nsw ministry of health patient flow portal

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Prepared by Melinda Pascoe and Damian Miners Principal Policy Analysts System Relationships and Frameworks Branch NSW Ministry of Health February 2013 Patient Flow Systems and the Patient Flow Portal

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Melinda Pascoe, Principal Policy Analyst - Patient Flow Portal & Damian Miners, Principal Policy Analyst - Patient Flow Portal, NSW Ministry of Health delivered this presentation at the 6th annual Hospital Bed Management & Patient Flow conference 2013 in Melbourne. For more information on the annual event, please visit the conference website: http://bit.ly/1f3Pp03

TRANSCRIPT

Page 1: NSW Ministry of Health Patient Flow Portal

Prepared by Melinda Pascoe and Damian Miners

Principal Policy Analysts

System Relationships and Frameworks Branch

NSW Ministry of Health

February 2013

Patient Flow Systems and the Patient Flow Portal

Page 2: NSW Ministry of Health Patient Flow Portal

Agenda

Patient Flow Systems

Patient Flow Portal Capability Demonstration

Patient Flow Portal Testimonial

Future Vision

Questions

Page 3: NSW Ministry of Health Patient Flow Portal

Navigating patients

through the health

system to prevent

delays

Care Coordination

Navigating patients

through the health

system to prevent

delays

Find it, Fix it, Log it, Escalate it

Transparent

accountable

leadership

Action Orientated

Governance

Transparent

accountable

leadership

Action Orientated Demand &

Capacity Planning

Organising your

service to build

Reduce the Chaos

Variation

smoothing the peaks

and troughs to

distribute the load

No Surprises

Variation

Management

Smoothing the peaks

and troughs to distribute

the load

No Surprises

Demand

Act early to preserve

capacity

Don ’

Demand

Escalation

Act early to

preserve capacity

Don’t wait till its too late

Practice

Promote best

practice to lock in

expected outcomes

Standardised

Practice

Promote best

practice to lock in

expected

outcomes

Express, Model, Reinforce

PATIENT FLOW

SYSTEMS

Quality

Structuring systems

around an expected

outcome

Patient Centric

Quality

Structuring systems

around an expected

outcome

Quality

Structuring systems

around an expected

outcome

Patient Centric

Page 4: NSW Ministry of Health Patient Flow Portal

Supporting Policies

• Care Coordination:

Planning from

Admission to Transfer

of Care in NSW Public

Hospitals (PD

2011_015)

• Inter-facility Transfer

Process for Adults

Requiring Specialist

Care (PD 2011_ 031)

• Emergency

Department-Direct

Admission to Inpatient

Wards (PD2009_055)

Approach to Sustainable Change

Capability

Education and Training

Tools

Patient Flow Portal

Page 5: NSW Ministry of Health Patient Flow Portal

• National Emergency Access Target (NEAT)

• National Elective Surgery Target (NEST)

• Activity Based Funding (ABF)

Current Context

Page 6: NSW Ministry of Health Patient Flow Portal

1700000

1800000

1900000

2000000

2100000

2200000

2300000

2400000

2500000

2600000

2002-03 2003-04 2004-05 2005-06 2006-07 2007-08 2008-09 2010-11 2011-12

Source is NSW Health Annual Report: Total ED Attendances by Year 2002-03 to 2011-12

ED Attendances are increasing in NSW

~ 25% increase in ED

Attendances over 7 years

Page 7: NSW Ministry of Health Patient Flow Portal

• Navigating the patient through the journey

• Identify, avoid and reduce and delays

• Involve all relevant staff in planning of care

from admission

• Commence at entry to the service and

progress through to discharge and beyond

Care Coordination

Key Requirements

Transfer of Care Risk Screen

Multidisciplinary Team reviews

Estimated Date of Discharge

Transfer of Care Checklist

Referrals, appointments and follow up

Page 8: NSW Ministry of Health Patient Flow Portal

• First step to reduce variation is identify sources in existing practices that create

unnecessary peaks and troughs:

Variation in patient admission or discharge processes

Variation in clinical management

Variation in booking tests or transport

Variation in pathology processing

• Flattening variation within a complex system can lead to smoother outputs and

better outcomes

Variation Management

Page 9: NSW Ministry of Health Patient Flow Portal

• Clinical practice

Align with Evidence Based Practice

Early identification of deterioration

• Work process practices

Communication

Referrals

Booking procedures

Escalating delays

Multi disciplinary Team meetings

Utilisation of Transit / Discharge Lounges

Standardised Practice in Action

Page 10: NSW Ministry of Health Patient Flow Portal

Presentations are

predictable

Admissions are

predictable

Demand & Capacity Planning

Predictability of Emergency Department Trends

Page 11: NSW Ministry of Health Patient Flow Portal

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

12

/31

/200

7

3/1

0/2

008

5/1

9/2

008

7/2

8/2

008

10

/06

/200

8

12

/15

/200

8

2/2

3/2

009

5/0

4/2

009

7/1

3/2

009

9/2

1/2

009

11

/30

/200

9

2/0

8/2

010

4/1

9/2

010

6/2

8/2

010

To

tal sep

ara

tio

ns f

or

su

rgic

al

pro

ced

ure

s

Emergency vs. non-Emergency Surgical Admissions

emergency other

Emergency

Surgery is

predictable

Predictability of Emergency Trends

Planned

Surgery is

not

Page 12: NSW Ministry of Health Patient Flow Portal

Predictive Tool collates

information about

• Patients coming into the

hospital

• Patients exiting

• Capacity to fit demand

Data is used to inform short and

long term capacity planning:

• Calculate tipping points

• Analyse daily demand for each

ward – deliver a plan for required

discharges each day

• Analyse demand over the long

term (e.g. identifying frequent

outliers – does this service require

extra capacity?)

• Manage predicted events –

medical term change / public

holidays / events

Demand & Capacity Planning What is Predictive Tool

used for:

• Historical data

• Current Emergency

Department status

• Expected overnight

Surgical and Medical

booked admissions

• Direct admissions

• Projected discharges /

EDD

Page 13: NSW Ministry of Health Patient Flow Portal

Tipping Points

• Emergency demand

• Patient with LOS > 9 days

• Staff shortages

• Patients waiting RACF

• Isolation Patients

• Inpatients waiting for surgery

Demand Escalation

Structure format to escalate response to

demand

•Capacity Action Plan (CAP) A strategic plan

to manage expected demand

•Escalate before the problem occurs

•Short Term Escalation Plan (STEP) for

short term unforseen and immediate

mismatches

•Unpredicted demand managed through

short term solutions

Page 14: NSW Ministry of Health Patient Flow Portal

Aim:

• PFS approach is to improve quality of service, therefore quality outcomes need to

drive the evaluation of the systems performance

Quantitative Data

• Falls, medication errors, wrong surgical site, deteriorating patients, etc

Qualitative Data

• Patient Experience, Patient Survey, Co-Design, feedback loop to staff?

• Staff Experience

Quality –

Performance and Quality need to co-exist

Page 15: NSW Ministry of Health Patient Flow Portal

• Robust - in structure to lock in process and behavioural change

• Defined with accountabilities at all levels

• Transparent with processes and accountabilities

• Action orientated to make decisions and solve issues

• Maintained and committed – throughout the project and beyond

• Focussed on the patient and staff experience

Governance

Page 16: NSW Ministry of Health Patient Flow Portal

Agenda

Patient Flow Systems

Patient Flow Portal Capability Demonstration

Patient Flow Portal Testimonial

Future Vision

Questions

Page 17: NSW Ministry of Health Patient Flow Portal

Agenda

Patient Flow Systems

Patient Flow Portal Capability Demonstration

Patient Flow Portal Testimonial

Future Vision

Questions

Page 18: NSW Ministry of Health Patient Flow Portal
Page 19: NSW Ministry of Health Patient Flow Portal

Agenda

Patient Flow Systems

Patient Flow Portal Capability Demonstration

Patient Flow Portal Testimonial

Future Vision

Questions

Page 20: NSW Ministry of Health Patient Flow Portal

2013

• Increased functionality and Redesign

• Working Party of NSW Local Health District Representatives

• Releases planned for May and November

2014

• Tablet application

Future Vision

Page 21: NSW Ministry of Health Patient Flow Portal

Select a Waiting for What Reason

Page 22: NSW Ministry of Health Patient Flow Portal

Edit a Waiting for What Reason

Page 23: NSW Ministry of Health Patient Flow Portal

Default User Preferences

Page 24: NSW Ministry of Health Patient Flow Portal

Colour Coded EDD and Ward Profile

Page 25: NSW Ministry of Health Patient Flow Portal

Reports Module – Download Reports

Page 26: NSW Ministry of Health Patient Flow Portal

Reports Module – Schedule Emailing Reports

Page 27: NSW Ministry of Health Patient Flow Portal

Hospital Dashboard Login

Page 28: NSW Ministry of Health Patient Flow Portal

Agenda

Patient Flow Systems

Patient Flow Portal Capability Demonstration

Patient Flow Portal Testimonial

Future Vision

Questions

Page 29: NSW Ministry of Health Patient Flow Portal

NSW Ministry of Health

Melinda Pascoe

Damian Miners

[email protected]

Phone: 02 9391 9368