redesign of patient flow unit and changes to discharge coordinator’s role at calvary healthcare -...

Redesign of Patient Flow Unit

and Changes to Discharge

Coordinator’s Role at

Calvary Healthcare - ACT

Little Company of Mary Health Care Limited

Liz Ganser

Discharge Liaison Officer

Calvary Health Care -ACT

Overview

Calvary Hospital

2010 AIP (Access Improvement Program-

Every patient in 4 hours Redesign Project)

Highlighted issues that needed to be

changed within the whole organisation –

within each department.

Calvary needed to be current and have a

plan that would continue to meet the needs of

Canberra into the future.

Overview

Overview •Where we were and where we are

•Activity Management Centre

•Patient Flow Unit

•Where we were and where we are

• Discharge Coordinators

•Discharge Liaison Officers

•Post discharge phone calls

Activity Management

Centre • Bed Manager 1xFTE

• After Hours Hospital Manager 4x FTE

• Recruitment Manager 1xFTE– am shift

only

• Admin Assistant 1xFTE

• The ACM was not functioning well –as

services out grew its effectiveness

Patient Flow Unit

• PFU Manager level 4.3 x1 FTE

• Patient Flow Coordinators/After Hours

Hospital Manager level 4.2 x 5.4 FTE

• Discharge Liaison Officers level 2 x 2.5

FTE

• Admin assistants x2 FTE ( 1 f/t and2 p/t)

• The unit is more robust and dynamic

PFU Responsibilities

• DOP – Daily Operational Planning Meeting – This happens at 0900hrs Monday –

Friday

– Head of each department attends including hospital Executive.

– All departments report staff leave planned and unplanned and identify where the shortfall will impede flow

0900 – 0915hrs

Daily - excluding wk/ends & PHs

Post Grad Seminar Room

• Capacity vs Demand balance

• integrated work priorities • identification of key barriers to discharge/patient flow • defined responsibilities

• prioritisation of work

• multidisciplinary attendance

Refer to Patient Flow Unit for further information

Daily Operational Planning (DOP) meeting

PFU responsibilities • Bed management

– Patient Flow

• Transport bookings – Instead of every ward booking individual transport the

system became centralised by e-referral

– More transparent/ streamlined/ data collection tool

– Taxi/ambulance ACT NSW/ PTV / destinations and what for.

• Staffing of hospital – While roster shortfalls are the responsibility of the

CNC the PFU Coordinator would manage the Relief Pool and Casual Pool staff and any overstaffing of units.

PFU responsibilities

• DLO -Discharge Liaison Officers – Manage and direct

– Weekly meeting to discuss issues and redefine role

– Oversee

• daily work flow

• d/c phone calls

• and data entry of result

• Monitoring of Red/Blue Dots- Blocks to discharge – Red/Blue dot on the PJB- patient journey Board

– Indicate that patients are medically stable to be d/c social issues prevent them going home.

Patient Journey Boards

• communication tool

• patient journey ‘snap shot’

• focus for planning discharge from day of admission

• ‘traffic light colours’ indicate time away from discharge

• PJB also indicates problems/delays for patients who are medically cleared for discharge

Discharge Traffic Light System & Patient Journey Board (PBJ)

White

Amber Green Blue Red RED with

BLUE

Dot

>3

days

from

EDD

2-3

days

from

EDD

within

24hrs

of

EDD

Day

of

D/C

overstay

: >EDD

Discharge

delayed for

non-medical

reasons

Start typing

Discharge Traffic Light System & Patient Journey Board (PBJ)

Discharge Traffic Light System & Patient Journey Boards Specific DAILY PRIORITIES: Discharge planning & traffic lights – actions

•AMBER DOT •GREEN DOT •BLUE DOT

Doctor “Discharge Focus Time” Daily Operational Planning (DOP) Meeting

KEY POINTS

Note: hospital policy for patients to discharge by 1000hrs.

Estimated Date of Discharge (EDD) •To be allocated within 24hrs of admission

•Date is estimation ONLY

•May be changed as clinically appropriate

•EDD based on requirement for clinical care – linked to

National Benchmark of average length of stay (ALOS) by DRG

Discharge planning & traffic lights

Handover with CNC /Team Leader at PJB Purpose:

‘handover’ meeting between team members of •Key discharge barriers •key clinical care matters for action •Prioritisation of patient care

DISCHARGE TRAFFIC LIGHT ACTIONS – Medical Officer Responsibilities

AMBER DOT

ACTIONS

•Ensure EDD is correct

•Plan & commence discharge referrals, documentation

•Inform CNC of any expected delays

GREEN DOT

ACTIONS

•As for Amber Dot •Review pharmacy-initiated e-script for accuracy & communicate any problems •Inform CNC IMMEDIATELY of any expected delays

BLUE DOT ACTIONS

•Prioritise any outstanding discharge referrals, documentation •Communicate discharge instructions: Patient

•Inform CNC IMMEDIATELY of any expected delays

Discharge Coordinators

X1 FTE Surgical floor

X1 RTW staff member on 1 medical ward

And occasionally another staff member on

the second medical ward

The job productivity was dependent on the

person holding the role rather than a job

description

Discharge Liaison Officer: Where we were

Discharge Liaison Officer:: Where we were

DISADVANTAGES: No clear referral system – saw everyone on

designated ward

Tendency to d/c plan for every patient simple

and complex

Could be as busy or quiet as the allocated

person wanted to be.

No clear job description/ career advancement

potential

Not in budget!

Discharge Liaison Officer:: Where we are now

Time line:- 2011 • Mid 2011 2x .5 FTE positions advertised

• August 2011 position started in PFU

• Sept/Oct 2011 e-referral for complex

discharges

• November 2011 the .5 FTE increased to

1x FTE and one .5x1 on month by month

basis.

Reasons for a referral – must be complex

1. Is my patient likely to have self-care

problems on discharge?

2. Does my patient live alone or have

accommodation issues?

3. Is my patient likely to have caring

responsibilities for others?

4. Has my patient needed community

services before this admission and will

they need to continue on discharge?

DLO – Role and function

Important things to remember! Everyone admitted is discharged. Where will they go? Home or Nursing home check address details and contact phone numbers and GP Assistance needs to be arranged Cleaning/ cooking /shopping/ complex wound care/transport/case management. Except for wound care Social Worker arranges the rest. Not everyone who lives alone needs help. But if they do make sure it is set up before d/c External services are not mind readers. Everyone who has services in place prior to admission will need these services to be reinstated prior to d/c.

DLO – Role and Function


Time line:- 2012 • Jan 2012 .5 position extended to 1xFTE

for 6 month

• Jan 2012 started d/c phone calls

• April 2012 started Weekend DLO .5 FTE

• June 2012 1x FTE and 1x.5 advertised

• August 2012 both positions filled.

• We now have 2x FTE and 1 X .5 FTE


Time line:- 2013

• Feb-March Discharge phone call survey

conducted

• May 2013 a generic

• [email protected] email address

was set up

• Referrals were being ‘lost ‘ in the

DOP/PFU inbox

• Email handovers to personal email

addresses not seen when staff on

unplanned leave


Time line:- 2013

June 2013 designed a “discharge for

DLO service” sticker which evolved

into an assessment/admission form

which will be filed in Medical Records

once evaluated and approved by forms

committee.

• July 2013 2 year review in progress

CHCACT DLO Handover Template Date: DLO: Wards:

Planned Discharges: Is DLO follow up required? Such as transport bookings or completion

of discharge envelope: Include Patients Ward and Name:

Referrals requiring follow up: Include Patients Name and Ward:

PT LABEL Discharge from DLO Service

o Happy with current level of

services this admission

o Refused DLO service this

admission

o t/f to other facility

………………...

o Other:

……………………………..

o No Post Discharge Phone Call

required

Print Name: …………………………………

Signature: ……………………………………

Designation: ……… Date: __/__/__

Ward: …………………….. Bed No:

………………

Referral Received Date: __/__/__

Review Date: __/__/__

Time: …………………………………………..

Category: ……………………………................

Admission Date and Reason: __/__/__

--------------------------------------------------------------

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Patient Contact Details

Address: …………………..................................

………………………………………………….

Suburb: …………………….. Post Code: ....…..

Contact Numbers: (H)……………………

(M)……………….. (W)……….…………..

Next of Kin

Name:

……………….......................................................

Relationship:

………………............................................

Contact Numbers:

(H)…………………………………

(M)………………

(W)……….………………………..

Other:

……………………………………………………

Medical / Surgical History

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Social History

--------------------------------------------------------------

-------

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--------------Current Services -------------------------

--------------------------------------------------------------

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-----------------------------------

ACAT Yes / No Date: __/__/__

EPOA Yes / No Date: __/__/__

Advanced Care Directive Date: __/__/__

Internal Referrals (insert dates where applicable):

Physiotherapy __/__/__ Social Worker __/__/__ Dietician __/__/__

Diabetic Ed. __/__/__ Psych Liaison __/__/__ Drug & Alc. __/__/__

Palliative Care __/__/__ Occ. Therapy __/__/__ RACLN __/__/__

External Referrals (insert dates where applicable):

CHI __/__/__ Event Notification Yes / No : Reason:

…………………………………………………..

PHSP __/__/__ CCP __/__/__ Carers ACT __/__/__ Respite

__/__/__

CAPS (Provider) ______________ EACH (Provider)_____________

NHP(Facility)_________________

Discharge Phone Calls

•Why do them?

•Discharge Phone Calls Deliver Quality Care, Higher Patient Satisfaction (Studer 2006)

•They have multiple benefits

•Engage staff

•Opportunity to glean

compliments and complaints



•Reconfirm discharge instructions, •Reduce patient anxiety, •Reduce complaints and claims, •Reinforce patient perception that excellent care has been provided, and Offer an opportunity for quick service recovery. (Studer 2006)



Jan 2012 Started –working very closely with

Studer Group coach Michelle Dobe

• initially called everyone we saw no

matter if simple or complex

•Ward/ED staff still learning the e-referral

system and criteria for referral

•Also called Nursing homes but stopped

after 4 months receiving enough

information to improve our d/c process to

all facilities in the ACT and NSW area.


Discharge Phone Calls To Complex Patients

In total for February 2013 there were a total of 187 Discharge Phone Calls made by the DLO’s. This equates to 97% of patients seen by the DLOs receiving a discharge phone call

Survey of Post-Discharge Telephone Calls

140 surveys have been sent out with 89 returned (63%). The Survey finished at the end of March.

Highlight of D/C phone calls

•Complaints/comliments about food

•Complaints/compliments about staff

•Hospital in general/specific ward

•Noise level at night

•Extended wait time to be discharged

•Patient readmitted –failed d/c

•Patient died ****

•Recommend that patient represent to

ED – readmitted

d/c phone calls

Since PFU inception

The hospital overall is more transparent

Communication is great

Saved money but centralising the

transport booking system

No longer rely on Agency staff.

Overall LOS has been reduced by 2 days

Sumary

Nursing Workforce Planning (Relief, Agency, Casual)

Thank You

redesign of patient flow unit and changes to discharge coordinator’s role at calvary healthcare -...

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