups  

•  20  interviews  

•  4  focus  groups  •  45  TCP  staff  and  stakeholders  •  12  health  agencies  

Evidence  –  rich  data  

QualitaFve  data  

-­‐  Transcribed  

-­‐  Collated  

-­‐  Themed  

-­‐  Triangula@on  of  results  –  further  evidence  

Results:  interviews  &  focus  groups  

•  Service  strengths  

•  Service  weaknesses  •  Training  opportuni@es  •  Staff  requirements  and  resources  

•  Impediments  to  service  delivery  

Results:  interviews  &  focus  groups  

Service  Strengths  

•  Capacity  •  Communica@ons  

•  Flexibility  •  Partnerships  •  Posi@ve  Program  

•  Team  •  Video  Conferencing  

Results:  interviews  &  focus  groups    Service  Weaknesses  

•  Aged  care  assessment  process  

•  Accessing  educa@on/informa@on  

•  Administra@on  and  support  •  Care  demands  

•  Communica@on  issues  

•  Consistency  •  Costs  •  Facility  constraints  •  Funding  •  Managing  wai@ng  lists  

•  Soqware  limita@ons  

•  Staffing  and  resources  •  TCP  awareness  

Results:  interviews  &  focus  groups  Training  opportuniFes  

•  Needs  assessment  and  analysis  •  Specific  therapist  focussed  forums    

•  Regional  coordinator  forum  •  Mentoring  

•  Allied  Health  Assistant  training  •  U@lisa@on  of  broader  regional  educa@on  opportuni@es  •  Work  shadowing  

•  Short,  sharp  clinical  updates  

Results:  interviews  &  focus  groups  Staff  requirements  and  resources  

•  Back  fill  for  part  @me  TCP  staff.      Risks  include:  •  Con@nuity  of  care  •  Outcomes  

•  Bed  occupancy  •  Repor@ng  requirements  

•  Therapeu@c  staff  mix  and  availability  

•  TCP  manual  •  Equipment  

Results:  interviews  &  focus  groups  Impediments  to  service  delivery  •  Aged  care  assessment  process  

•  Addressing  bed  vacancies  

•  Succession  planning  •  Suitable  and  available  backfill  

•  Repor@ng    

•  Therapeu@c  services  available    •  TCP  awareness  

•  Travel  distance  

•  Bed  based  versus  community  beds  

•  Complex  clients  

•  Service  changes  •  Costs    

•  Part  @me  staff  

•  No  access  to  restora@ve  care  beds  

•  Border  regions  

•  Referrals  •  IT  issues  

•  Bed  blockages  

•  Limited  TCP  places  

Data  Collec@on    -­‐  Quan@ta@ve  (1)  

Data  Collec@on  -­‐  Quan@ta@ve  (2)    Loddon  Mallee  Region  •  Occupancy  •  Readmission  •  Death  •  Discharge  des@na@on  

•  High  care  •  Low  care  •  Home  

•  Average  length  of  stay  •  Quality  ac@vi@es  •  Client  sa@sfac@on  •  Data  •  Mee@ng  aVendance  

PRODUCTS  OF  REVIEW  

•  EVIDENCE  •  CONCLUSIONS  •  RECOMMENDATIONS  

EVIDENCE    -­‐  TCP  Guideline  Compliance    

Australian  Government  Department  of  Health  and  Ageing  ‘TransiFon  

Care  Program  Guidelines  2011  Quality  Standards’  

•  Standard  1    -­‐  Op@mising  independence  and  wellbeing  

•  Standard  2    -­‐  Mul@disciplinary  approach  and  therapy  focused  care  

•  Standard  3    -­‐  Seamless  care  

EVIDENCE    -­‐    NSQHSS  Compliance  (1)  Review  and  evaluaFon  against  the  ten  NaFonal  Safety  and  

Quality  Health  Services  standards  (NSQHSS):  •  Governance  •  Partnering  with  consumers  

•  PrevenFon  and  controlling  healthcare  associated  infecFons  •  Adherence  to  infec@on  control  guidelines  •  Educa@on  to  clients/carers/families  

•  Medica@on  safety  

•  PaFent  idenFficaFon  and  procedure  matching  •  Health  agency  procedures  adhered  to  regarding  iden@fica@on  bands  •  Pre-­‐procedure  iden@fica@on  of  pa@ents  

EVIDENCE    -­‐    NSQHSS  Compliance  (2)  •  Clinical  handover  

•  Key  handover  points  iden@fied  •  Handover  tools:  ISBAR/ISoBAR  •  Referral  processes  

•  Blood  and  blood  products  •  PrevenFng  and  managing  pressure  injuries  

•  Pressure  risk  assessments  

•  Repor@ng  of  injuries  •  Educa@on    

•  Recognising  &  responding  to  clinical  deteriora@on  in  acute  health  care  

•  Preven@ng  falls  and  harm  from  falls  

EVIDENCE  –  Quan@ta@ve    Benchmarking:  Victoria  

Health Area (Bed Numbers) Occupancy

(%)

Length of Stay

(days)

Total for Loddon Mallee Region 89.7 66.3 Total for Loddon Mallee Region without Bendigo 87.7 62.6 Total for Region B (42) 73.2 52.7 Total for Region B without Major Regional Hospital 71.5 Total for Region C (63) 78.3 52.4 Total for Region C without Major Regional Hospital 73.3 Total for Region D (73) 89.7 60 Total for Region D without Major Regional Hospital 82.9

CONCLUSIONS  -­‐  Issues  

•  Par@cipa@on  •  Delayed  assessment  for  eligibility  •  Small  numbers  of  beds  –  part  @me  coordinators  •  Backfill,  service  con@nuity,  bed  occupancy  •  Regional  coordina@on  •  Template  for  standards,  contract  and  NSQHS  

standards  •  Compliance  with  repor@ng  •  Benchmarking  

CONCLUSIONS  -­‐  Overall  

•  Valued  and  valuable  program.  •  Resourcing  issues  need  to  be  considered.    •  Consider  transparency  and  consistency  of  processes.  

RECOMMENDATIONS  (1)  Resource  and  staff  requirements:  1.  Considera@on  of  a  regional  coordinator  2.  TCP  succession  planning  and  backfill  for  leave  resolu@on  

Impediments  to  service  delivery:  1.  Aged  Care  Assessment  process  2.  Alterna@ve  models  of  aged  care  assessment                                                                                          

explora@on  

Training  opportuniFes  Educa@on  and  training  needs  analysis  to  be  undertaken  

ICT  Deficits  and  Technical  Support  Requirements  Standardised    appropriate  and  accessible  TCP  soqware  

RECOMMENDATIONS  (2)  Unmet  needs:  •  Development  of  a  prac@cal,  user  friendly  

TCP  guide/manual  

•  Development  of  consistent  TCP  communica@on                                                              and  repor@ng  processes  

•  Protected  networking  @me  between  TCP  Coordinators  

Review  of  previous  report  and  recommendaFons:  •  Reconsider  TCP  becoming  a  standard  agenda  item  on  regular  

Director  of  Nursing  mee@ngs  

•  Reconsider  invi@ng  Aboriginal  Liaison  Officer  to  provide  VC  educa@on  to  regional  TCPs  

DISSEMINATION  OF  RESULTS  

Audience  Commissioner  of  review  Stakeholders  Informants  Community  User  groups  

Consider:  Risks  Confiden@ality  Ownership  

Method  WriVen    

–  Formal  report  –  Execu@ve  summary  –  publica@on  

Audio  visual    Media    

Review  process  lessons    

Stakeholder  engagement  –  broader  (ACAS  etc)  Balance  

Self  report  –  content  of  responses  

Scope  of  review  

Access  to  data  

References  Department  of  Health  (2012)  Local  government  area  profiles:  Loddon  

Mallee  Region.  Department  of  Health,  Melbourne  Australian  Commission  on  Safety  and  Quality  in  Health  Care  (20110  

Na>onal  Safety  And  Quality  Health  Service  Standards.  ACSQHC.    Australian  Government  Department  of  Health  and  Ageing  (2011)  Transi>on  

Care  Program  Guidelines  2011  Quality  Standards.  Department  of  Health  and  Ageing,  Canberra  

Australian  Government  Department  of  Health  (2008)  Na>onal  evalua>on  of  the  Transi>on  Care  Program.  Australian  Government  Department  of  Health,  Canberra  [online]  hVp://www.health.gov.au/internet/main/publishing.nsf/Content/ageing-­‐transi@on-­‐na@onal-­‐evalua@on-­‐summary.htm    

Australian  Government    (2011)  TCP  Handbook.  [online]  hVp://www.health.gov.au/internet/publica@ons/publishing.nsf/Content/

ageing-­‐transi@on-­‐handbook.htm~ageing-­‐transi@on-­‐handbook02.htm