PATIENT JOURNEY BOARDS

Transcription

1 PATIENT JOURNEY BOARDS at Manly, Mona Vale and Hornsby Ku-ring-gai Hospitals Sue Hair : Director of Nursing and Midwifery, Manly Hospital Deb Stewart : Manger Clinical Redesign, Northern Beaches and Hornsby Ku-ring-gai Health Services

2 NEAT gave us an opportunity and a mandate for change Whole of hospital -system wide reform Operational change Strategic change Cultural change

3 Our goal was not just to improve performance, but to improve the way our hospitals function and the quality of care our patients can expect.

4 CLINICAL REDESIGN STRATEGY for HKGHS and NBHS 1. ED and access projects 2. Capacity projects 3. Patient flow projects

5 CAPACITY MANAGEMENT Discharge planning projects Length of stay projects. Visual Management Systems ->Patient Journey Boards

6 Traditional MDT meetings at our Hospitals Responsibility for discharge was not owned - nursing, medical, social work Ward rounds and MDT meetings focused on clinical care and did not have a discharge focus Most patients found out they were going home on the day of discharge Average time of discharge 4-5 pm or later!

7 Average Discharges by Time of Day 2012

8 Average Discharges by Day of Week 2012

9 Percent of Discharges on or within 24hrs of EDD SW5 SW4 Ortho Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun

10 Patient Journey Boards Significant body of national and international research and evidence demonstrate PJBs: Improve interdisciplinary care planning and discharge planning Improve interdisciplinary communication Improve efficiency of referral making and status of involvement of all clinical staff. Reduce time waste

11 Patient Journey Boards at a glance Where the patient is What is planned next for the patient Which consultant team is looking after the patient What allied health involvement is required for the patient What else the patient requires before discharge When the patient is due to go home (the Estimated Date of Discharge) Whether the discharge medication has been requested/ received Whether transport is required / has been booked to take the patient home

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14 Patient Journey Boards at Manly Hospital

15 Implementation of PJBs Establishment of Clinical Redesign strategy Executive buy in, support and governance Establishment of Discharge Clinical Redesign discharge project to drive implementation (eg DOT) Staff awareness sessions: matrix approach at ward level and across departments Implementation of PJBs managed centrally but local ward level ownership for business rules, and flexibility to grow and develop boards Monitoring and evaluation of implementation

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17 Daily PJB Rapid Rounding Multidisciplinary meeting in the form of rapid rounding held daily at the PJB. COW taken to PJB where possible. These meetings staggered through morning to allow medical teams to attend all meetings. Time: < ½ hour Multiple stakeholders attend daily rapid round: ward staff, patient flow manager, APAC nurse, ward clerk Each medical teams patients reviewed, few minutes only for each team. Ownership by all staff for updating board and managing ready for discharge by EDD Patient portal updated by NUM and Patient Flow Manager at completion of meetings Board updated at night if required and on weekends.

18 Post PJB implementation : MDT meetings Involve all staff groups, including in some wards the CSOs and ward clerks team approach Team communication focused on care planning and on discharge planning Discharge planning initiated immediately EDD established and team work towards EDD Ensure patients are aware of their discharge plan Support from all staff groups

19 RESULTS 85% of staff believed the introduction of the Patient Journey Board has been useful in improving care planning and discharge planning. 96% of staff indicated the Patient Journey Board has improved communication between health professionals. 96% of staff felt the implementation of the Patient Journey Board allows staff/patients/carers to be more aware of the estimated date of discharge. Significant improvement in AAD = EDD +/- 24 hours Improvements in number of am discharges each day

20 Percent of Discharges on or within 24hrs of EDD SW5 SW4 Ortho Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun

21 NEXT STEPS Repeat staff survey Establishment of robust KPIs for ADD =EDD and time of discharge Ongoing data collection and comparison of data to 2012 results 2 by 10 clearly identified each day for next day discharges