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IMPLEMENTATION OF A NEW O OMODEL OF CARE

Minimise waste and maximise use of Resources

CALOUNDRA HEALTH SERVICE

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TAKING THE LEAD INVOLVES:

PlanningDesignNurturingHolistic ApproachCommitment & VisionReview & Evaluation

PLANNING

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A CATARACT

Cat 3 : 6/12 - 6/24

Cat 2 : 6/24 - 6/48

Cat 1 : 6/48 - LP

One good eye < 6/48

Other factorsOther conditionsOther conditions

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DESIGN

Project Justification A iAssumptionsDependenciesConstraints

Project Management PlanResource ManagementResource ManagementRisk ManagementPredicted Outcomes

BILATERAL CATARACT SURGERY PATHWAYID Task Name Resource Names

% Complete: 0%1 Ophthalmologist Appt2 Case Manager PAC Assess3 OTB - designates OT Date4 Anaesthetist Assessment

1 t E S

October November December January February March April May June July

5 Cataract Surgery 1st Eye Surgery6 1 Day Post Op Appt7 2 Week Follow Up Appt8 Rebooking for 2nd Eye9 Theatre Date via OTB Cat 3. 3-6months10 Anaesthetist Assessment11 Cataract Surgery 2nd Eye 2nd Eye Surgery12 1 Day Post Op Appt13 2 Week Post Op Appt discharged17 Appointment Letter 18 OCM Phone Interview

1st Eye Surgery

Cat 3. 3-6months

2nd Eye

d

19 Ophthalmologist Appt 1st Appointment20 Case Manager PAC Assess21 Anaesthetist Assessment22 Cataract Surgery 1st Eye Surgery23 1 Day Post Op Appt24 2 Week Follow Up Appt25 2nd Eye Cataract Surgery 2nd Eye Surgery26 1 Day Post Op Appt27 2 Week Post Op Appt discharged

1st Appointment

1st Eye Surgery

2nd Eye Surgery

discharged

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PREDICTED OUTCOMES

Decreased Repetition of Patient Presentations to the Decreased Repetition of Patient Presentations to the Hospital

Reduce Anaesthetic Assessments

Improved Flow through Clinics

Planned Pathway from Initial Consultation

Familiarity of Staff to Patients & Patients to Staff

UNFORESEEN OUTCOMES

Review of Ophthalmology Emergency ManagementManagement

6 Less Chart Movements per Bilateral Cataract Patient Pathway

Referral Management Letter used to alert Referring Practitioners of minimum VA’s

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Referral for Triage

Comprehensive Review of Waitlisted Referrals

79% of total number were for cataracts

23% had better than 6/12 VA’s/

48% VA’s were less worse than 6/12

21% were non‐cataract referrals 

187 of the referrals were for pterygium,Diabetic Monitoring, lid lesions, stating blurred or reduced vision problems , Ectropions, Blocked Tear Ducts Glaucoma Ptosis StrabismusDucts, Glaucoma, Ptosis, Strabismus etc

NURTURING

Project Management Plan Document assisted

DevelopmentEncouragementFosteringPromotionPromotion

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HOLISTIC APPROACH

Whole pathway planningSupports a patient focussed model of care

Social & Emotional as well as physical needs were considered & addressed at 1st

appointment appointment

A SUGGESTED HEALTH SYSTEM HEIRARCHYThere are no Money Trees

Makes the world go round

Patient

Staff Confidence

Staff more receptive to change

Assimilate Values

Success in Quality Improvements

Patient Compliance

Waste Reduction

Enhanced Patient Experience

Staff Satisfaction

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COMMITMENT

Primary Stakeholders Nurse Leaders - 4 departments ManagementStakeholders must be included in communication to gain commitment

M di l N i g Ad i i t tiMedical, Nursing, AdministrationPatients

VISION – SPECIFIC TO THIS PROJECT

Integrated Care Pathway (ideal service to fully computerise) computerise) PAC appointments with all 1st Appointments & Completion of Care within 2 months of 1st

appointment. Planned pathway with all patientsPlanned pathway with all patientsNurse Triage

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VISION FOR SURGICAL STREAMS

Planned Pathways for all streams

Comprehensive Referrals from which to plan pathways

Optimal OT/Clinic Ratios for all Surgical Streams with

built in flexibilitybuilt in flexibility

Clear, documented definition of services

REVIEW & EVALUATION

70% of all projects undertaken – failChallenges to imbed new systems/processesChallenges to imbed new systems/processesEngaging Support – Give it a go & see!Convincing all Stakeholders to continue in/if change of leadershipSustainability – is ongoing y g g

Check/Implement/Review Check/Implement/Review

Application for other Systems

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THANK YOU