IF Quality Improvement Award Application Form

Transcription

1 Applicant Details: IF Quality Improvement Award Application Form First Name: Brett Surname: McPherson Address: Level 7, 267 Collins Street. Melbourne. Vic. Post Code: 3000 Telephone: Mobile: Primary health care organisation: Collins Street Medical Centre Medicare Local: Inner North West Melbourne Position: Manager Which IF program you have been involved in? ehealth / Shared Health Summaries, How did you hear about the award? (e.g. IF newsletter, IF website, networks) IF newsletter Upload your entry to the IF website at: Closing Date Submissions for the Quality Improvement Award will close 5pm on Friday 17 January Please answer the following question: How have you implemented a change within your primary health care organisation using a quality improvement approach? Include in your answer: An outline of how you used a technique, tool, process or system (or any combination of these) to implement your improvement. (Plan) What were the direct outcomes? (Result of implementation) What were the benefits of implementing this quality improvement approach and what have you learnt from your quality improvement efforts? (Review) What learning s would you take forward? (Improvements) Answers to the question will be assessed on the way you have made a change in your organisation through planning, implementing, reviewing and improving using a quality improvement approach / method. Please write your submission here: The submission starts on Page 2.

2 Please answer the following question: How have you implemented a change within your primary health care organisation using a quality improvement approach? OBJECTIVES: Create an efficient system for Patient Registration, whilst maintaining high quality patient demographic / clinical data Improve access to GP services Improve utilisation of the Practice Nurses and Promote concept of a Practice Primary Care Team. As a busy CBD GP practice, our anecdotal experience suggested that, by nature of our location, a significant number of patients were New Patients, many patients utilised the practice for episodic care and that Collins Street Medical Centre (CSMC) was not necessarily the prime practice for a significant number of our patients. At the same time it is a practice priority to ensure patient data exceeds RACGP Standards (accreditation requirements), provides an accurate and current clinical record for each patient and patient data is recorded in the correct fields within clinical software so as to provide accurate information as part of data interrogation and review. ( e.g. - PEN CAT reporting) The conundrum how do we maintain quality data, with so many New and Episodic patients; balancing required vs desired data and creating an efficient system to acquire and process the data? We identified that the patient registration process was the key component of the process: - identifying the nature of the patient so that appropriate high quality demographic / clinical data was being collected and maintained, whilst at the same time ensuring we utilised an efficient process that provided a positive impression for the patient s 1 st clinical contact. A time frame of 1 month was set to complete the review and initiate a revised process. PLAN: - To gain an accurate measure of the issue, we needed to quantify the magnitude of the problem. The process involved creating a number of reports from our Practice Management Software (PMS) that would provide Step 1. Number of - total patient visits per annum - New Patients attending the practice per annum - New Patients - single visits per annum - Ongoing CSMC Patients average visits per annum - New Patients per CSMC The second part of the planning process was to review the current Registration Process for New Patients. Step 2. Data - required v desired:- based on patient identification (episodic v ongoing) - when collected - where collected - time taken to collect - process from collection / registration to consultation Collins Street Medical Centre: Quality Improvement Patient Registration Process & Improved Access to GP Services 2

3 Step 1 confirm the actual patient numbers / cohort affected: period From our PMS (Zedmed) we were able to confirm - Consolidated data Total Patient Attendances 21,200 Individual Patient attendances 7,900 Avg Attendances / patient 2.7 Specific Data Episodic Care (43%) 3,400 i.e. CSMC not regular GP practice Avg Attendances / patient 1.5 Ongoing CSMC patients 4,500 i.e. CSMC IS regular GP practice Avg Attendances / patient 3.6 New Patients (NP) seen (15%) 1,187 Consulting days per annum 250 ( 50 5 days / week ) Avg NP / day 5 Step 2 review the current NP registration process (Demographic & Clinical data collection / recording). Current Appointment time 11:00 am 10:45 am Patient arrives at clinic completes registration form 11:00 am Consult with GP duration minutes. Time Taken Location By Whom Registration Form Completion 15 minutes Practice Patient Clinical Data collection/entry minutes Practice GP / PN Clinical Consultation minutes Practice GP Total Patient Practice Total Patient time with GP ~ 60 mins ~ 45 mins Issues identified identify NP type when booking appointment - episodic v ongoing treatment create Differential registration form for NP type - Part A & Part B registration forms complete registration form prior to arrival - upload registration forms to Website reassign demographic clinical data collection - utilise PN instead of the GP utilise PN preliminary consult - marketing, health prevention, CDM Collins Street Medical Centre: Quality Improvement Patient Registration Process & Improved Access to GP Services 3

4 OUTCOMES: The key outcomes that have been experienced are outlined below - Differential Registration Process reflecting NP Type (Episodic v Ongoing) initiated. Part A = minimum data set to meet needs of patient consult and conform with Accreditation requirements. final questions relate to local traveller vs resident & likelihood to utilise for ongoing care Are you an Interstate or Overseas visitor to Melbourne? Yes No Do you intend to use the practice for ongoing medical care? Yes No If YES then to Part B Part B = comprehensive questionnaire that includes desired practice data necessary for provision of quality long term care. Differential registration forms were created and uploaded to our website as pdf documents; patients could print / complete and bring with them to their 1 st appointment. This reduced the initial registration time process upon arrival. Revised Appointment time 11:00am 10:55 am Patient arrives registration completed. 11:00 am Nurse consult = 15 mins 11:15 am GP consult = mins Time Taken Location By Whom Registration Form Completion 15 minutes Off-site Patient Clinical Data minutes Practice PN Clinical Consultation minutes Practice GP Total Patient Practice Total Patient time with GP ~ 45 mins ~ 30 mins Further review modified Part B registration; removed certain clinical questions that were included as base line questions asked by PN as part of Nurse Consult Developed Nurse Questionnaire template that was used to standardise data collection as part of the PN consult The revised process reduced the time a patient spent in the practice by 15minutes. For a significant number of patients that attend a CBD practice, this can have a definite benefit in reduced time away from their workplace. Collins Street Medical Centre: Quality Improvement Patient Registration Process & Improved Access to GP Services 4

5 BENEFITS. The key benefits that have resulted from the revised process are outlined below - Improved Patient Access to GP services. Saved GP Consult time per NP = ~ 15 minutes. Average NP / day = 5 Total time saved = ~ 75 mins 80% efficiency, therefore time = 60 mins) Average patient consult = 20 minutes Additional GP consults / day = 3 Additional GP consults / year = 750 Improved Financial performance. If Average Fee / Patient = $ 60 Increased income per year = $ 45,000 (GPs retain $ 27,000 & Practice retains $ 18,000) If Average Fee / Patient = $ 85 Increased income per year = $ 63,750 (GPs retain $ 38,250 & Practice retains $ 25,500) Improved Efficiency of Registration Process through utilisation and role of PN. - ALL NP attend consult with PN for 15 mins prior to GP consult - Base line demographic & clinical data entered into correct location in clinical software; encourages GP to continue to record data in these areas. - PN promoted as integral part of Practice Care Team from 1 st contact able to assist patient with completion of Part B able to highlight preventative health / CDM issues to raise with GP able to market practice and practice services - Patients were not overloaded with clinical history questions when only attending for flu shot /minor ailment. - Administrative process far more efficient and data quality remained high. - GP commences consultation with clinical data updated / entered in software. Improved job satisfaction for PN. - The structured nature of the process and proactive role assigned to the PN provided professional recognition highlighting the key role the PN played as part of the Practice Team. - Subsequent follow-up enquiries from patients could be directed to the PN as they (PN) had been established as a key member of their treatment team at registration. Collins Street Medical Centre: Quality Improvement Patient Registration Process & Improved Access to GP Services 5

6 REVIEW & IMPROVEMENTS. All staff and patients were (and continue to be) encouraged to provide feedback on the system. From feedback a number of enhancements and modifications have occurred - Registration Forms - continue to be reviewed and as previously outlined a Nurse Questionnaire Template was developed to ensure consistency as part of the PN consult - have been enhanced to allow patients to complete and submit on-line via the CSMC website. IT innovation / adoption - NP are now able to book appointments & complete registration process on-line; this service is available 24/7 thus enhancing patient access to practice services. - Staff have immediate access to a legible form that can be imported to patient clinical file. Data Quality Operational Efficiency Future development Time frame - we continue to monitor data quality via PEN CAT. There has been no degradation in data quality - patient registration process has become an efficient process and ensured that patients do not spend unnecessary time at the practice. - we are now investigating utilising patient registration kiosks and working with our software vendor to allow direct import of patient registration form to PMS - the initial modification to the registration process was completed with the 4 week timeframe and review is ongoing. SUMMARY. The change process undertaken has achieved the original objectives of our project. Through lessons previously learned from using a PDSA process, we were able to: - clearly identify and quantify our objectives - create an appropriate strategy - implement a robust operational system & - review and adapt the process to enhance efficiency We now have an efficient registration process that better reflects the needs of our patient cohort, maintains quality patient data and promotes the value of a Practice Primary Care Team. Our registrations forms can be viewed on our website and on following pages The registration process is another aspect of our overall improvement strategy that includes, on-line repeat script request, daily Swift Clinic, On-line / smart phone appointment booking and secure electronic Result Advice service. Brett McPherson. Manager. Life Member AAPM, CPM, FAAPM. Collins Street Medical Centre: Quality Improvement Patient Registration Process & Improved Access to GP Services 6

7 Appendix 1. Patient Registration Form Part A Episodic Care. Collins Street Medical Centre: Quality Improvement Patient Registration Process & Improved Access to GP Services 7

8 Appendix 2. Patient Registration Form Part B Ongoing Patient Care. Collins Street Medical Centre: Quality Improvement Patient Registration Process & Improved Access to GP Services 8

9 Appendix 2. Patient Registration Form Part B Ongoing Patient Care Collins Street Medical Centre: Quality Improvement Patient Registration Process & Improved Access to GP Services 9

10 Appendix 2. Patient Registration Form Part B Ongoing Patient Care Collins Street Medical Centre: Quality Improvement Patient Registration Process & Improved Access to GP Services 10

11 Appendix 3. Patient Registration Form Nurse Consult Collins Street Medical Centre: Quality Improvement Patient Registration Process & Improved Access to GP Services 11

12 Appendix 4 Website screen shot Collins Street Medical Centre: Quality Improvement Patient Registration Process & Improved Access to GP Services 12