A3 TEMPLATE - RQHR STRATEGY

Transcription

1 A3 TEMPLATE - RQHR STRATEGY Title: ED Waits and Patient Flw Strategy Which prvincial hshin/utcme des this strategy supprt: By March 31, 2017, n patient will wait fr care in the Emergency Rm. Primary Owner (SLT Lead): David McCutchen/Sue Neville Team Lead(s) (Leaders f key initiatives): Glen Perchie, Jhn Ash Expert Advisr (if applicable): 1. Prblem Statement (Current state and the reasn fr actin.) [Explain what and hw big the prblem is and why strategic actin is required t address it.] Date f Original Draft: March 2, 2014 Date Last Updated: Estimated Requirements: Estimated Resurce Requirements: 4. mentatin Plan (What are the high-level actins that will be taken t address the prblem within the given timeframe? What actins need t be taken t achieve the future state?) [Mre detail can be included in a separate implementatin plan.] One f the eight negative patient experiences raised within the Octber 2009, Patient First Review was feeling inadequately served in hspital emergency rms. Mre specifically, the mst cmmnly heard negative experience was excessively lng waits (i.e. 3 hurs r mre) in hspital emergency rms. Key Areas t Wrk On (fill ut supprting multi-year summary as well attached) 1. Accuntability Framewrk Wh Date Health Quality Cuncil s 2010 Saskatchewan Emergency Department Patient Experience Survey, which included results frm 14 f Saskatchewan s busiest emergency departments (EDs) fund the fllwing: Only 22% f patients rated their verall experience as excellent. Patients are almst 3 times as likely t rate the experience as excellent wh als identified their time in the ED as excellent. 44% access the ED because there is n ther ptin available. 60% waiting mre than 30 minutes befre they were examined by a dctr. 27% f patients reprted that their identity was nt cnfirmed by staff befre receiving medicatins, treatments r tests. 2. Human Resurces 3. (and/r ther majr infrastructure requirements) 4. Technlgy ( IT/IM/Heath Technlgies/Equipment) 5. Plicy/Legislatin In January f 2012, the Premier f Saskatchewan challenged the health care system acrss the prvince t eliminate waits fr emergency rm treatment. And reinfrced this directin in Octber 2012 with the release f the Saskatchewan Plan fr Grwth. 6. It is knwn that lng-waits in the emergency department are a symptm f multi-faceted prblems impacting patient flw acrss the cntinuum f care, and that t reduce ED waits, the rt causes must be identified and addressed (i.e. Why peple are ging t the EDs). 2. Rt Cause Analysis (What is causing the prblem and what evidence can be prvided t supprt the analysis?) [Highlight baseline data and analysis that helps clarify the magnitude f the prblem statement and narrws the fcus fr the future state sectin. What are the barriers impeding change r success?] (Fr strategies f large scale this sectin can be supplemented by prject plans r ther plan template. See example f Multi-Year Plan template the MOH is using.) 5. Metrics (Hw will yu knw whether the prject is successfully mving twards the future state? Hw will yu knw a change has been an imprvement?) [Identify bth utcme and prcess metrics that will help indicate the prject success and include balancing measures t ensure the prject desn t negatively affect ther metrics. These shuld relate t the actins nted abve in the implementatin plan sectin]

2 Lng waits and vercrwding in the EDs is an issue that is caused by multiple failure pints and bttlenecks in the system related t patient flw acrss the cntinuum f care: 1. High vlumes f patients accessing ED fr their care needs as a result f: Inadequate primary care ptins available in the cmmunity (less urgent, nn-urgent); Lack f awareness f existing alternatives; Lack f same day access t primary health care (PHC) services; Lack f after-hurs and weekend ptins fr primary and urgent care services; Specialists using EDs as an ambulatry clinic r admissin clinics; Peple attending ED t receive mre timely access t diagnstics services. 2. Operatinal inefficiencies within the ED (intake prcedures, registratin, triage, access t diagnstic services, crdinatin f specialty cnsults). 3. High ccupancy rates in inpatient medical/surgical/mental health units. Evidence is clear that when ccupancy rates in inpatient units is greater than 85% that back up int the ED ccurs. The fllwing cntribute t high ccupancy rates: Lack f cnsistent discharge planning prcesses; High variatin in clinical practice. Lack f standardized care pathways. High frequency readmissins. Admissins being made t access diagnstics in mre expedient fashin. 4. The high number f alternate level f care (ALC) days in acute care, which can be attributed t: Lack f capacity in alternate care settings; Issues regarding repatriatin t hme hspital frm tertiary hspitals. 5. Lack f apprpriate cmmunity resurces and supprts Lack f cmmunity-based supprts that enable patients t reside in the cmmunities withut seeking emergency rm r acute care services (e.g. senirs, mental health & addictins, and patients with cmplex medical, scial, and behaviural needs). Wait times in the emergency department are a symptm f deficiencies that ccur acrss the cntinuum f care. As such, slutins will need t be sught in each phase f the patient s jurney thrugh the system. Prvincial Measures: Hshin Outcme Measure 1-50% reductin in ED waits (Physician Initial Assessment) fr CTAS 3, CTAS 4 and CTAS 5 Prcess measure 1-25% reductin in ED LOS fr CTAS 4 and CTAS 5 Balancing Measures 1 - Number f patients LWBS (left withut being seen) & - Decrease r n change in PIA fr CTAS 1 and CTAS 2 Outcme Measure 2 - At least 85% f patients requiring admissin frm ED admitted t an apprpriate bed within 5 hurs Prcess Measures 2 - Maintain the number f ALC days (waiting placement) acrss the prvince and in each regin at n mre than 3.5% f ttal. - Establish baseline measure fr ALC days (CIHI definitin) - 25% reductin in the delay frm the time a bed is assigned t the time patient arrives t IP bed Balancing Measure 2 - N change r a reductin in Acute Care 30 and 60 day Readmissin Rates Patient Experience Measure - A measure assciated with the verall care experience related t patient s expectatins RQHR Measures Outcme Measure 1 - Medicine Occupancy 95%; - Surgical Occupancy 85% - Critical Care Occupancy 85% Prcess Measures - 100% f Patients have a visible care and discharge plan. - 50% reductin in the delay frm the time a bed is assigned t the time patient arrives t IP bed - % f patients waiting ALC placement less than??% f ttal

3 - At least 85% f patients requiring admissin frm ED admitted t an apprpriate bed within 4 hurs Target Statement (Describe the future state by March 31, 2017.) 6. Engagement (Hw is this plan infrmed by the principles f Patient and Family Centred Care and hw are patients and families being engaged in the wrk? Please als explain hw physicians are being engaged as well as any ther necessary stakehlder.) Prvincial Outcme: - By March 31, 2017, n patient will wait fr care in the Emergency Rm. Prvincial Target: - By March 31, 2015, decrease by 50% the wait times in the ER (need t cnfirm updated wrding re. physician initial assessment).

4 Multi-year Summary Which prvincial hshin/utcme des this strategy supprt: By March 31, 2017, n patient will wait fr care in the Emergency Rm. Imprvement Targets: By March 31, 2015, decrease by 50% the wait times in the ER (need t cnfirm updated wrding re. physician initial assessment). Hshin r Shrt Term Target: At least 85% f patients requiring admissin frm ER are admitted t an apprpriate bed within 5 hurs Key Areas t Wrk On Lead / Supprt Accuntability Framewrk (PF prgram gvernance) Steering Cmmittee Advisry Cmmittee (Service line and KOT) Develp Leaders Standard Wrk fr Patient Flw PF Vis Wall Schedule ment Prgram Planning Cycle Length f Stay Reductin Develpment f perating guidance LOS utlier management prcess and functin. Develpment f requirements fr Service Line Capacity Plans. Develpment f standard prcess fr unit and acute site daily prductin reprting Visible Patient Care and Discharge and Plans Patient Flw Key Areas t Wrk On Lead / Supprt Patient Flw Prgram Accuntability Framewrk Planning Cycle Gvernance LOS Reductin Develpment f Discharge Risk assessment tl and standard wrk Care and discharge plan barrier reprting Standard wrk, reprting and audit prcess Onging Kiazen cycle Additinal wrk will be defined thrugh implementatin f prgram Patient Flw Key Areas t Wrk On Lead / Supprt Accuntability Framewrk Planning Cycle Gvernance Additinal wrk will be defined thrugh implementatin f prgram gvernance and planning cycle. Outcme will be imprved detail n multi-year planning Patient Flw Key Areas t Wrk On Lead / Supprt Accuntability Framewrk Planning Cycle Gvernance Additinal wrk will be defined thrugh implementatin f prgram gvernance and planning cycle. Outcme will be imprved detail n multi-year planning Patient Flw

5 ( inclu TDD, white bards) Establish- plicy framewrk, standard, criteria and audit prcess ment demand capacity predictability tl Develpment f tl Adjustment f Amendment f MDR and RTDC standard wrk Care and discharge plan barrier reprting Standard wrk, reprting and audit prcess ment Kiazen cycle Technlgy Supprt fr implementatin f Predictive tl Supprt fr develpment f Patient Flw Reprting Capital ptential fr IT infrastructure (servers) Cnsultants- develpment f predictive tl, and reprting Human Resurces Crss functinal staff participatin fr prgram develpment and activity Access t Reel Time Data Understanding Data surces and interpretatin. gvernance and planning cycle. Outcme will be imprved detail n multiyear planning Medicine Service Line Accuntability Framewrk Accuntability Accuntability Accuntability

6 Mdel f Care mentatin Human Resurces Technlgy Plicy/Legislatin Add in prjectins fr related budget pressures CCA Supprt t Cardiac Arrests ALC Beds fr Elderly pt discharge planning assessment Bedline Patient Referral standard wrk Cnsultant respnse t calls frm clinic physicians in timely manner. Multiple Islatin patients in ED requiring inpatient beds Cmprehensive wrk pertaining t T meets. Suitability, staging, and lcatin. Hspitalist usage IT Training Supprt fr Lcums Family Medicine n-call rtatins Framewrk Mdel f Care mentati n Human Resurces Technlgy Plicy/Legislatin Add in prjectins fr related budget pressures Framewrk Mdel f Care menta tin Human Resurces Technlgy Plicy/Legislatin Add in prjectins fr related budget pressures Framewrk Mdel f Care mentat in Human Resurces Technlgy Plicy/Legislatin Add in prjectins fr related budget pressures

7 After hurs SCA Patients pst bipsies and prcedures requiring mnitring r recvery services Right patient in Right bed Direct admit Onclgy versus ED stp fr wrk up. Develpment f Clinical Pathways fr t 6 Chrnic cnditins Pilt and implement Patient Intake prcessash Accuntability Framewrk Mdel f Care mentatin Human Resurces Technlgy Plicy/Legislatin Add in prjectins fr related budget pressures Slidify and implement Trauma Prgram Surgen Respnse t trauma when in OR with lng case. Use f Shrt Stay Units fr Endscpy/GI unit patients Surgical Service Line Accuntability Framewrk Mdel f Care mentati n Human Resurces Technlgy Plicy/Legislatin Add in prjectins fr related budget pressures Accuntability Framewrk Mdel f Care menta tin Human Resurces Technlgy Plicy/Legislatin Add in prjectins fr related budget pressures Accuntability Framewrk Mdel f Care mentat in Human Resurces Technlgy Plicy/Legislatin Add in prjectins fr related budget pressures

8 Accuntability Framewrk Mdel f Care mentatin Human Resurces Technlgy Plicy/Legislatin Add in prjectins fr related budget pressures Accuntability Framewrk Mdel f Care mentatin Human Resurces Technlgy VP Medical Services Accuntability Framewrk Mdel f Care mentati n Human Resurces Technlgy Plicy/Legislatin Add in prjectins fr related budget pressures Primary Care Accuntability Framewrk Mdel f Care mentati n Human Resurces Accuntability Framewrk Mdel f Care menta tin Human Resurces Technlgy Plicy/Legislatin Add in prjectins fr related budget pressures Accuntability Framewrk Mdel f Care menta tin Human Resurces Accuntability Framewrk Mdel f Care mentat in Human Resurces Technlgy Plicy/Legislatin Add in prjectins fr related budget pressures Accuntability Framewrk Mdel f Care mentat in Human Resurces

9 Plicy/Legislatin Add in prjectins fr related budget pressures Enhance Extended hurs Clinics Enhance Extended hurs Diagnstics (Lab and Imaging) Cnnecting rphan patients t GP Direct access fr extended hurs diagnstics frm Meadw r Fur Directins Cmmunicatin f all strategies t rural physicians Accelerate Discharge Frm ED (Orphan Pts) Hw will patients be seen at Meadw after being seen in ED? Primary Care - Hme Care facilitating cnversatins re: discharge Hme IV Therapy and Fllw-up with n GP IV treatment - Emergency treatments - transfer f care frm ED physician t MRP ut f hspital Accelerated Discharge frm ED with supprt f HFQR. Technlgy Plicy/Legislatin Technlgy Technlgy Plicy/Legislatin Plicy/Legislatin Add in prjectins fr related budget pressures Add in prjectins fr related budget pressures Add in prjectins fr related budget pressures

10 Accuntability Framewrk Mdel f Care mentatin Human Resurces Technlgy Plicy/Legislatin Add in prjectins fr related budget pressures Mental Health and Addictins Service Line Accuntability Framewrk Mdel f Care mentati n Human Resurces Technlgy Plicy/Legislatin Add in prjectins fr related budget pressures Accuntability Framewrk Mdel f Care menta tin Human Resurces Technlgy Plicy/Legislatin Add in prjectins fr related budget pressures Ensure Acceptance f Patients referred frm rural physicians t psychiatrist d nt require ED physician medical clearance prir t acceptance. Accuntability Framewrk Mdel f Care mentat in Human Resurces Technlgy Plicy/Legislatin Add in prjectins fr related budget pressures * Ntes