FINAL Last Revised January 21, 2013

Transcription

1 WRHA PATIENT FLOW STRATEGIC PLAN The WRHA Patient Flow Strategic Plan will enable all care sectors in the Winnipeg Health Region to work toward the common goal of providing care to patients, in the right setting of care, with the right resources, for the right amount of time. The WRHA Patient Flow Strategic Plan will be built on four pillars: 1) Governance and Leadership Leadership within the WRHA must have the will for Flow to be embedded as part of everyday core business processes. Strong leadership support is well documented in the literature as being an enabler and facilitator of flow change practices. An Executive Sponsor for Patient Flow will be assigned. Accountability for flow performance is required through the development of a flow action plan that is measured at regular reporting intervals. The action plan will detail the actions required to support the achievement of performance targets. A Patient Flow Steering Committee will oversee the implementation of the action plan. The Executive Sponsor and the Steering Committee will create the culture change needed in the organization, anchored by a desire to approach flow from a dignity based perspective. 2) Flow Resources A regional Patient Flow and Transition Support team exists to support interdisciplinary, crossprogram teams to improve patient flow and in turn build knowledge capacity in the organization. Unified quality improvement methods, such as LEAN/DMAIC will guide teams as they develop integrated care pathways for patient flow. A central repository of transition best practices will promote knowledge translation and exchange and prevent duplication of effort. This work with teams will with efforts to establish Collaborative Care Practices wherever possible and specifically with those flow measures whose outcomes are linked in evidence with an improved flow target. 1

2 3) Performance Monitoring and Reporting- Performance measures related to flow exist in many different repositories. Indicators need to be matched with specific components of the flow action plan. Various flow targets will be developed in order to promote accountability. A set of comprehensive flow indicators will capture change at both macro and micro levels of the organization. Reporting and sharing of information is needed to track change, engage participation, and provide transparency. Dashboards, monthly, quarterly, and annual reports specific to flow will be refined and or developed. 4) Research and Evaluation Patient Flow and Integrated Services are priorities in most health care organizations nationally and internationally. Collaboration with partners will serve to exchange knowledge and compare performance. The WRHA will participate in the Western Canadian Patient Flow Collaborative. Demand-capacity issues which impact flow and transitions are important to understand via predictive modeling science. Innovative practices such as Virtual wards will be connected to the Flow Action plan. 2

3 2012/15 Flow Action Plan Structural Components PILLAR INITIATIVE ACTION LEAD TARGET/TIMELINE Governance and Leadership Executive Sponsor Flow WRHA CEO; WRHA VP Clinical Services/CMO; WRHA VP Interprofessional n/a Completed Flow Steering Committee Create Integration Councils by each Community Paired Area Practice/CNO RISC to serve as Flow Steering Committee Modify RISC T of R Modify Agenda to include Flow Items Identify Hospital COO and CAD as Co-Chairs in each Community Area Circulate draft terms of reference for Integration Council Arlene Wilgosh/Brock Wright /Dan Skwarchuk November 2012 October 2012 October 2012 RISC November 2012 RISC Flow Resources Re-Structure Regional Utilization Program Meet with each Integration Council to review the Regional Flow Action Plan Re-name unit to Patient Flow and Transition Support Reflect change on Regional Org Charts/InSite, etc Arlene Wilgosh/Brock Wright /Jonathon Hildebrand November 2012 March 2013 December 2012 December 2012 Memo communicating change Arlene Wilgosh/Brock Wright December 2012 Revise Job Descriptions Brock Wright/Trish Bergal November 2012 January 2012 Assign Patient Flow and Transition Coordinator to each Integration Council Completed but continue to communicate and facilitate November 2012 February

4 PILLAR INITIATIVE ACTION LEAD TARGET/TIMELINE Create a Regional Flow Collaborative Team to support the Integration Councils and Regional Program Teams in the implementation of the Flow Action Plan Identify key members of the Collaborative. Members are Michel Tetreault (LEAN); Frank Krupka (PMO); Sandra Fedirchuk (Quality and Patient Safety); Decision Support (Michael Zhang, Ann Hakansson, Evelyn Fondse); Research and Evaluation (Mike Moffat, Colleen Metge); e-health (Liz Loewen); Chronic Disease Collaborative (Jeanette Edwards); Patient Access (Luis Oppenheimer); Clinical Services and Integration (Dan Skwarchuk); Regional Program Teams; WRHA Allied Health Ongoing Support the Collaborative Practice Strategic Action Plan for teams that directly impact Patient Flow Directors Facilitate the Flow Collaborative Team to assist the Community Integration Councils in the implementation of the Regional Flow Action Plan Any new innovative patient flow practice will be reviewed by WRHA PAC to ensure strategies to address collaborative practice are indoctrinated into the practice proposal November 2012 March 2013 Lori Lamont/RISC December

5 PILLAR INITIATIVE ACTION LEAD TARGET/TIMELINE Report Progress on Determine reporting method and frequency December 2012 Flow Targets defined in the Flow Action Plan PERFORMANCE MONITORRING AND REPORTING RESEARCH AND EVALUATION Create a Data Warehouse for linking of flow data from various repositories Assist Integration Councils in developing granular flow targets which pertain to the acute/community/long term care sectors Review of Patient Flow Initiatives in the WRHA Participate in the Western Patient Flow Collaborative Define which data sets need linking Evelyn Fondse March 2014 Define sub-components of Flow targets by sector and by community area Inventory of current and past patient-flow initiatives In-depth analysis to identify promising practices in Flow Compare flow performance and processes to Western Regions /Evelyn Fondse March 2014 Colleen Metge January 2012 Colleen Metge February ?? Ongoing 5

6 Flow Targets and Action Plans At the request of the WRHA CEO, an economic analysis was prepared to show potential savings if the region s hospitals were to achieve the average performance of the Western Regions in 3 length of stay indicators. Using the CMG assignment, per diem weights from CIHI s ELOS-RIW tables and hospital specific cost per weighted case (adjusted to include only direct nursing services and food costs), a site level estimate of conservable acute and ALC days and dollars was calculated for typical and long stay outlier cases. The resulting fiscal savings at best Western performance was estimated at roughly $46 million. The resulting fiscal savings at 100% performance (ELOS) was estimated to be in the excess of $70 million dollars. To initialize the planning for significant patient flow improvement, targets for ALOS: ELOS, Long Stay Outliers; ALC Days as percent of total in-patient days have been established. The targets have been set to achieve the Median of current Western performance. The WRHA CEO has also identified that areas of focus for enhanced patient flow should address: 1) Ambulance Off-Load Delays; 2) ED LOS improvements in alignment with Western Regions; 3) A reduction in ALC days in acute care hospitals. The Flow Targets and Action Plan have been developed in response to the economic analysis and identified areas of focus. 6

7 TARGET STRATEGIES LEAD Reduce CTAS 4 and 5 visits as a percent of total ED visits by 6-7% percent per year. (20% reduction by 2015) Advocate for legislative changes to enable the creation of a Community Paramedic role to reduce pre-hospital arrivals of non-urgent patients who can be safely cared for in a setting other than an ED Helen Clark/Arlene Wilgosh Reduce Utilization of ED by High Users Meet Ambulance Off-Load Target of minutes Develop algorithms to enable safe referral from ED to Quick Care Clinics or the Crisis Response Center or Primary Care Clinics without first requiring a physician assessment In keeping with the development of Primary Care Networks, improve access to diagnostics for primary care providers to reduce tendency to refer patients to ED for DI access Educate the public on options for accessing patient care information and care options including self care, access to primary care, Quick Care Clinics and emergency departments Provincial Health Call Centre to review and revise protocols to offer alternatives to the ED Promote use of Nurse Practitioners in Long Term Care to avoid use of acute care systems Provide detailed profiling of this population with a goal to develop alternate supports in the community to reduce the use of ED by this group Monitor and reinforce need to offload patients to hospital stretchers or to the waiting room, per Regional Off-load Delay policy Alecs Chochinov/Karen Dunlop/Sheldon Permack/Murray Enns Primary Care Program/DSM/Integration Councils Jonathan Hildebrand/Heidi Graham/Primary Care Program/WRHA ED Program Team/Integration Councils Real Cloutier and Rosie Jacuzzi as co-chairs of the Provincial Health Call Centre Working Group/Primary Care Lori Lamont Joanne Warkentin Hospital COO s and CEO s/wrha ED Program Team/Helen Clark 7

8 TARGET STRATEGIES LEAD ED LOS Targets Review ED Site Human Resource Needs in Lori Lamont/Brock Wright 90% of non-admitted relation to ED activity and trends patients treated and released within 4 hours Implement ED Surge Plans to increase efficiency within EDs WRHA ED Program Team 90% of admitted patients Establish a Minor Treatment Area at all EDs Karen Dunlop treated and moved to an with a Nurse Practioner in-patient area within 8 Introduce Physician Assistants in EDs to Alecs Chochinov hours improve patient safety and flow Improve ED access to diagnostics and lab services WRHA DI Program/WRHA ED Program/Brock Wright 24x7 access to Consultants with response Alecs Chochinov/Brock Wright/WRHA Medical time within 2 hours Directors/Hospital CMO s No patient to remain in ED longer than 24 hours Standardize models of care for specialty patient groups across the Province, including the role of the ED in accessing specialty care Implement Regional Escort pool to enable ED staff to remain on-site to care for patients All acute care sites to review their existing peak demand plan to clearly include this expectation Enable Emergency Department Physicians to admit, in consultation with either Admitting Physician or Most Responsible Physician Ensure medical model of care allows for movement from the ED for those individuals who do not meet formal admission criteria Review and adjust Home Care processes and assessments to facilitate expedient discharge planning from the ED Review and adjust the Urgent Respite process Provide Programs by Site information related to Bed Turn Around Times Brock Wright via Provincial Medical Leadership Council Helen Clark/Milton Good Hospital COO s and CEO s/ Alecs Chochinov/Brock Wright/WRHA Medical Directors/Hospital CMO s Alecs Chochinov/Brock Wright/WRHA Medical Directors/Hospital CMO s Eliette Alec/Integration Councils Linda Norton/Integration Councils 8

9 TARGET STRATEGIES LEAD Review existing Care Maps and ensure maps are being adhered to Identification of ELOS on admission and use of ELOS flag in UMS Review Repatriation practices with Rural RHA s Use of whiteboards in patient rooms with Hospital COO s/ceo s agreed upon Dates of Discharge with Patient and Family ALOS: ELOS Ratio 1.0 Decline in ratio by 0.02 per year Reduction in Long Stay Outliers 5% reduction over 3 years or 1.5% per year Goals of admission documented on admission and updated as needed in UMS/Patient record Interdisciplinary rounds conducted in keeping with ABC Project recommendations WRHA Program Teams/WRHA Quality and Patient Safety Program /Evelyn Fondse Brock Wright/ (via Provincial Medical Leadership Council) Hospital COO s/ceo s with support from Trish Bergal and Regional Allied Health Directors 90 % Compliance with UMS use Hospital COO s/ceo s with support from Trish Bergal Reduction in ALC Days 3% reduction over 3 years or 1.0 % per year Continue to work on predictors of over-stay Develop processes and action plans for patients whose transition plan will be complex due to gaps in system resources Continue with work of Panel Process Improvement Action Council Develop new forms of service delivery in the Home Care Program which support PCH placement from home Continue with implementation of EFT project in Home Care Expansion of Virtual Ward concept WRHA Medicine Program Team/Trish Bergal/Research and Evaluation Linda Norton/ Eliette Alec/Integration Councils Eliette Alec/Integration Councils Integration Councils Increase PCH capacity including spaces fro specialized services Lori Lamont 9