Point of Care Admission Royal Victorian Eye & Ear Hospital

Elective Surgery Redesign Conference 12-13th Nov 2012

Mitchell Wilson mitchell.wilson@eyeandear.org.au

RVEEH Clinical Services

• 180,000 occasions of service in

outpatient clinics

• 46,000 occasions of service in

Emergency

• 13,000 theatre cases per year

• 50% of public eye including most

Special Eye and 10% of public ENT

services in Victoria

• Theatre access: 80% eye & 20% ENT

workload

RVEEH Surgical Services Day Surgery Department (DSF)– 3 Theatres (Level 3 Peter

Howson Wing) Operating Theatre Suite (OTS) – 5 Theatres (Basement

Peter Howson Wing)

Short Stay Care Centre (SSCC) – 21 recliner bays (Level 4 Peter Howson Wing)

SSCC provides admission and discharge services for patients whose theatre allocation is for the basement OTS

Operating Theatre Suite & SPC

Day Surgery

Short Stay Care Centre

Pre-admission

Medihotel

Ward 8 / Bed Management

Admissions GF

3rd

4th

6th

7th

8th

Basement Entrance

Smorgon Family Wing

RVEEH Surgical Service Location

Peter Howson Wing

• Operates 7am to 7pm Mon – Fri

• Two shifts

o0700 to 1530 – 4 nursing staff

o1030 to 1900 – 3 Nursing Staff

• Approx 6000 admissions annually

RVEEH Short Stay Care Centre

Centralised Admissions

• Crowded admission waiting area – DSF & SSCC

patients in the one area waiting for admission

• There has been both formal and informal patient

complaints about the waiting time and environment

• Delays in prepping patient for theatre & delays in

theatre start time - 6% of incident reports for SSCC

• Staff disquiet - rework in data entry in PiMS and

clerical work taken on by nursing staff

Point of Care Project May - August 2012

Background

• Issues

– Patient & staff disquiet

– Delays in admission and theatre start time

– As part of the enabling works for redevelopment

• The admission process was reviewed and the Point of

Care Project established

Methodology and Staging

• The methodology adopted for the project was

Process Redesign

• Phases:

– Defining the scope of work

– Diagnosing the issues

– Developing appropriate interventions

– Implementation

– Evaluation of outcomes

User Group • Project Executive Sponsor

• Project Manager: Staff from Planning & Innovation

• Project Leads: NUM SSCC & DSF

• NUM Inpatient Ward & Preadmission

• Perioperative Services Manager

• Manager Health Information Services

• Admissions Clerk

• Accounts Manager

Scope

• Inclusions are all admission during the hours of 7am

to 7pm Monday to Friday – core business hours

• Exclusions are admissions that occur out of hours

and weekends – these are managed via the

Emergency Department

Diagnosing the Issues

• The User Group mapped the current admission

process.

• The mapping process provided an:

– understanding of patient flow

– bottlenecks and

– constraints

Current State - Admission

Developing appropriate interventions

• A future state for the admission process was then

created which mitigated constraints.

• Principles used to guide the development of a future

state focused on changing the way patients waited

and travelled before their surgery.

• The aim was to create a future state which was

patient centred and reduced delays.

Future State - Admission

Prerequisites for Future State

• Space available on the SSCC and DSF

• Wireless access for data entry and printing of

admission registration form

• PiMS availability on mobile computer units

Trial Period

• One month before Go Live implementation a series of

trial dates were identified.

• Theatre bookings were reviewed to identify lowest

activity for alternating morning and afternoon

sessions

• Staff feed back was recorded immediately after

patients had been admitted and debriefing meetings

discussed resolution for identified issues

• As the trial period progressed and issues were

resolved busier and full days were trialled

Implementation

• Go live was 20th August 2012

• Modifications to the Future State were made for Point

of Care due to limitations of PiMs & patient privacy

issues

o Unable to have 2 patients assigned to the one

patient recliner bay

o Patient demographics required to be checked on

admission, difficult to maintain privacy in a

shared room.

Implementation Model

Evaluation

The project realised three key objectives:

• Improved patient experience

• Reduced delays in prepping patients for theatre

• Streamlined patient admission process by removing

rework and delays

Benefits realised as a result of the project are:

• Released space on ground floor for enabling works

• Improved communication between admission and

inpatient staff

Evaluation • No RiskMan entries for delays in patient admission since Go

Live

6:54

6:57

7:00

7:03

7:06

7:09

7:12

20/08/2012

21/08/2012

22/08/2012

23/08/2012

24/08/2012

25/08/2012

26/08/2012

27/08/2012

28/08/2012

29/08/2012

30/08/2012

31/08/2012

1/09/2012

2/09/2012

3/09/2012

4/09/2012

5/09/2012

6/09/2012

7/09/2012

8/09/2012

9/09/2012

10/09/2012

11/09/2012

12/09/2012

13/09/2012

14/09/2012

15/09/2012

16/09/2012

17/09/2012

18/09/2012

Time of first Patients presentation at Nurses Station (SSU Specific)

User group Review

• Composition of the project team

• Communication breakdown in private rooms

• Resistance to change

• Increased patient involvement

• Involve IT earlier

• Limited baseline data to compare with post go-live

data

Patient Feedback

• It is good to go straight to an area where there are

nurses and doctors

• I’ve been here before and this time it was much

better, I had to stand last time as there were not

enough chairs

• The new waiting room is very comfortable and warm

and it is good to have the big TV to watch

• There is plenty of staff around to answer your

questions

Thank You

mitchell.wilson@eyeandear.org.au