Winter 2015 Bankstown-Lidcombe Hospital

The Problem

Reliance on Surge Beds – 1277 occupied overnight bed days

in 2014 Winter

Large queues in the Emergency Department – up to 26

admitted patients

Patients were scattered across the facility despite a

Homewards strategy

Respiratory separations

Periods Respiratory Team

Discharges

2013 Winter (April-September) 802

2013/14 Summer (Oct-March) 456

2014 Winter (April-September) 746

2014/15Summer (Oct-March) 470

What did we already have in place? Admission Matrix

SIBR rounding in two aged care wards

ED Navigator Role

Frequent Presenters Program

Rapid Intervention Treatment Zone

Patient Journey Board Rounds

Reviewing surgical demand across the week

Plus Plus Plus

What did winter look like in 2014?

25

20

15

10

5

0

What did we do differently?

• Two audits – WAISH and WOTL

• Winter planning meetings, ED, inpatient teams and Executive.

• Used data to inform decisions

• Built on organisational culture, patient flow strategies and models of care in 2014

• Initial hypothesis – We needed more outpatient clinics or to open a winter ward

• I was wrong

Three strategies

Early Intervention Group

Respiratory Outreach Service

Specialist Geriatric Outreach Service

What were we measuring?

LOS > 9 days

What did winter 2015 look like?

700

750

800

850

900

950

1,000

1,050

1,100

1,150

1,200

04

-Jan

-15

18

-Jan

-15

01

-Fe

b-1

5

15

-Fe

b-1

5

01

-Mar

-15

15

-Mar

-15

29

-Mar

-15

12

-Ap

r-1

5

26

-Ap

r-1

5

10

-May

-15

24

-May

-15

07

-Ju

n-1

5

21

-Ju

n-1

5

05

-Ju

l-1

5

19

-Ju

l-1

5

02

-Au

g-1

5

16

-Au

g-1

5

30

-Au

g-1

5

13

-Se

p-1

5

27

-Se

p-1

5

11

-Oct

-15

25

-Oct

-15

08

-No

v-1

5

22

-No

v-1

5

06

-Dec

-15

20

-Dec

-15

Week Ending

ED Presentations 2014 v 2015

Presentations2014

Presentations2015

WINTER

40

60

80

100

120

140

16001

-Jan

15-J

an

29-J

an

12-F

eb

26-F

eb

12-M

ar

26-M

ar

09-A

pr

23-A

pr

07-M

ay

21-M

ay

04-J

un

18-J

un

02-J

ul

16-J

ul

30-J

ul

13-A

ug

27-A

ug

10-S

ep

24-S

ep

08-O

ct

22-O

ct

05-N

ov

19-N

ov

03-D

ec

17-D

ec

31-D

ec

Nu

mb

er o

f p

atie

nts

wit

h L

OS

> 9

day

s

Inpatients with a LOS >9 days (calculated daily) 2014 v 2015

LOS > 9 days2014

LOS > 9 days2015

Threshold

June-September 2014 -1277 overnight surge bed days were used, 2015 - 192 overnight surge bed days

Discharge Liaison Nurse

Transfer of Care CNS = 14 -18% of weekly discharges on a weekend.

Efficient patient journey board rounding = increased collaboration in the multidisciplinary team

Improved allocation and accuracy of clinician defined EDD

Re emphasis on the use of the Discharge Lounge

Catchcry: LOS > 9 days

Respiratory Outreach Program

Respiratory Outreach Program

Early Intervention Group

• Improved multidisciplinary teamwork in managing patients with a difficult transfer of care

• Identification of frequent barriers to discharge (‘waiting for whats’)

• Well informed Executive on transfer of care issues occurring at ward level and support where required.

• Reduced length of stay - 924 bed day reduction for LOS greater than 30 days

Geriatric Outreach Program

• The 173 patients that were seen and treated by the Geriatrician in the nursing home avoided further presentations to the Emergency Department and possible admissions.

• This resulted in a decrease of 2.27 days of the ALOS for nursing home patients over winter 2015 as compared to winter 2014.

Overall ETP

2015 Winter overview

Highlights - Improved ETP

- Average LOS reduced by 0.4 days

- Average monthly improvement of 13% in TOC

- Decrease in the use of surge beds

- Collaboration + clinician engagement

- Continuous path of advancement