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A Balanced Set of Clinical Measures and the discussions they have provoked

A Balanced Set of Clinical Measures and the discussions they have provoked. Bruce George Executive Director (Operations) Quality, Improvement and Patient Safety Capital & Coast DHB. SITUATION (September 2013). Lots and lots of bar graphs Many providers of “data” and “charts”

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A Balanced Set of Clinical Measures and the discussions they have provoked

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  1. A Balanced Set of Clinical Measuresand the discussions they have provoked Bruce George Executive Director (Operations) Quality, Improvement and Patient Safety Capital & Coast DHB

  2. SITUATION (September 2013) Lots and lots of bar graphs Many providers of “data” and “charts” Multiple systems from which data is extracted Some data extracted and turned into charts without any internal oversight

  3. SITUATION (September 2013) Inconsistent definitions Some very complex denominators to “enable” comparisons Multiple (connected?) committees where insight from data or charts is discussed

  4. CURRENT STATE (April 2014) Standard Balanced Set of Clinical and Quality Measures Clear definitions of “counts” to drive improvement Discussion, agreement and action at Clinical Governance meetings

  5. CURRENT STATE (April 2014) Balanced Set includes: Patients Discharged Deceased (monthly) SAC 1 & 2 events (monthly) Placements to Aged Residential Care (monthly) ED 6 hour target (weekly) Hospital Occupancy at 4pm (daily) All Reported Events (weekly) Readmissions (monthly) Complaints (weekly) Falls (monthly) Medication / Fluids errors (monthly) Pressure Sores / Ulcers (monthly) Peri-operative Harm (quarterly) Restraints / supportive Devices (monthly) Safe Staffing (monthly)

  6. INVESTIGATIONS (April 2014) Investigations into signals Readmissions Safe Staffing Peri-operative Care

  7. INVESTIGATIONS (April 2014) Investigations into signals Readmissions Safe Staffing Peri-operative Care

  8. INVESTIGATIONS (April 2014) Initial analysis using existing tools Unforeseen readmission – new problem Unforeseen readmission – existing problem

  9. By Specialty: Monthly Readmit Rates (Jan12 to Jan14) • Three specialties highlighted as higher rates – understandable as likely to be complex cases

  10. By original visit LOS Readmissions All Admissions • Distributions of LOS resulting in a readmission are in synch with those of all admissions

  11. By Clinician: General Medicine Doctors names Doctors names • Readmit rates largely in synch with the overall admission rates per clinician

  12. By DRG: General Medicine Readmissions All Admissions • Readmission DRG’s in synch with total IP admission DRG’s, except X62 & G70

  13. Outcomes of Readmissions analysis Has driven development and deployment of new charts, insight from data and discussion at Clinical Governance No clear single reason for increase but two DRGs to investigate further Progress with internal clinical audit Include Primary Care in investigations

  14. Visibility of data and analysis of signals has driven Greater use of Central Dashboard Planning for Operations Centre to optimise flow & safety CURRENT STATE (April 2014)

  15. CURRENT STATE (April 2014) Visibility of data and analysis of signals has driven Greater use of Central Dashboard Planning for Operations Centre to optimise flow & safety

  16. FUTURE STATE (December 2014) Standard Balanced Set of Clinical and Quality Measures Clear definitions of “counts” to drive improvement Discussion, agreement and action at Clinical Governance meetings

  17. FUTURE STATE (tbc) Charts (Statistical Process Control) accessed via intranet dashboard. Proactive not reactive - act upon early warning from signals not trends. Analysis for improvement (count) and comparison (rate). Full DHB perspective not just Hospital. Integrated Operations Centre

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