patient flow collaborative learning session 2

Department of Human Services

Patient Flow Collaborative Learning Session 2

Welcome

5TH October 2004

Melbourne Convention Centre


Patient Flow Collaborative Learning Session 2

Dr Jenny Bartlett

Chief Clinical Advisor

5TH October 2004

WelcomeWelcome

• Challenge each other to improve patient care

• Promote team work

• Plan to spread

• Lots to share

• Have fun

Victorian Travelling Fellowship ProgramVictorian Travelling Fellowship Program

• Strategically drawn together to underpin the Patient Flow Collaborative innovations

• Story boards on display highlighting– Who– Where– When– Major learnings

HousekeepingHousekeeping

• Mobile phones to silent/vibrate

• Delegate Packs on tables

• Lunch will be served in the foyer (12:00 – 12:45)

• Rest rooms

• Fire alarms and exits

HousekeepingHousekeeping

• Take your belongings with you during the day – room configuration will change

• Work in partnership – no one knows all the answers

• Support people – Clinical Innovations Team & Planning Group Members (red badges)

Story Board VotingStory Board Voting

• Each team has been given a sticker to allocate to the storyboard they think is the best

• Criteria includes:- Achievements- Team development- Impact for communication

• Deadline for voting is 14:30hrs • Winner announced at the end

of the day

Agenda

9.10 – 10.30 Where are we and what’s next? Lee Martin

10.30 – 10.45 Morning Tea

10.45 – 12.00 First Concurrent Session

Team Presentations

12.00 – 12.45 Lunch

Second Concurrent Session12.45 – 2.00 How to encourage a culture of innovation Cathy Balding and

Mary Mitchelhill

Outpatient department toolkit Veronica Strachan and Kim Moyes

Communication strategies Julian Murphy and Sharon Neal

Advanced project management Ruth Smith and Claire Mackinlay

Managing variation, elective & emergency Lee Martin and Bernadette McDonald and Marcus Kennedy

Agenda2.00 – 2.30 Afternoon tea

2.30 – 3.15 Team planning time

3.15 - 4.30 Healthsmart Anthony Bibby

Update web delay tracker Marcus Kennedy

Paper based delay tracker Peter Wright

4.30 – 4.45 Update Melbourne Health Melbourne Health

Next steps and close Marcus Kennedy

““To change the results, we need To change the results, we need to change the paradigm”to change the paradigm”


Hospital Demand Management Performance

Kathryn CookDirectorMetropolitan Health Service Relations

5 October 2004

Hospital BypassHospital BypassHOSPI TAL BYPASS FROM J UL 2001 TO SEP 2004

0

50

100

150

200

250

300

Months

Occasio

ns o

f B

yp

ass

12 major metro hospitals, plus Sunshine from J ul 2001

Nurse Strike

Ambulance dispute: Data incomplete

Sharp peak in "winter" illness

Percentage of time spent on bypass by hospital September 2004

Patients spending longer Patients spending longer than 24 hours in the EDthan 24 hours in the ED

0

500

1,000

1,500

2,000

2,500

3,000F

Q1

FQ

2

FQ

3

FQ

4

2000/01

2001/02

2002/03

2003/04

Patients spending longer than Patients spending longer than 24 hours in the ED by hospital24 hours in the ED by hospital

0 500 1000 1500 2000 2500

Patients spending longer Patients spending longer than 48 hours in the EDthan 48 hours in the ED

0

50

100

150

200

250

300

350

400F

Q1

FQ

2

FQ

3

FQ

4

2000/01

2001/02

2002/03

2003/04

Patients spending longer than Patients spending longer than 48 hours in the ED by hospital48 hours in the ED by hospital

0 100 200 300 400 500

Mental Health Patients spending Mental Health Patients spending longer than 24 hours in the EDlonger than 24 hours in the ED

0

50

100

150

200

250

300

FQ

1

FQ

2

FQ

3

FQ

4

2000/01

2001/02

2002/03

2003/04

Mental Health Patients spending Mental Health Patients spending longer than 24 hours in the ED by longer than 24 hours in the ED by hospitalhospital

0 50 100 150 200 250 300

Percentage of elective patients Percentage of elective patients postponed before admission grouped by postponed before admission grouped by postponement reason by hospitalpostponement reason by hospital

0% 10% 20% 30% 40% 50%

Clinical

Patient

Hospital

Surgeon

Data for patients admitted in the quarter ending 30 J une 2004

Patient FlowPatient Flow


Where are we and what’s next?

Lee Martin

Collaborative Director

5 October 2004

Resource packResource pack

Orientation Orientation Learning session 1Learning session 1

• Masterclass series

• 12 weeks of rigorous diagnostics

• Whole system overview

• Social networks

• Breaking the myths

Learning session 1Learning session 1

• Formed innovation teams

• Constraint diagnostics

• Started improvements

• Utilisation of the first draft toolkits

• Building on the excellent work done already

• Formed communication plans

Individual constraint areasIndividual constraint areas

•Bed management

•OPD

•LOS

•Elective stream

•Theatres

•Radiology

•Emergency Care

•Sub-acute

Bed Mgt

Sub Acute

Elect LOS

OPD Radiol ED OR

Bed Mgt

Sub Acute

Elect LOS

OPD Radiol ED OR

StickersStickers

Individual constraint areasIndividual constraint areas

OPD

Radiology

ED OR

Bed Mgt

ElectLOS

Sub Acute

VotingVoting

The answer is NO

• disruptive• pointless• vote the right/best way

The answer is YES

• progressive • helpful• moving in right direction

The answer is AMBIGUOUS

• results are mixed• pros and cons• good in parts

The answer is HARD TO DETERMINE• not enough data• not clear, not sure • need to investigate• hard to make sense of

No

Ambiguous

Hard to determine

Yes

From the Collaborative work so far, do you feel you have identified the true constraint areas?

Voting timeVoting time

Organisational viewOrganisational view

Building whole care view

Removing key constraint area

Practiced improvement tools and creating new ones

Building on appreciation in our organisation (Can do this task!)

Starting to look at sustainability?

Sustainability planningSustainability planning

SUSTAINABILITY ASSESSMENT MODEL

I nstructions

Choose an improvement area to focus your assessment on such as improving the legibility of prescriptions. Select the level of each factor that best describes the improvements you are currently undertaking. Add the scores from each factor that you selected. The closer your score is to 100, the better chance of successful sustainability.

Preliminary evidence suggests, a score of 55 or higher offers reason for optimism while a score of 45 or lower suggests reason for concern. This is AS THINGS CURRENTLY STAND.

I t helps to monitor the situation over time because if changes occur in any of these factors the score will change for the better or worse.

CHOOSE THE FACTOR LEVEL THAT COMES CLOSEST TO YOUR SITUATION AND CIRCLE THE SCORE TO THE LEFT OF IT

Factor Score Factor Level 1) Benefits 8.7 Improves efficiency and makes job easier

beyond helping 4.7 Improves efficiency but does not make job easier patients 4.0 Makes jobs easier but does not improve efficiency

0 Neither improves efficiency nor makes jobs easier

9.1 Benefits are immediately obvious, supported by evidence and believed by stakeholders 2) Credibility (to affected

staff) of benefits from 6.3 Benefits are supported by evidence and believed by stakeholders but are not immediately obvious

improved process 3.1 Benefits are supported by evidence but not believed by stakeholders 0 Benefits are neither supported by evidence nor believed by stakeholders

7.0

The process can be adapted to organisational changes and there is a system for continually improving the process

3) Adaptability of 3.4

Process can be adapted to organisational changes but there is no system for continually improving the process

improved process 2.4

There is a system for continually improving the process but it cannot adapt to organisational changes

0

Process cannot adapt to organisational changes and there is no system for continually improving the process

11.5

Staff have been involved from the beginning and adequately trained to sustain the improved process

4) Staff involvement and training to sustain 4.9

Staff have been involved from the beginning but not adequately trained to sustain the improved process

the process 6.3

Staff have been adequately trained to sustain the new process but have not been involved from the beginning

0

Staff have neither been involved from the beginning nor adequately trained to sustain the improved process

11 Staff feel empowered and believe the improvement will be sustained. 5) Staff attitudes 5.1 Staff feel empowered, but don’t believe the improvement will be sustained.

toward sustaining the 5.1 Staff believe the improvement will be sustained but don’t feel empowered improved process 0 Staff don’t believe the improvement will be sustained and don’t feel empowered

Sustainability assessment toolkit

Next challengeNext challengeOnce removed major constraint, what next?

1. Remove constraint 2. Understand and manage capacity and demand

3. Manage flow with pull systems (no delays in process)

4. Build new ways to treat patients

5. Develop your modernisation plan

No

Ambiguous

Hard to determine

Yes

Would establishing capacity and demand management with scheduling systems help to build effective organisational flow?

Voting timeVoting time

Analysing variation and manage Analysing variation and manage capacity and demandcapacity and demand

Ward

Speciality

Divisional

Organisational

Emergency AdmissionsEmergency Admissions

Range between the process limits is 20-55

Average is 38

Elective AdmissionsElective Admissions


Average is 27

Understanding EL/EM VariationUnderstanding EL/EM Variation

Which has the greater variation… Emergency or Elective

AdmissionsAdmissions


Average is 57

DischargesDischarges


Average is 56

Understanding Adm/Disch VariationUnderstanding Adm/Disch Variation

Which has the greater variation… Admissions or Discharges

Variation in Inpatient ProcessesVariation in Inpatient Processes

Admission via ED Day range Mean

Cardiology 3 5 4

Medicine 8 10 9

Surgery 7 10 8

Neuroscience 2 6 4

Total beds needed for ED admits in 24 hrs

20 31 25

Predicting Emergency Admissions Predicting Emergency Admissions

Variation in Admissions and Variation in Admissions and Discharges/DeathsDischarges/Deaths

Variation in Bed UsageVariation in Bed Usage

Murphy’s lawMurphy’s law

Problem will occur at the worst point, the worst time and when you least expect it.

Simple pull system for Simple pull system for managing inpatient delaysmanaging inpatient delays

Patient ID Delay (refer Action Plan) Action taken1005723 Discharge paperwork not prepared Registrar paged 1140hrs

Will do d/c summary and script

Delay Action Plan

Discharge paperwork not prepared Complete discharge plan, contact SMO

Waiting results Contact pharmacy on ext 435Contact radiology on ext 871Contact pharmacy on ext 771

Waiting transport Request relatives/friends transportBook taxiBook ambulance

Front page

Backpage

Hot topic callHot topic call

Managing capacity and demandManaging capacity and demand

ED Capacity and DemandRemove % through Chronic Disease Management

ElectiveIncrease day surgery

Length of stayDecrease repeat tests, examinationsEliminate not

ready for care, cancellations on day of admission

Remove delays in length of stay

NHS: NHS: 10 High Impact Changes10 High Impact Changes

Further information

??

Right now, what is the one service improvement program you would choose to assist with flow

constraints?

??

Right now, what is the one service improvement program you would choose to assist with flow

constraints?

??

For future planning what service improvement program would impact most effectively on

waits/delays for patients across the system?

??

For future planning what service improvement program would impact most effectively on

waits/delays for patients across the system?

PostcardsPostcards

Right now, what is the one service improvement program that is your priority to deal with flow constraints?

Concurrent Session 1Concurrent Session 1Team PresentationsTeam Presentations

Bellarine Room 1– Ballarat Health Service– Goulburn Valley Health– Western Health– Royal Children's Hospital

Felicity Topp and Rochelle Condon


Bellarine Room 2– Royal Women’s Hospital – Southern Health – Monash Medical Centre– Peter MacCallum Cancer Centre– Maroondah Hospital– Calvary Health Care

– David Langton and Mary Mitchelhill


Bellarine Room 3– Northeast Health - Wangaratta – Bendigo Healthcare Group– Southern Health – Dandenong Hospital– Peninsula Health– Box Hill Hospital

– Melanie Hendrata and Kim Moyes


Bellarine Room 4– LaTrobe Regional Hospital– St Vincents Health– Northern Health– Angliss Hospital– Bayside Health

– Tony Snell and Prue Beams


Bellarine Room 5– Royal Victorian Eye and Ear Hospital– Melbourne Health– Barwon Health– Austin Health

– Peter Bradford and Ruth Smith

Morning TeaMorning Tea

Meet us in the

concurrent sessions at 10.45


Team Planning Time

Lee Martin

Manager Clinical Innovation Agency

5H October 2004

Team PlanningTeam Planning

• Share the knowledge and ideas you have gained today

• Use sustainability tool results in planning

• Work through the planner and develop your strategic approach

Ask yourselvesAsk yourselves• Will our plans help us make a significant improvement in our

program measures?

• What other clinical areas would benefit from learning about the improvements we have made?

• Who are the expressive team members that can help us engage with other departments and disciplines?

• Does our communication plan support spread of our improvements?

• Do we have all the key people involved in our innovation work that we need?

Task ListTask List

• Share today's learnings

• Develop the project plan

• Use the laptops and CD’s for further ideas

• Review and update communication plans

• Use results of sustainability tools

Health SMART


Anthony BibbyPortfolio ManagerPatient and Client Management SystemsOffice of Health Information Systems

AgendaAgenda

• The HealthSMART program

• The Governance Structure

• Status of Projects– Finance & Materials Management– Patient & Client Management– Clinical Systems– Shared ICT Services

HealthHealthSMARTSMART — The Strategy — The Strategy

• Replace obsolete, unsupported core systems with capable, industry-standard ones

• Introduce new systems capable of supporting the transformation of health care

• Refresh and develop the ICT infrastructure

• Develop a strategic program management structure

• Deliver ICT services through Shared ICT Services using accredited (panel) products

HealthHealthSMARTSMART a 4 year Program - a 4 year Program -

Three project streamsThree project streams

1. Resource Management Systems– Finance and materials – Human resources

2. Clinical Systems– Medication management (e-prescribing)– Investigative services ordering and

results reporting

3. Patient / Client Management Systems– Hospitals (deliverable)– Primary and Community Health Services

(deliverable) – Mental Health (integration)– Ambulance (VACIS project)– Dental (EXACT project)

HealthHealthSMARTSMART a 4 year Program - a 4 year Program -

Three project streamsThree project streams


Governance

Offi

ce o

f H

ealt

h I

nf o

r mati

on

Syste

ms

Resource Management Steering CommitteeChair: Kathy Byrne

Financial Management GroupSupply Chain Group

Policy/Legislative Change Groups

Technical Expert GroupsDevelop and implement technical design and standards

Health Service Implementation

Health Service Staff

Vendor

Inpatient Management GroupAmbulatory Services GroupClient Management GroupHealth Info Mgmt Group

Clinical SystemsSteering Committee

Chair: Brendan Murphy

Medication Management Group

Orders & Results Group


Health Service Staff


HealthHealthSMARTSMART program structure program structureAgency participation – the partnershipAgency participation – the partnership

Vendor Health Service Staff Vendor

Ch

ief In

form

atio

n O

fficer G

rou

p

Board of Health Information SystemsChair: Patricia Faulkner

Patient & Client ManagementSteering Committee

Chair: Sherene Devanesen

System-wide ApproachSystem-wide Approach

• Lead Agency approach

• Funding provided to all Health Services to support participation in Program

• Single product evaluation and selection processes (Panels)

• Standard baseline of core products across all agencies

• All implementations will use defined standards and project methodologies

• Single program with multiple projects

Guiding principles Guiding principles

• Maximum leverage will be derived from existing investments

• Buy not build — Internal development, if any, will be minimised

• Purchasing power will be maximised

• Financial support conditional on adopting the HealthSMART strategic approach and principles

• DHS provides majority funding (70% - 80%) to implement panel products, agencies contribute to projects and carry recurrent

OHIS functionsOHIS functionsThe Office will provide a number of core competencies, functions and services supporting delivery of the Health ICT Strategy

Strategy & Policy Health Systems Development

Technical Services Program Management

Engages other departments including state and regulatory representation on strategy development, healthcare system design and innovation, and policy and standards creation.

Comprises portfolios of Resource Management Systems, Patient & Client Management Systems, and Clinical Systems.

Works with stakeholder groups to provide direction on all stages of product life cycle management - development, procurement, implementation, maintenance and support.

System architecture and design. Technical architecture and design. Development and implementation of standards.

Establishment of essential hardware and software infrastructure, development of shared services capability. Design and implementation of integration technologies.

Provides expertise to portfolio managers and health services to insure infrastructure, technical services and underpinning integration supports systems delivery.

Methodologies and tools to ensure consistency and accountability across projects in the areas of procurement, implementation, project management,, financial, risk, quality and change management, governance, benefits realisation and outcome evaluation.


Shared ICT Services

Shared ICT services - ScopeShared ICT services - Scope

• Data centres

• Communications (agencies data centres)

• Technology platforms to support core applications

• Database administration

• Specialist application support (2nd level)

• Redundancy

Shared ICT Services - StatusShared ICT Services - Status

• Technology refresh funding – 2004– Acute $20M– Community $2M

• HealthWAN– Southern Region commenced– Conceptual design complete

• Shared ICT Services– Work plan developed– Work to “design entity” commenced– Architectural design commenced– FMIS infrastructure ordered– Interim arrangements through Bayside Health


Resource Management Systems

Current Status:Current Status:Finance & Materials ManagementFinance & Materials Management

Lead Agencies: Bendigo, Eastern, Peninsula• Contract let with Oracle February 2004• Implementation Planning Studies commenced 1

March 2004 – recently signed off• Design of common system configuration complete

(involved all health services NOT just lead agencies)• Issues:

– Request for scope creep (Discoverer, report writer)– Difficulty in establishing business cases with costs of

Shared ICT Services not available– 20% contribution by sector

Current Status:Current Status:Human Resource ManagementHuman Resource Management

• Allegiance sale to Mantrack (and subsequent dispute with SAP) finalised

• Advisory Group established• Consultants appointed to facilitate development of common

requirements (agencies and DHS) and business case.• Workshops held - >150 agency staff participated• Issues:

– Agencies will need to commit to participate (or not) to allow business case to be developed accurately

– Not clear that there is a common commitment to progressing with functional HR management systems as compared to doing little more than payroll management


Patient & Client Management Systems

Current Status:Current Status:Patient & Client ManagementPatient & Client Management

Lead Agencies: Peninsula, Gippsland, Melbourne, Southern, Northern, Western, Mercy, SWARH, Women’s, MonashLink, Inner South, Western Region and Bendigo

• RFT released 6th August• Tender closed 23 September• Pre implementation project funding allocated ($250k)• Issues:

– Media aggravation - Probity issues– Enormous amount of effort required for evaluation –

pressure on staff– Difficult getting and retaining Community sector

involvement

Note – Grampians have been removed from Lead Agency group as they entered into a contract with a vendor to replace their patient management systems


Clinical Systems

Current Status:Current Status:Clinical SystemsClinical Systems

Lead Agencies: Barwon, St Vincent’s, Bayside, Children’s, PMCI, RVEEH, Hume, Austin

•RFT released late September 2004•Pre-implementation project funding allocated ($250k)

• Issues:– Difficulty attracting staff to the project– Most difficult to define and manage scope

OHIS & HealthOHIS & HealthSMARTSMART Contact detailsContact details

• Office of Health Information SystemsTelephone: 03 9616 2787

• [email protected]@dhs.vic.gov.au

• OHIS websitehttp://www.dhs.vic.gov.au/ahs/healthit

• HealthSMART website http://www.health.vic.gov.au/healthsmart


Victoria’s Whole-of-Health ICT Strategy


Royal Melbourne HospitalWeb Delay Tracker

Dr Marcus KennedyClinical LeadPatient Flow Collaborative

An initiative of the Patient Flow Collaborative, E.D. – R.M.H., Melbourne Health

Introduction Introduction

• Monitoring Patient Flow through the Emergency Department, R.M.H. via a Web Browser.

• This will help in identifying ‘bottlenecks’ in patient flow through the Emergency Department to the Wards, and other Depts.

• Accessible on the hospital intranet

OutlineOutline

• Accessing the Web browser• Web Browser appearance• Significance of colours• How to update the Status of a Patient• Who updates the Status of the Patient• Action Sheets

Overview Overview

• Emergency Departments through out Victoria are facing a dilemma with Patient Flow through the Department.

• The Patient Flow Web Browser has been developed by Melbourne Health I.T. Dept., in conjunction with the Patient Flow Collaborative, & Emergency Dept. R.M.H. to help identify the ‘bottlenecks’ associated with Patient Flow through the E.D.

• These ‘bottlenecks’ will be addressed by ‘Action Sheets’ which have been developed to tackle the respective ‘bottleneck.’

Accessing the Web BrowserAccessing the Web Browser

• On the Desktop of the designated PCs there is an icon

• Click on the icon the Patient Flow Display will open…….

Patient Flow DisplayPatient Flow Display

Button /Field Action / Description

Refreshes the screen with up to date informationRefreshes the screen with up to date information

Sorts the associated column in the corresponding Sorts the associated column in the corresponding directiondirection

UR NumberUR Number Extracted from HASSExtracted from HASS

Patient NamePatient Name Extracted from HASSExtracted from HASS

EDLOS (hrs)EDLOS (hrs) Calculated from Presentation Time (HASS)Calculated from Presentation Time (HASS)

LocationLocation Current Location of Patient (HASS)Current Location of Patient (HASS)

Adm. UnitAdm. Unit Extracted from HASS – Speciality Codes (HASS)Extracted from HASS – Speciality Codes (HASS)

Status Status (time last (time last changed)changed)

Displays current Delay Reason and time since it was Displays current Delay Reason and time since it was last updatedlast updated

Patient Flow Display - detailPatient Flow Display - detail

Significance of the ColoursSignificance of the Colours

ColourColourTime in EDTime in ED

(from Presentation to (from Presentation to ‘now’)‘now’)

0 59 mins

1hr 2.59 mins

3hr 5.59 mins

> 6hrs

Under the Status column, click on the Drop Down arrow

Updating the Patient StatusUpdating the Patient Status

Select the appropriate Delay Reason to update the Status of the Patient.

to display the list of Delay Reasons:

Once updated, the time since the last update reverts to ‘0’ m

Who Updates the Status?Who Updates the Status?

• Senior Staff on duty for each shift are responsible for updating the Status of the Patients i.e. Clinical Coordinator in Charge & Consultant in Charge.

• The Status should be updated every 60 minutes (second hourly overnight)

Action SheetsAction Sheets

• Action Sheets have been developed in association with the Delay Reason, these Actions Sheets will guide the next step to take in rectifying the Delay.

• Action sheets refer to actions that will be taken in ED, wards, at exec level, in service departments etc in response to specific situations. They are policy driven.


LaTrobe Regional HospitalPatient Delay Tracker

Peter WrightEmergency Care DirectorLatrobe Regional Hospital

Manual Hourly ED TrackingManual Hourly ED Tracking

• Why we embarked on manual tracking

• Detailed analysis of ED patient flow

• Simple • Well accepted by ED staff• Highly visible• Highlighted key constraints

Initial hourly tracking templateInitial hourly tracking templateEMERGENCY DEPARTMENT PATIENT FLOW CONSTRAINT LOG

midnight 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

R1

R2

3

4

5

6

7

8

9

10

Cons 2

Jungle

Proc Room

Aquarium

Lounge

Codes usedCodes used

Radiology RPathology P

W Waiting to be seen by HMOED Treating E Has been seen by HMO, requiring ongoing treatmentBed Waiting BW Waiting for bed to be allocatedBed Avail BA Bed has been allocated, waiting ward pick upCommun. Delay CorT Ambulance pickup, HITH, HARP, PAC etc. Inpatient Review I Awaiting inpatient review, Use appropriate letter for each speciality

O OrthoM medicalS surgicalE ENTG O&GP PeadiatricU urologyEY Psych

Waiting to be seen

ED consultant

Completed day sample Completed day sample

mid-nig

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23

BW BA BA BA BA BA E E E E BA BA BA

E E E BA E E E E

BW BW E E E E M M BA BA BA E BW BA E E

BW BA E E E E E E E E E M C C E

W E M M E E E E R R E E W E E E

BW BA E BW BA BA BA E Y Y Y W

BA E E R C E P E P BA BA BA BA BA E

E R R R R E BW E E E E E M M M M BW

E E E R P W S BW

M BW BW BW BW BW BA BA BA BA BA BA E P E S E

E P P E E W E E E

E E E E E

P BW BW BW BW BW BW BW BW BW BW BW BW BW E O O O E E E E

E E E BW BA BA BA

FRIDAY 6/08/2004

Refinement of hourly trackingRefinement of hourly tracking

Radiology RPathology P

W Waiting to be seen by HMOED Treating E Has been seen by HMO, requiring ongoing treatmentBed Waiting BW Waiting for bed to be allocatedBed Allocation BAF Bed allocated, but bed not empty

BAC Bed allocated, but needs cleaningBAS Bed allocated, awaiting staff pickup, ie ward nurses, orderly etcBAT Bed allocated, treatment in ED before transferred, ie clinically unstable, IV meds etcBAP Bed allocated, paperwork holding up transfer, ie doctors notes, admission notes etcC or T Ambulance pickup, HITH, HARP, PAC etc.

Inpatient Review I Awaiting inpatient review. Use appropriate letter for each speciality.O OrthoM medicalS surgicalE ENTG O&GP PeadiatricU urologyEY Psych

Communication Delay

ED consultant

Waiting to be seen

Refinement of hourly trackingRefinement of hourly tracking

mid-night

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23

R1 E E E E T

R2 W R M M BAT BAT BAT BAT BAT BAT BAT BAT

3 E R E E E E E ED M BAS BAS E R R R E E E E BW BW BAS BAS

4 E E E E E E ED M C C C E BW BAS E E E E E E

5 E E E ED E M BW BAS

6 W E E E BW BWy BWy BWy BWy

7 BWy BWy BWy BWy BWy BWy BWy BWy W W E P E E E E E E M BAS

8 W E W E E ED ED R R R E E M M E E E E

9 E E E BAS BAS BAS BAS BAS E E E BW BW

10 W E R E C E E E E E M BW BW BW

Cons 2 E E W E E E E E E E BW BAS

Jungle E W E E E E E E E E E

Proc Rm BAS W BAS BAS BAS E E E

Aquarium BAS E S BAS E E E E E

Lounge Y Y

Sunday 12/9/04

Desired ImpactDesired Impact

Our expected impact will be;

• Bed allocation time reduced to an hour for all stable patients

• Refinement of hourly patient tracking will determine new action plans

Questions

Wendy Bezzina PFC Coordinator [email protected] (03) 5173 8139

?

Melbourne Health team Melbourne Health team updateupdate

• Access Subacute services• Bed Management• Workforce Communication• Access Theatres• Access Radiology• Emergency Department

Next StepsNext Steps

• 16 weeks take us to the week before Learning Session 3

• Plan to make a significant change to your program measures

• Test all your changes carefully before spreading

• Next site visit with the Executive Sponsor and project facilitator only

Next StepsNext Steps

• Involve the Collaborative management team

• Use your planning group members and each other as resources

• Connect to the Travel Fellows and the test bed work

RememberRemember

• Urgency out of Emergency conference Le Meridien 19th 0ctober

• Web casts, see sheet or website• Project Coordinators training day 2

Melbourne Health 11th November• Hot Topic Call

– Simple Length of stay management– Call 1800 063 705 pin number 4405 173– Wed 3rd November 2.30-3.30 pm

Project Coordinator Training Project Coordinator Training Day Number 2Day Number 2

• November 11th

• Royal Melbourne Hospital• Registration pack will be out shortly

Best Storyboard CompetitionBest Storyboard Competition

As voted by you

The winner is…….

Evaluation formsEvaluation forms

• Fill out the evaluation forms

• Safe trip home

• Thanks for a great day ,see you in February next year!


Conclusion

Marcus Kennedy

Clinical Lead (Flow)

5 October 2004

Access BlockAccess BlockHOSPI TAL BYPASS FROM J UL 2001 TO SEP 2004

0

50

100

150

200

250

300

Months

Occasio

ns o

f B

yp

ass

12 major metro hospitals, plus Sunshine from J ul 2001

Nurse Strike

Ambulance dispute: Data incomplete

Sharp peak in "winter" illness

Common cause variation reduced

Process improved

Special causes present

Process out of control - unpredictable

Special causes eliminated

Process under control - predictable

Improvement / ChangeImprovement / Change

patient flow collaborative learning session 2

Documents