MLHD Patient Flow and Transport Unit

Transcription

1 MLHD Patient Flow and Transport Unit

2 The goal of PFTU is to ensure all patients receive the right care, in the right place, by the right team and at the right time.

3 Commitment Develop a coherent system of care- many doors to one service. Improve the health of our population Improve the patient experience Deliver services closer to home out of country Improve the health of our population

4 MLHD Patient Flow/Transport Unit Organisational Chart Director Operations Patient Flow Unit Manager NM 6 Patient Transport Manager HSM 3 Nurse Coordinator Patient Flow NM 2 VMOs, Staff Specialists and GP s IN CCAS and RMC Patient Transport Unit Coordinator HSM 1 On afterhours shifts Dispatch Coordinators 4FTE Drivers and Transport Crew 22FTE

5 Patient Flow Unit Hours: 07:00 to 20:00 hrs, 7 days Phone & video link Established 9 November Key functions 1. Critical Care Advisory Service 2. Centralised Patient Flow coordination Staffed by Critical Care Nurses Receives & books all requests for Emergent & Urgent transports & liaises with patient flow managers re beds Has merged with the PTU to continue to provide clinical input into transfers

6 Patient Flow Unit Critical Care Advisory Service: Staffed by Critical Care nurses who: Can link in: Intensivist AMRS, NETS (ARV or PIPER) Receiving MO NSW Ambulance (if not using AMRS) - Can visualise resus area and provide advice - Will stay on line or re-call every 30 mins until AMRS arrive - Recording of Calls & Clinical feedback to sites

7 CCAS Medical Officer Owns the clinical problem Provides expert emergency care advise Determines the need for specialist care and escalates delays Escalate tertiary referrals where timeframes not being achieved. Assists with end of life discussions

8 Patient Flow Nurse Coordinators Escalation point for deteriorating patients requiring a higher level of care Have a unique tool kit of escalation contacts and collection of MLHD wide clinical resources including facility profiles Clinical resource to support clinicians at all MLHD sites within telehealth protocol support, critical care equipment support and general logistical support Change agents for Whole of Health Program and associated strategies

9 Patient Flow Centralised Coordination Relies upon: ALL INTERHOSPITAL TRANSFERS entered into the Patient Flow Portal & Booking with PTU Base Hospitals effectively engaging in Whole of Hospital processes including early planning for transfer of care. Each site effectively managing their Patient Journeys Relies on & will assist the LHD in effectively managing patients requiring Specialist medical referral NSW Health PD 2011_031 Ensuring that ALL AFTERHOURS Ambulance transfers are those that are genuinely clinically necessary

10 PFTU Responsibilities Critical Care Advisory Service Inter-facility transfers NEPT for diagnostics, medical appointments, return to Aged Care Facilities and private residence Non Emergency Health Related Transport Rural Aerial Health Service MLHD Reach Program IPTAAS advice and payments

11 MLHD Referral Pathway

12 Categories of Urgency for Transport Category 1 Urgent Specialist Care (<24 hrs) indicates where patients require specialist intervention to prevent or manage further deterioration within a short timeframe Category 2 Inpatient Specialist Care or Diagnostics (24-72 hrs). Please note that a number of Surgical conditions require surgery in <48 hours. Category 3 - Non-urgent (>48 hrs) these planned transfers are usually patients returning to their home hospital.

13 Levels of Transport Level A Retrieval - Critically Ill patient with a life threatening condition Ph Level B Urgent (within 24 hours) - the potential to deteriorate & must be closely monitored &may also require active treatment during transport. Will be booked through the Patient Flow Unit Ph Level C Intra Transport Care Supervision required but no active treatment during transport. Level D Non Complex Intra Transport Care (within 48 to 72 hours) Level E Routine No Intra Transport Care required

14 MLHD Patient Transport Unit Hours Coordination Unit to 1800 Wagga Wagga to 1900 Griffith to 1700 Temora to 1700 Deniliquin to 1700 Narrandera to 2000 Young to 1830

15 MLHD Patient Transport Vehicle Fleet Our Fleet 1 - Multi Purpose Vehicle includes Electric Stretcher to carry up to 315 kgs 2 - Vehicles equipped for Mental Health Transfers 8 - Mercedes Sprinter Vans equipped similar to ASNSW 2 - Sedans to Transport as clinically indicated

16 MLHD Patient Transport - Mode of Transport Walking Frame 1% Walk 8% Capsule 1% Booster 1% Stretcher 41% Wheelchair 48%

17 MLHD Patient Transport Road Transfers % 19% 70% PTV 8am to 6pm ASNSW 8am to 6pm ASNSW 6pm to 8am

18 Ambulance Transfers from MLHD Facilities Jul Jan 2015 ACT 5% Victoria 19% MLHD 64% WWBH 47% Rest of NSW 12% Other MLHD 7% GrBH 10% Rest of NSW Victoria ACT WWBH GrBH Other MLHD

19 $1,600,000 $1,400,000 $1,200,000 $1,000,000 $800,000 $600,000 $400,000 $200,000 $- All MLHD Road Ambulance vs PTV cost Jul Jan 2015 PTV Cost Barham Batlow Berrigan Boorowa Coolamon Cootamundra Corowa Culcairn Deniliquin Finley Griffith Gundagai Hay Henty Hillston Holbrook Jerilderie Junee Lake Cargelligo Leeton Lockhart M_Harden Narrandera Temora Tocumwal Tumbarumba Tumut Urana West Wyalong Young PTV Cost RoadAmbulance Cost

20 Cost Comparison NSW Ambulance and MLHD Patient Transport From - to PTU Emergency ASNSW Young to Canberra $ $2, Young to Wagga Wagga $ $2, Young to Young Imaging $80.83 $684.30

21 Patient Flow - Business Rules Daily MLHD Patient Flow Teleconference 1. Interhospital Transfers for Non Critical Care Patients needing to access Specialist Advice 2. Accessing the Critical Care Advisory Service 3. Booking Patient Transport Ambulances or other vehicles 4. Return to Home Hospital 5. Afterhours Urgent NSW Ambulance Bookings 6. Inter-hospital Transfer Communication 7. Discharge Case Conference with General Practitioner 8. Mental Health Interhospital Transfers 9. Bed Allocation of Admissions to Hospital Beds 10. Capacity and Demand Communication draft only

22 Policy & Procedures Critical Care Advisory Service Policy Governance Processes - CCAS Governance & MLHD Patient Flow Reference Group Critical Care Advisory Service Procedure Will retain current referral pathways e.g. Stroke referral; ECG Reading etc. Paediatrics have a revised referral pathway to reflect the interaction with the MLHD Patient Flow Unit Obstetrics referral pathways remain unchanged

23 Future development Remote Medical Consultation Service Description Extension of the Patient Flow Service to support High Definition (HD) video-conference for patients in district and rural hospitals who require a higher level of care than can be provided locally. Coordinated via the PFU and a Medical Officer aimed at improving the patient journey. Target Population Patients presenting to non-base hospital sites with increased levels of acuity or sites with limited medical support Enhancement Mobile cameras in multiple areas of non base hospitals allowing for virtual clinics and specialist care.

24 Conclusion PFTU hub of patient flow & district demand / capacity planning Cost containment ensuring the right mode of transport Quality/Safety and ensuring a patient journey that meets consumer expectations Right time, right place, right reason Effective Governance of all PFU services seamless change management process

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