fiona butler, metro south health: improving the entire system
DESCRIPTION
Fiona Butler, Nursing Director - Patient Flow, Metro South Health, Queensland delivered this presentation at the 2014 Hospital Bed Management & Patient Flow Conference, Australia's foremost patient flow improvement meeting, showcasing innovative case studies and pioneering best practice in the nation’s hospitals. Over 150 hospitals and state and federal departments of health throughout Australia and New Zealand have attended this conference over the past years. For more information about the annual event, please visit the conference website: http://www.healthcareconferences.com.au/bedmanagement14TRANSCRIPT
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
Emergency Department Presentations by Month
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-11
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-11
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12
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-12
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2
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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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Project 1
Output
(e.g. New
Building)
Governance
Project
Manager /
Resources
Time Frame
Budget
Risks
Communications
Project 2
Output
(e.g. New
Software )
Governance
Project
Manager /
Resources
Time Frame
Budget
Risks
Communications
Project 1
Output
(e.g. New
Building)
Governance
Project
Manager /
Resources
Time Frame
Budget
Risks
Communications
Project 2
Output
(e.g. New
Software )
Governance
Project
Manager /
Resources
Time Frame
Budget
Risks
Communications
Project 1
Output
(e.g. New
Building)
Governance
Project
Manager /
Resources
Time Frame
Budget
Risks
Communications
Project 2
Output
(e.g. New
Software )
Governance
Project
Manager /
Resources
Time Frame
Budget
Risks
Communications
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