influencing demand – altering preload for canterbury eds dr greg hamilton planning and funding
TRANSCRIPT
Influencing Demand – Altering Preload for Canterbury EDs
Dr Greg HamiltonPlanning and Funding
The Problem
• Longer stays driven by three factors
• Need system-wide solutions
Pre-loadcommunity activities to
reduce demand
Contractilityeffective functioning of
ED
After-loadservices to accept people from ED –
hospital and community
Outcomes logic - Pre-load
Data Driven Response – Weekly Dashboard
Patients arriving at ED
ED attendances
ED admission rate
111 calls transported to ED
Managing Acute Demand
• Supported Discharge and CREST• After Hours and Nurse led telephone triage• Acute Demand Management Services
Opportunity for People to Stay Home
755
755 clients so
far2,600
Capacity to manage 2,600 pa
CREST
17% 17% decline in rest home bed days over 2 years
18,000 18,000 acute admissions managed in the community
Ambulance diversion to primary care as required
CREST Activity
Nurse led telephone triage
Acute Demand Management Services (ADMS)
• Community-based health services to support patients who can be safely managed in the community
• Applied during an acute medical episode (up to 5 days)
• When a hospital presentation would otherwise be imminent
• Commenced in 2000 within urban Christchurch to support extend patient care
Where we have been?
• In 2000, ADMS commenced within urban Christchurch to support Pegasus practices to extend patient care
• Since October 2007 services expanded to all Canterbury patients from Kaikoura to Ashburton
• Engagement of general practice
ADMS: a collaborative approach
• Acute community nursing services• Community observation services• Timely supported discharge liaison service (hospital-
based)• Service coordination• Packages of Care (POC) – general practice• Rapid diagnostics: radiology and lab services• Consumables• 5 hours/1000 patients (post quake)
Who refers to ADMS?
• Any health professional can refer a patient into ADMS who would otherwise need assessment and/or treatment within Secondary Care– GP– Practice nurse– Community nurse– Midwife– Ambulance paramedic– Hospital physician or staff nurse (ED and inpatient)
Monthly referrals to ADMS
-
200
400
600
800
1,000
1,200
1,400
1,600
1,800
2,000
Nov Dec Jan
Feb
Mar
Apr
May Ju
nJu
lAu
gSe
pO
ctN
ov Dec Jan
Feb
Mar
Apr
May Ju
nJu
lAu
gSe
pO
ctN
ov Dec Jan
Feb
Mar
Apr
May Ju
nJu
lAu
gSe
pO
ctN
ov Dec Jan
Feb
Mar
Apr
May Ju
nJu
lAu
gSe
pO
ctN
ov Dec
Qtr4 Qtr1 Qtr2 Qtr3 Qtr4 Qtr1 Qtr2 Qtr3 Qtr4 Qtr1 Qtr2 Qtr3 Qtr4 Qtr1 Qtr2 Qtr3 Qtr4
2007 2008 2009 2010 2011
ADMS referrals
ADMS referral monitoring
ADMS Referrals – Variation by General Practice
0 2,000 4,000 6,000 8,000 10,000 12,000 0
1
2
3
4
5
6
7
Data
Average
2SD limits
3SD limits
Enrolled Population
Re
ferr
als
as
a P
erc
en
tag
e o
f En
rolle
d P
op
ula
tion
Source: Acute Demand Referrals Nov 2009-Oct 2010
Most Common Referrals to ADMS
Celluliti
s
Chest P
ain
Asthm
a
DVT Path
way
Abdomin
al Pain
Pneumonia
Shortness
of B
r...
Chest In
fect
ion
COPD
Gast
roente
ritis
0
1000
2000
3000
4000
5000
6000
Oct 2007- Jul 2010
The New ChallengeADMS Post 22 February...• Increased breadth of ADMS services available to high needs patients• Population determinants of health (especially housing) mean increased risk
of deterioration and hospital attendance• Proactive management of vulnerable population by general practice – 5
hours/1000 patients• ADMS re-invigorated with General Practice Teams through Pegasus Education
to increase utilisation
22
Change in inpatient discharge rates (2000 – 2009)
Acute Medical Discharges
Canterbury Auckland Combined
Waitemata Auckland Counties0.00
0.20
0.40
0.60
0.80
1.00
1.20
1.40 2006/07
2009/10
NZ
Next Steps
• ADMS Service Level Alliance established - clinical and service leadership to drive service development and improvement– ADMS in residential care– Stronger linkages with St John– Community management for COPD– Service improvement – coordination, problem solving,
trust, acute nursing• Project Chain – coordinated care management