western health day2 rm216

7/28/2019 Western Health Day2 Rm216

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QUICKNOF improving theinpatient journey

CLAIRE CULLEY MONICA SHAW

Divisional Director ManagerSurgical Services Service Improvement


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Challenge

Improve the patient journey

ED to theatre

Acute to Subacute journey

Constraints

11% less subacute beds compared to peers

Excess LOS compared to state average


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Diagnostics

Value stream map patient journey

Process map highlighted the cornerstones of the referral

process from acute to subacute

Length of stay in days spent in the silos

Comparative Health Service data


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Value Stream Map - Fractured Neckof Femur patient journey

Western Health Acute to Sub Acute Redesign

handover to discharge

theatre nurse ready

orderly and referral to ambulance

nurse transfer Sub Acute booked

ring to find medical consults Bed Ready

theatre time to other areas 1 day prior

medical daily ortho phone call from

hanodover sheet ward round GEM bed avail

medical history Tues ortho Checking of

bed board meetings list

bed managers Dr admission PAC handover allied health Daily [patient reviews

find bed drug chart (V) referreals by ACCS/ GEM NUM

bed managers nurse obs orderly and update comm Placed on sub-

notified A & D form nurse transfer board,H/O sheet acute wait list

referral to face to face face to face face to face Assesment on

orthopaedics handover handover handover Mon/Tues/Thurs

10 1590 10 1440 30 30 10

type 1 Triage 1 air matress (hi 1 1 30 min obs fo 1 assessments 1 Ambulance 1 1

process 1 medical assessement pain management 4 hours ordered transfer

data 1 x rays traction check dressing ready for rehab/GEM Average LOS

10 here 1 bloods IV therapy morphine chart Seen by physio 11.44 days

1 ted stockings seen by physio daily 16473.6 min

day 1 OT Allied health as needed

flagged for Gem Total Lead 16780

enter wait day 2-3 Time

0 1402.5 10 6720 4102.5 0 0 Wait 12235

Time

Pr ocessing 4545

Percentage 27.1

0 Value Add

240480 120

type process

step location

type staff

member

Operating Theatre

060603585

time

ED Ward

0

enter processing

Ward Assessment Transfer Subacute

Seen by ACCSNBM Operating time NBMW

WW30

WWWW W W

Patient

Bubble


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Tracking on Wards - NUM


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Tracking Ward 1A - Nurse

Nurse Bed 10-13

Admin

5%Bedside

Clinical

34%

Communica

tion

24%

Motion

31%

Rework

6%

Admin Bedside Clinical Communication

Motion Rework


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Key issues prioritisation wardlevel

Up to 10 stakeholders requiring similar information from NUM per shift

Significant amount of time spent in the corridor

Interruptions upon interruptions

Significant time spent searching for equipment

Dependant patients furtherest away from utilities

Limited desk space


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Countermeasures

Patient J ourney Board

BEFORE AFTER


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NUM Before vs. After


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Countermeasures

Medical ward round trolley

with frequent use items

Noted ward round reduction

from 35 minutes to 10

minutes


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Countermeasures

Staff station

BEFORE AFTER


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Outcomes - Length of stay

Length of Stay - Ward 3B/1

0

2

4

6

8

10

12

14

16

18

20

All Ortho #NoF

Days

07-08

Apr-May-Jun 09

Length of Stay- ward 1A

0

2

4

6

8

10

12

14

All Ortho #NoF

Days

07-08

Apr-May-Jun09


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Outcomes Linen savings

Ward 1A Linen cos t r eduction

0

1000

2000

3000

4000

50006000

7000

8000

April May J une July

Mon th 2009

$ Series1


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Reducing adverse outcomes

Combined wards

0

10

20

30

4050

60

Complaints OHS

incidents

Pressure

Ulcers

Falls Total adverse

events

March - May 08

March - May 09


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Potential bed days saved

Annuali sed potential bed day savings

Non-ortho

891

Non-ortho

233

Ortho, non #NoF

480

Ortho, non #NoF

2317

# NoF

223

# NoF

213

0

500

1000

1500

2000

2500

3000

1A 1W

This chart shows potential annual savings in bed

days, assuming the decreased length of stay

demonstrated during April, May & J une of 2009 is

maintained.

Total potential bed days saved annually:1A: 1594

1W 2762

Total 4356


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Thank you

[email protected]

western health day2 rm216

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