FEEDBACK FROM THE VICTORIA QUALITY COUNCIL INTERHOSPITAL PATIENT TRANSFER WORKSHOP

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1 FEEDBACK FROM THE VICTORIA QUALITY COUNCIL INTERHOSPITAL PATIENT TRANSFER WORKSHOP Results arising frm the survey f Participants at the Victrian Quality Cuncil (VQC) Interhspital Patient Transfer Wrkshp Authrs/Invlved Wrking Grups: VQC Wrkplace Culture Wrking Grup April 2008

2 Feedback Frm the VQC Interhspital Patient Transfer Wrkshp Table f Cntent Backgrund... 3 The Wrkshp... 3 The Reprt... 3 Summary f findings frm the survey / 12

3 Feedback Frm the VQC Interhspital Patient Transfer Wrkshp Evaluatin f the Interhspital Patient Transfer Wrkshp Final Reprt Backgrund Clinical handver is a recgnised issue in maintaining patient safety. A survey f Victrian public hspitals identified that shift t shift and interhspital patient transfer patient handver are tw significant areas f cncerns. The Victrian Quality Cuncil (VQC) has acknwledged these risk areas, and has taken a staged apprach t address these areas f cncern. The activities undertaken t address shift t shift clinical handver include: the develpment f a Clinical Handver Infrmatin sheet, utlining generic cncepts; the develpment f a set f standardised clinical handver tls that includes a minimum data set t supprt shift t shift handver and the trial f these tls in fur public health services fr shift t shift medical handver. A prject relating t interhspital (IH) patient transfer is currently underway. The bjective f the prject is t develp a standardised apprach fr interhspital patient transfer. The prject includes the cllectin f infrmatin frm Victrian public health services n current interhspital patient transfer practice. The Wrkshp On March the VQC held an Interhspital Patient Transfer Wrkshp at the Melburne Cricket Grund (MCG). The wrkshp attracted 150 participants frm acrss the Victrian public and private health sectr. Attendees included representatives frm metrplitan, rural and reginal public and private health services, metrplitan and rural and private ambulance services, general practitiners, ther experts n the field, specialised patient retrieval services and cnsumers. The bjectives f the wrkshp were t present current hspital practice, t discuss issues related t interhspital patient transfer and t seek agreement n a standardised prcess fr interhspital patient transfer. The Reprt This reprt is a summary f the feedback based n the 6 questins asked f the participants at the wrkshp. A ttal f 100 evaluatin frms (67%) were submitted. 3 / 12

4 Feedback Frm the VQC Interhspital Patient Transfer Wrkshp Summary f findings frm the survey Q 1 Please rate the cntent f the presentatins prvided during the wrkshp (Rate 1 5, 1 frm 1 = nt useful/interesting t 5 = very useful/interesting). (n = 99) Ninety-nine participants t the questin. One participant missed the presentatin and did nt answer the questin, and ne respndent qualified their answer (rated 4) by saying that the cntent will nly be useful if it is acted upn. Percentage 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 2% 18% 61% 18% Level f usefulness/interesting (1=nt useful/interesting t 5=very useful/interesting) Cmments frm the participants Very relevant and useful It helped t prvide sme cntext, but wuld have been gd t hear frm a selectin f health services All the things are cmmn prblems t rural and metr hspitals that we wrk with n a daily basis. 4 / 12

5 Feedback Frm the VQC Interhspital Patient Transfer Wrkshp Q 2 Please rate the verall usefulness f the wrkshp (Rate 1 5, 1 frm 1 = nt useful t 5 = very useful). (n = 100) Three respndents (rated 3, 4 and 5) qualified their rating by stating that the wrkshp wuld be very useful in the lng run if the suggestins are acted upn a result f the wrkshp. 100% 90% 80% 70% Percentage 60% 50% 40% 30% 20% 23% 53% 23% 10% 0% 0% 1% Level f usefulness (1=nt useful t 5 = very useful) Cmments frm the participants: Psitive cmments Great use f technlgy - n butcher s paper It was cncise and very useful Great facilitatr Great venue The wrkshp was very useful in helping with a current Rt Cause Analysis investigatin We will be able t take ideas back t ur facility t assist in the prcess f imprving intra-hspital transfer Anther great initiative frm VQC, yu shuld be prud f the utcmes frm yur department and the usefulness f same t health care facilities. 5 / 12

6 Feedback Frm the VQC Interhspital Patient Transfer Wrkshp Qualified cmments The usefulness f the wrkshp will becme mre bvius with what cmes ut f trends. Hpefully slutins will be develped - frms shuld be standardised - we all need the same infrmatin. Negative cmments Need mre time fr wrkshp issues. Q 3 Did the wrkshp identify the key issues relating t interhspital patient transfer? (Rate 1 5, frm 1 = nt useful t 5 = very useful). (n = 100) 100% 90% 80% Percentage 70% 60% 50% 40% 30% 63% 26% 20% 10% 0% 0% 2% 9% Level f usefulness ( 1= nt useful t 5=very useful) Cmments frm participants: Psitive cmments Yes, the wrkshp identified the key issues but these issues are bvius t many already Negative cmments Only cncentrated n emergency transfer/critical patients, nt enugh fcus n interhspital, lw acuity transfer which attracts similar issues. Nn-critical patients are much greater in number, as inexperienced sl dctr lk after them and may waste hurs lking fr a bed. 6 / 12

7 Feedback Frm the VQC Interhspital Patient Transfer Wrkshp Did nt identify all the difficulties within the hspital system that limit patient mvement - e.g. re-timely retrieval by ambulance services, issues in relatin t accuracy f infrmatin nt addressed. Other cmments The huge number f entries n the system indicates the issues A little t brad The time frame was gd, but the tpic was large Have example frms at the wrkshp t prgress discussin further rather than wasting time n whether we need t cnslidate frms. Q 4 Did the use f electrnic sftware assist yur invlvement in the grup discussin? (Rate yes, n and unsure). (n = 100) 100% 90% 88% 80% 70% Percentage 60% 50% 40% 30% 20% 10% 0% 5% 5% 2% Yes N Unsure yes & n Cmments frm participants Psitive cmments Excellent/fantastic/awesme/very useful tl/great innvatin/much better than butcher s paper Displayed all the issues, gd t see what thers were cnsidering Enable ther grups t share yur grup s ideas, encurage/inspire further thught/discussin 7 / 12

8 Feedback Frm the VQC Interhspital Patient Transfer Wrkshp Allwed discussin t be fcused n the actual tpics at hand and cllated the infrmatin fr evaluatin later Very effective methd t capture input frm participants Easy t use and write, much quicker Fund verbal cmments added t feedback Qualified Cmments Tw peple fund there were gd and bad things abut the Zingthing technlgy. One persn liked the cncepts but had sme reservatin abut the technlgy. Like the cncept, but all participants need t be fcused Interested t see it s usefulness Gd n transfer f infrmatin but hard t get a sense f what is n the bard t much infrmatin Nt as per grup as hard t discuss and read at the same time, hwever having facilitatr summarise pints s easily was f value. Negative cmments It was very patchy Technical difficulties, t hard t read n screen Sme prblem with receptin Key bard did nt wrk all the time N real time t read cmments. 8 / 12

9 Feedback Frm the VQC Interhspital Patient Transfer Wrkshp Q 5 Was there anything else yu wuld like t be included in the wrkshp? ((Rate yes, n and unsure). (n = 100) 100% 90% 80% 70% Percentage 60% 50% 40% 30% 20% 10% 25% 40% 17% 18% 0% yes N Unsure N respnse Other things participants wuld like t be included Use scenari invlving Adult Retrieval Transfer, e.g. mre infrmatin re: what questins t ask at the time f call, what mnitring equipment is needed and available fr transfer, etc. Time frame fr this wrk t be cmpleted and rlled ut t health services, s that facilities are nt trying t re-invent the wheel Time line t see the finished prducts Department f Human Services (DHS)/Gvernment vice fr the subject Invlvement f private sectr Strategies t build capacity in peripheral hspitals Bed access system Patient separatin and types f separatin e.g. rute, subacute, cmmunity A presentatin frm DHS n future directins and pririties arund transfer 9 / 12

10 Feedback Frm the VQC Interhspital Patient Transfer Wrkshp Cnsideratin f distance regarding transfers fr patients and the effect f this n them and their families. Further discussin frm members f VQC Wrking Grup f issues/slutins Fcus n acute public facilities Present sme f the research r feedback frm ther grups/states/cuntries A stry f success ther than critically unwell nenates r adults retrieving by Nenatal Emergency Transprt Services (NETS) r Adult Retrieval Victria (ARV) A slutin Mre time needed n transfer prcess Detailed lk at transferring back f patient Q 6 D yu have suggestins fr future patient transfer wrk fr the VQC? A number f participants are keen t see that smething cmes t fruitin as the result f the wrkshp. The fllwing are sme f their recmmendatins fr the VQC and/r Department f Human Services (DHS): VQC shuld wrk with DHS t lk at a frmalised health service referral framewrk Feedback f the analysis f the grup s input, actin plan, and utcme after the wrkshp Cnsultatin with interstate clleagues Regular feedback via health services Chief Executive Officers and Quality Manager Inclusin f nn emergency transprt prviders in the cntinuum f care required during transfer imprtance f giving infrmatin t staff escrts emplyed by the nn emergency transprt prviders The infrmatin generated at the wrkshp shuld be used t scpe the cmpnent f the prblems in a way they can be addressed Establish the wrking grup/s with clear bjectives, time frames and resurce supprt t deliver against the bjectives ensure all persnnel included e.g. dctr, nurse, allied health, ambulance services, cnsumer etc that encmpasses metrplitan, reginal/rural and small base facilities Infrmatin transfer Develpment f a tl, be it electrnic r paper based, that enfrces cmmunicatin and sharing f imprtant infrmatin between hspital Dcumentatin that is standardised and user friendly- different needs f metrplitan versus rural hspitals VQC shuld lk at the Sctt tl (a state-wide referral frm fr cmmunity based services) befre creating anther frm. The frnt cver f bth frms shuld be the same with supprting mdules behind this fr different/varius referral needs. Further public/grup invlvement nce draft transfer frm is develped. 10 / 12

11 Feedback Frm the VQC Interhspital Patient Transfer Wrkshp Encurage electrnic health recrd that is accessible t all health care prviders Develp E-template fr transfer guidelines Cncentrate n the critical issue f the prcess f arranging transfer f a nn-critical patient Anther similar wrkshp but fcusing n transfer t residential care, hme, and transfer frm ne rural t anther rural hspital Tw peple want mre clinical handver wrkshps Hspital t General Practitiner handver Invlve private sectr mre fully Distance regarding transfer f patient and the effect this has n them Things participants wuld like DHS r VQC t t d t imprve interhspital patient transfer A number f participants suggested that the number f peple at the wrkshp reflects the critical state that exists in Victria. The participants suggested that VQC/DHS needs t capture this energy and ensure that this pprtunity is used. The participants als believe that the imprvement f the transferring prcess needs t be facilitated by DHS, t ensure that the new prcess will result in imprved patient utcmes. System Fcus n services being prvided in reginal and peripheral Melburne areas t decrease transfers. They are cstly and increase patient risk Clarity f netwrk between health services t have a clear understanding between metr/reginal/rural and what rles specialty services play e.g. Austin fr spine patients, St Vincent fr neurlgical patient Prcess Develpment f a central gverning bdy t manage/crdinate the transfer prcess Slve the chain f respnsibility gap t ensure patients are allcated beds in a timely fashin Reduce the time taken t lk fr nn-critical beds Cnsideratin f a state wide system fr transfer f nn critical adults between hspitals Standardise and frmalise transfer prcess single pint f cntact fr nn emergency/nn time critical patients e.g. Newbrn Emergency Transprt Service/Adult Retrieval Victria type f system fr back transfer f returning patients All critical adult transfer shuld be dne by ARV (including within Melburne) Using nurse escrt where the patient is a day-stay in an ambulatry area but requiring nursing care Infrmatin transfer 11 / 12

12 Feedback Frm the VQC Interhspital Patient Transfer Wrkshp Addressing infrmatin transfer issues Reduce the number f frms Standardised cntent/dcumentatin state-wide Cnsider natinal electrnic recrd and make the electrnic medical recrd happen Develp feedback prcess between sending and receiving hspitals patient details t all relevant stakehlders, s that staff are aware f relevant patients medical cnditin prir t transfer 12 / 12

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