Shorter Stays NMDHB

Data Analysis

NMDHB

• Nelson ED• 25,500• 334 breaches = 98%

• Wairau ED• 21,000• 752 breaches = 96%

• NMDHB– no EDIS– no whiteboard – outdated PMS

Hospital's cat missing BY CLAIRE CONNELL

Wairau Hospital has lost its much-loved pet, Norman, and wants people to help with any sightings of the ginger cat

ED Process• Triage time recorded directly on PMS• Clerical staff transcribe hand written time seen, discharge time, diagnosis and

disposition into PMS• Business support team collate this data into monthly reports• Two hospitals – multiple separate reports and some combined• Electronic data available:

• No further electronic detail available or searchable• So….

Triage time Number of patientsATS Triage benchmarksTime seen EDLOSTime discharged Admission ratesED handwritten diagnosis - not codedDisposition

Photo of big pile of notes

The SpreadsheetNHI Name Age Triage Triage date Visit Time EDLOS Doctor Disposition Complaint/Diagnosis

FDF6796   43 4 08/10/2010 17:30 8.2     PR BLEED

CZC9233   64 3 09/10/2010 10:18 7.5   Admitted BACK PAIN

AKN0299   29 3 09/10/2010 13:50 6.3   Admitted PUJ OBSTRUCTION

BQM1407   41 3 13/10/2010 01:00 6.0     ABDO PAIN ? CAUSE

MGX4583   18 2 14/10/2010 00:15 8.1     PNEUMONIA

CFM7017   50 2 14/10/2010 12:52 10.0   Transfer #C5/6

RRA8628   52 2 15/10/2010 14:10 7.5     CHEST PAIN

LNQ8487   48 2 16/10/2010 03:32 7.5   Admitted PANCREATITIS

CDA8286   38 3 16/10/2010 10:58 8.2     POLYPHARMACY OD

AJB1690   30 2 17/10/2010 02:25 12.0   Admitted OVERDOSE

DTJ9674   76 4 17/10/2010 13:35 7.7     CELLULITIS (L) LEG

BYE1944   29 3 18/10/2010 00:40 7.8     SEIZURES

BRB6026   72 3 18/10/2010 02:42 7.5     UTI

BRM1207   77 3 18/10/2010 03:30 8.4     RENAL COLIC

ATH1375   68 5 20/10/2010 10:45 6.4   Admitted WOUND INFECTION

LAB6373   21 2 20/10/2010 11:54 7.0   Admitted ABDO PAIN? CAUSE

FZF9290   54 2 21/10/2010 02:44 8.8     CHEST PAIN TROP NEGATIVE

Making sense of it all

• Not a perfect science– Appropriate– Clinical Decision Making (the doctor, patient complexity,

time of day)– Test Delay– Delay in RV– Access Block

• Which Doctor?• Which team?• When?• Admitted or Not?

T1 T2 T3 T4 T50

20

40

60

80

100

120

140

160

180

200

Breach by Triage Code

Breach by Triage Code

ENT/Fax-Max

Med O&G Ortho Psych Surg Urol0

20

40

60

80

100

120

140

160

Nelson ED Breaches by Specialty

TransferredAdmittedDischarged

ENT/Fax-Max

Med O&G Ortho Psych Surg Urol0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Nelson ED Breaches by Specialty

TransferredAdmittedDischarged

Med All Surgical Psych0

50

100

150

200

250

Nelson ED Breaches

Discharged Admitted Transferred

Med All Surgical Psych0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Nelson ED Breaches

Discharged Admitted Transferred

0000

-010

0

0100

-020

0

0200

-030

0

0300

-040

0

0400

-050

0

0500

-060

0

0600

-070

0

0700

-080

0

0800

-090

0

0900

-100

0

1000

-110

0

1100

-120

0

1200

-130

0

1300

-140

0

1400

-150

0

1500

-160

0

1600

-170

0

1700

-180

0

1800

-190

0

1900

-200

0

2000

-210

0

2100

-220

0

2200

-230

0

2300

-240

00

5

10

15

20

25

30

35

40

Time of Day that Patients Breach - Nelson ED 2010-11

27%

24%9%8%

32%

Daytime Breaches - greatest contributor

Clin Decision making

Delay to RV

Lab & Rad

Access Block

Appropriate

15%

44%15%

27%

Evening Breaches – greatest contributor

Clin Decision making

Delay to RV

Lab & Rad

Access Block

Appropriate

19%12%

31%4%

34%

Overnight Breaches - greatest contributor

Clin Decision making

Delay to RV

Lab & Rad

Access Block

Appropriate

1 14 27 40 53 66 79 92 1051181311441571701831962092222352482612742873003133263393520

2

4

6

8

10

12

14

16

Nelson EDLOS > 6 Hours : Oct 10 - Oct 11LO

S in

Hou

rs

How was the data used?

• Informing ED team – more watchful attitude (both nurses and doctors)

• Added EDLOS to the SBAR handover tool• Bed managers more aware• Target the surgeons• Improved lab TAT’s• Medical Triage for patients referred

to inpatient teams• New admission policy Wairau ED

Jul-0

8

Sep-08

Nov-08

Jan-09

Mar-0

9

May-09

Jul-0

9

Sep-09

Nov-09

Jan-10

Mar-1

0

May-10

Jul-1

0

Sep-10

Nov-10

Jan-11

Mar-1

1

May-11

Jul-1

1

Sep-11

Nov-11

Jan-1292.0%

93.0%

94.0%

95.0%

96.0%

97.0%

98.0%

99.0%

100.0%

0

500

1000

1500

2000

2500

3000

3500

4000

4500ED Length of Stay - NMDHB

Wairau ED Nelson ED Total ED Visits per Month

% P

atien

ts D

isch

arge

d <

6 H

ours

Patient presentations per month