Patient Flow Software

Patient Flow Software

You ve heard it all before! Ambulance ramping Bed block Wait lists New hospitals Alternate models of care Overflowing emergency departments

Why do we have this problem? Supply Vs demand Ageing population Use of ED for primary care Under utilisation of existing infrastructure

Solution Maximise capital infrastructure Replace ALOS with patient appropriate length of stay Hospitals are an acute setting Understand the blockages in the hospital and where they are occurring Use business intelligence to identify quantum of blockages Seek new services

Medworxx streamline patient flow and safeguard the appropriateness of care and transitions. 350+ Hospital Clients; international client base Founded in 2004; based in Toronto, ON. Listed on TSX Venture Exchange in 2007

Medworxx : Customers Expanding in USA 34% Acute-care Beds in Canada.. 4 Provincial Agreements.. 350+ Patient Flow Hospitals Canada, UK.. ~28,500 Acute-care Beds Canada, UK.. 1,900 Acute-care Beds UK..

Patient Flow Platform Appropriate Time Appropriate Place Appropriate Care

Medworxx :: Patient Throughput Solutions Medworxx offers two patient flow solutions: Patient Throughput software and a Patient Throughput Review (PTR) tool ( used by Medworxx and independent consultants) Patient Throughput Software -Operational Use- Medworxx sells Patient Throughput software to Hospitals. This software can interface with all key IT vendors. Tool tracks patients throughout the patient s stay (real-time data). Patient Throughput Review -Diagnostic Use- Medworxx provides Consulting Firms at Hospitals a review tool to collect hospital specific data related to the patient throughput process. Data can be used by Performance Improvement Teams to support their work and to monitor improvements over time.

Clinical Criteria to Optimise Patient Flow

Clinical Criteria : Clinical Value Key Enabler for Change Standardised and Objective assessments Integrate Medworxx data into Clinical & Management Processes (consultant ward rounds / strategic planning) Improve Coordination with Multidisciplinary Team and Community partners Measurement supports Management and decision making Use data to support strategic plan & Patient Flow Corporate Indicators

Clinical Criteria :: Clinical Value Ensure Appropriateness of Care Use the evidence based clinical assessments to determine: Whether patients are currently receiving care in the most appropriate setting for their needs = MET If they are not currently receiving care in the most appropriate setting for their needs = NOT MET Reason for inappropriate care settings, or causes for delays in discharge are identified Readiness for Discharge/transition Assessment = RFD Transitions the patient care plan

Standards Based Approach 1. Assess appropriate level of care Monitor and match intensity of service with level of care 2. Identify flow status and bottlenecks Identify, track primary reason for day of stay and take action on barriers, interruptions and delays 3. Assess discharge/transfer readiness Assess clinical stability and prepare for safe discharge/transfer Outcomes Improve patient throughput Reduce avoidable days Achieve timely discharge Reduce preventable readmissions Decrease LOS 1 + 2 + 3 = Enable decision making based on facts, not suspicion Turn data into information, make it visible to everyone who needs it, and make decisions based on facts

Hospitals Gain Insights Into Barriers To Discharge Clinical Criteria is used to identify causes of potentially avoidable acute care days such as Physician Unclear plan of care. Physician consultation has been ordered for physician/specialist internal to the organisation. Diagnostic tests and/or therapeutic assessments are ordered. Physician orders indicate a form of therapy not meeting criteria or beyond the time parameter. Day of stay is primarily for observation. Hospital Delay accessing services or resources provided by the organisation. Completing processing placement arrangements. Patient requires services directed towards improving independence; mobility, strength, endurance, and activities of daily living, required for a safe return to home or alternative setting. Community Waiting for acute services/consult from another facility. Waiting for community assessment or bed placement. Patient, family, social, financial or home environment barriers that delay a safe discharge.

Data and Intelligence Across the Whole Patient Flow Continuum Operational /Management Reports and System Dashboards Front Door Episode of Care Back Door Need for Admission: Need for continued Meets criteria stay: Rapid assessments Meets criteria Admit source % beds utilised Reasons for admission Totals by Provider Admission by Organisation Consultant Total by By day of week unit/provider/drg etc. Service Gaps Reasons for Delays: Days since ready for discharge/transfer Reasons for delay Delays by Consultant Delays by Service/Dept Delays by Provider Days beyond ABF Service Gaps Safe Discharge / Transfer Pull and push patients to correct level Avoidable re-admissions Integrated and shared information Risk assessments

Patient Throughput Review (PTR)

Patient Throughput Review Patient Throughput Review (PTR) Quickly Unlocks Critical Barriers to Patient Flow If patients were clinically appropriate (or not) for the level of care they are receiving. If patients were clinically ready for discharge or transition to an alternate level of care. Barriers for each acute care hospital day beyond what is clinically necessary: segmented by hospital, physician, or community. Reasons and details for each barrier or delay, such as services delays, observation days, and community placement issues.

PTR Insights :: Allows You To Effectively visualise, assess, analyse and share information to increase understanding and promote timely data-driven decisions Access a snapshots of unique patient flow barriers and delays Assess opportunities for hospital improvement via clear visibility into performance and performance gaps Profile Key Performance Indicators such as patient days, Average Length of Stay (ALOS), discharges, % occupancy, Alternate Level of Care (ALC) days and many more

Reporting and Analytics

Medworxx Glossary Term Clinical Criteria Sets Met Not-Met Readiness for Discharge Assessment (RFD) Not Ready for Discharge Meaning Standardised, evidence-based clinical criteria The patient is receiving the appropriate level of care on that day of stay. The patient no longer requires the level of care that they are receiving. Not Met criteria identifies the barrier, delay or interruption to care which is the primary reason for the patient s day of stay. Satisfying this assessment indicates a patient s clinical readiness to transition or discharge from their current level of care. The patient has unmet needs that must be satisfied before transition or discharge, but they do not require their current level of care to address these needs.

Use of Averages Ignores the Opportunity for Optimising Care to Individual Patient Needs Care Pathways, EDD and ELOS promote a focus only those patients who extend beyond the mean; this ignores: The individual variation that creates the average The safety of patients who are ready before the average or being declared medically fit The outlier patients who are the 2week + stays The result is average mediocre performance Robust validated criteria stretch performance towards global best practice Ignored Opportunity EDD or ELOS Neglected Opportunity

Patient Encounters Visibility Board Provides Comprehensive Real Time Tracking Clinical status of every patient, and associated barriers and delays are visible throughout the organisation or across a health system

Medworxx Progression of Care - Every Patient Every Day-Right Place, Right Time

Reasons and Details Provides Customisable Barrier & Delay Tracking If a patient no longer meets criteria for the level of care they were receiving, on the day of stay assessed, specific reasons for the delay are captured. Custom Built Attributes to standardise data collection and processes within the hospital or across a health system

Readiness for Discharge/Transition Assessment Provides Shared Currency This is a standardised, evidence based assessment, It is completed on every patient who no longer meets level of care requirements. If they pass this assessment patients are considered clinically stable and ready for discharge or transition to a lower level of care.

Cumulative interactive real-time view of patient journey

Medworxx Reports :Readiness for Discharge Tree Provides a tree diagram detailing the RFD days applicable to each category. Provides data as to why patients that are clinically stable remain in hospital. Possible Insights There are conservable days related to either a physician, hospital or community reasons Opportunities Drill down to reasons clinically stable patients remain in hospital Implement strategies to address/manage conservable days

Potentially Avoidable Days : Readiness for Discharge by Category Potentially avoidable days are incurred when a patient no longer meets clinical criteria for inpatient status For 38% of the days audited, patients were RFD - ready for discharge or transfer to a lower level of care. These were clinically stable patients who remained in an acute care bed. 27

Potentially Avoidable Days: Physician Reasons The majority of RFD days for Doctor-related reasons were attributed to pending plans Discharge orders required, unclear care plans, and no current physician orders contribute to the greatest number of Doctor-related RFD days. 30 25 20 15 10 5 0 24 Discharge order required Medworxx Patient Flow Avoidable Days: RFD - Physician Details (multiple reasons may be selected per day) 17 Unclear plan of care 16 No current physicians orders Pending 12 Other 28 1 Referrals: Dietician

ALOS : By Admission Day Patients who are admitted on Saturdays have an exponentially greater ALOS than patients admitted on all other days and the audit ALOS of 6.2 days. 29

ALOS :: Actual vs. Potential The ALOS for patients in this audit was 6.2 days. We evaluated what the potential ALOS could be if patients had no Ready for Discharge (RFD) days. 30

Alternative Level of Care Days Community reasons (Processing Placement and Waiting Community) accounted for the largest percentage of reasons for ALC days. All activation reasons were attributed to one patient who was clinically stable but had mobility issues post total knee replacement who could have been managed in an inpatient rehab bed. 25 Medworxx Patient Flow Alternate Level of Care: Days By Status 20 21 15 15 10 11 5 0 Processing Placement/ALC Activation/ALC Waiting Community/ALC Social Issues/ALC 31 1

Discharges by Days of the Week A very large discrepancy between the beginning of the week Mon-Weds and end of week/weekend was observed. Medworxx Patient Flow 18 16 17 14 12 10 8 13 12 6 4 2 5 5 5 4 0 Monday Tuesday Wednesday Thursday Friday Saturday Sunday Day of Discharge Charge: Count By Day Of Week 32

Reporting and Analytics Regional & Provincial Examples

Alberta Health Services :: Statistical Reports Edmonton Zone (Acute Mental Health) Total Bed Days Alternative Level of Care (ALC) categories i.e. patients occupying an acute bed who should be in an alternative level of care bed.

Alberta Health Services :: Statistical Reports Edmonton Zone (Acute Mental Health) There were 38% of patients in acute beds at a not-met, ready for discharge (RFD) status across the region.

Alberta Health Services :: Breakdown of the reasons for delay by category

Winnipeg Regional Health Authority :: Regional Patient Flow Report

Case Studies

Examples of benefits achieved by our clients - Liverpool

Medworxx Case Study Improvements Yr1 Yr2 Yr3 % Reduction Potentially Avoidable Days Achieved 40% 60% 80% New ALOS 5.28 4.92 4.56 Number of Hospital Beds Required 264 246 228 % Capacity Increase 9% 15% 21% Capacity Increase Annual Admissions 1810 3238 4891 Activity Based Funding Opportunity to increase efficiency NEAT targets Free up more beds, delivering increased capacity Changes culture of organisation to a pull from the units as opposed to a push from ED. Capacity and Throughput Theatre lists Reduced ramping/crisis management

CONTACT ASPEN MEDICAL: E: AOwttrim@aspenmedical.com.au M: +61 (0)412 042 728