Beyond Overcrowding: Western Canadian Forum on Innovation and Evidence-based Decision Making in Emergency Care. October 26 & 27, 2007

Transcription

1 Beyond Overcrowding: Western Canadian Forum on Innovation and Evidence-based Decision Making in Emergency Care October 26 & 27, 2007

2 Presenters Suann Laurent, Senior Vice President, Health Services, Sunrise Health Region, and Dawn Calder, Executive Director, Medical Administration, RQHR

3 Agenda 1. Multi Region Program Objectives 2. The Journey 3. Pilot Project 4. Lessons Learned 5. Next Steps

4 Multi-Region Patient Flow Project: Challenges, Charter & Objectives Challenges: Lack of timely access to beds at the tertiary care centers and the home region inpatient units Patient transfer processes are not standardized Inconsistent exchange and availability of patient information within region Charter: Improve the flow of patients between regions by providing coordinated and timely access to care appropriate to their needs. Objectives: Develop a full understanding of patient flow between tertiary care centers and home regions care centers. Develop viable ideas/solutions to optimize the flow of patients between the regions. Implement pilot solution(s), measure and document the improvement outcomes

5 Project Overview Analyzed and documented current processes for patient movement between the four health regions and RQHR tertiary acute care Identified staff, process, information and policy issues that prevent effective patient flow Identified leading practices Redesigned patient transfer process and piloted it in Sunrise Health Region

6 The Journey Current State Assessment 1 day in each region (June 14/15, 2006) interviewed 108 stakeholders in 5 regions reviewed current processes, forms and performance data summarized findings

7 The Journey Developed current state value stream maps two full days for Design Team (June 28/29, 2006) conducted training session learned about Lean, Six Sigma and other tools developed value stream maps from Home Region ED to RQHR ED from Home Region Inpatient to RQHR Inpatient from RQHR Inpatient to Home Region Inpatient from RQHR Inpatient to Home Region Homecare from RQHR Ambulatory Care to Home Region Homecare from Home Region Inpatient to RQHR ED

8 Multi Region Patient Flow: Current State Value Stream Map

9 The Journey Data collection (September 2006) Leading practices document (September 2006) Data analysis (early October 2006)

10 Future State Workshop Objectives / Outcomes: Review the data analysis of the Current State Value Stream Map (cvsm) Identify root causes of inefficient patient transfers within the Multi Region Identify solutions to address the root causes using a variety of techniques Prioritize the solution using a Prioritization Matrix 1. Hi Benefit / Lo Effort 2. Hi Benefit / Hi Effort 3. Lo Benefit / Lo Effort 4. Lo Benefit / Hi Effort Identify project(s) to pilot Identified over 200 solutions Identified and developed project charters for 7 Hi Benefit / Lo Effort projects Selected - a hybrid of two projects - the best attributes of both projects

11 Root Causes Analysis Example

12 Identified Projects Proactive patient education through a patient pamphlet, physician transfer document to expedite defining the target discharge date (TDD) and communication of the discharge plan and date with physician and regions Comprehensive Use of RQBedline Across Southern Health Regions Maximize Internal Regional Health Authority Capacity

13 Identified Projects Collaborative Policies, Procedures and Standardized Forms between tertiary care and the regional health authorities Efficient use of existing technology telehealth and teleradiology Central Coordination of EMS Transfers

14 Prioritization Matrix Example Use all available technology RHA ED TO RQHR ED RHA IP TO RQHR ED 7-day /w eek tertiary services Mobile team and resources Sharing specialist support 5 Use bedline for referrals to ED Specialists see pts. In timely manner pt. holding/assessment area Specific support to EMS to EMS arrivals MRI/Nuclear med in some home regions Electronic Health Record Benefit 3 Management of care in home region Central EMS coordination Standardized info sharing Effort

15 Solutions Priority Matrix Ranking Cost Savings Estimated Improvement Benefit Ranking Project Cost Effort Project Requirements Project Timeframe Ranking 1 <$10,000 0% - 10% Little 1 <$10,000 Little Within the Scope of Multi Region Team <3 months 1 Ranking Reference 3 $10,000 - $20,000 10% - 30% Moderate 3 $10,000 - $20,000 Moderate Other departments require within the Multi Region e.g. IT 3 6 months 3 5 >$20,000 above 30% Extremely High 5 >$20,000 Extremely High Outside the scope of the Multi Region e.g. Need Sask Health Approval > 6 months 5

16 The Journey Pilot Project Goals: To ensure physicians and staff in SHR and RQHR are aware of and using RQBedline when appropriate. To provide timely and appropriate information to referring regions and RQHR on the use of RQBedline. To manage patient expectations for transfer process. To standardize policy, protocol and set of information to travel with patients.

17 KAI ZEN Kaizen Rapid Improvement Event three full days for Kaizen Team (December 5 7, 2006) Kaizen Is a rapid improvement event usually lasting from 2 5 days Kai Take Apart Zen Put Together/Make Better

18 Kaizen Event Process Identify the changes required to implement the new process(es) such as staffing, roles, training, policies, procedures and information. Identify the activities that need to be completed to prepare for a pilot of the new process(es) in one selected health region. Trial and verify the applicability of the pilot project materials in the clinical settings Develop metrics and targets to measure the success of the pilot project Finalize the pilot project logistics

19 Kaizen Accomplishments Pilot Project Goal 1: To ensure physicians and staff in SHR and RQHR are aware of and using RQBedline when appropriate. Activities Developed education material (presentations) to roll out to physicians and nurses Developed an awareness poster and a tear pad to be placed in hospitals, clinics and physician's offices Developed a comprehensive communication plan on how to inform various stakeholders

20 Kaizen Accomplishments Pilot Project Goal 2: To provide timely and appropriate information to referring regions and RQHR on the use of RQBedline. Activities Revised Bedline Case File Developed a Call Process Swim Lane Developed a Fax Disposition for Physicians Created a Data Base for reporting Identified data points for each stakeholder Developed an education tool for Bedline staff

21 Kaizen Accomplishments Pilot Project Goal 3: To manage patient expectations for transfer process. Activities Developed and verified patient transfer fact sheet and poster for hospitals waiting rooms Modified the EMS satisfaction survey Revised the roll out plan (pilot marketing plan) Made contact list of Team members

22 Kaizen Accomplishments Pilot Project Goal 4: To standardize policy, protocol and set of information to travel with patients. Activities Modified and trialed NISS Inter-Agency Referral Form Contacted NISS for pre-approval regarding the revision of the NISS form Received a confirmed reply date from NISS Developed an audit form to track usage and improvements in communication Incorporated education needs required for new form into the Pilot PowerPoint

23 After the first Kaizen Day!!!

24 Upon Completion of the Kaizen!!!

25 Post Kaizen Accomplishments Received feedback from NISS about changes to form Finalized Draft Form Executed Marketing Plan (SHR) News Release Articles TV show scripts Website Uploads Received Board & MAC endorsements (SHR) Transitioned Calls to Switch Board (RQHR) Completed Education Plan RQHR Nurse Sunrise Nurse Sunrise MD/staff Bedline RQHR UC

26 Pilot Results Results originated from: 6 Sunrise Care Centers Canora Esterhazy Kamsack Melville Preeceville Yorkton 38 Sunrise Referring Physicians 2 Regina Inpatient Care Centers Regina General Hospital Pasqua Hospital Participation included: RQHR & SHR Inpatient units, RQHR & SHR EDs, EMS, SHR & RQHR Physician Groups, RQHR SWADD team and RQBedline

27 Pilot Results (Output) Metrics Cycle time from call to RQBedline from MD in Sunrise to time connected with RQHR MD Overall Cycle time - From Sunrise MD call to patient registration in RQHR facility Percentage of patients who accessed RQHR tertiary care through RQBedline Goal * / Baseline 30 minutes* 14:21 hours 8.3 % Pilot Result 14 minutes 9:13 hours 82%

28 Pilot Results (call volume) Regional Call Volume to RQHR Bedline Call Volume Sunrise Cypress Five Hills Sun Country 20 0 April May June July Aug Sept Oct Nov Dec Jan Feb Mar Months

29 Pilot Results (Process) Metrics % and actual number of patients who were sent to ER for assessment and subsequently admitted, where the referring facility was advised by RQBedline that patient was admitted in Regina # and % of fully completed NISS Pilot Interagency Referral Forms Goal* / Baseline 90%* 0% Pilot Result 81% 25% # of NISS Pilot Interagency Referral Forms faxed at time of departure 50%-75%* 65-70%

30 Pilot Project Comments Quotes from Sunrise referring MDs in Health Matters titled "Sunrise soars with pilot": "I hope other doctors are using it because I wouldn't want to go back to the old way. I would sometimes spend half an hour on the phone trying to get a hold of a specialist. The RQBedline seems to sort that that out. The process is much more efficient.. Dr. Van Zyl "I was worried that I wouldn't be able to contact the specialists that I wanted to consult with, that I would have to use whomever was available. Instead I have found that the RQBedline is excellent. Dr. Soumbasis The final paragraph of the article is: "Rural physicians in Sunrise already give the pilot a thumbs up. Both Soumbasis and Van Zyl call the RQBedline 'excellent' and both agree, this pilot has wings."

31 Lessons Learned What Went Well Physician and staff education through various medium (+ office staff) Dedication of design team members Use of data and data analysis expertise Consultants guidance and coordination Regular status call

32 Lessons Learned What Went Well Kaizen accomplished a lot Capacity building Developed relationships and network Many good ideas generated

33 Lessons Learned What Did Not Go Well Completion rate of some forms and surveys Tight timeframe for education Patient and physician satisfaction not quantitatively measured

34 The Project Plan Activities Current State Assessment 1 day in each region (June 14/15, 2006) Develop Current State Value Stream Maps (June 27/28, 2006) Data Collection and Synopsis of Evidence (September 2006) Data analysis (October, 2006) Future State Value Stream Maps (October 17/18, 2006) Activities Pilot between two regions Eight Weeks (February 1 March 31, 2007) Evaluate pilot and lessons learned Develop sustainability and rollout plan (May 9, 2007) Rollout to remaining regions Kaizen - Rapid Improvement Event (December 5 7, 2006)

35 Next Steps Finalize Sustainability Plan metrics to be reviewed quarterly by South Regions Forum +/or Steering Committee Integrate patient satisfaction survey into HQC continuity of care survey Finalize the NISS Inter-Region Form with SAHO Design a roll-out plan specific to each region: Cypress Five Hills Sun Country Coordinate with RQHR on go live date Celebrate

36 Questions