1. stream 2: SURGICAL MANAGEMENTTopic: Improving Elective Patient Journeys through the HospitalTranslating Evidence into Practice: Lessons Learnt in Improving Elective Patient Journeys through Evidence-Based CarepathsPresenter: Bettina Vines(Carepath Project Coordinator)Hospital: (Hera) 9-10 May 2006Melbourne

2. KEY PROBLEMS • How do we know that our carepaths translate evidence into practice? • How do we bridge the gap between current practice and “best practice” • Could a review of care practices result in improved patient outcomes & improved outcomes for the organisation?

3. GOAL Ascertain whether Models of Care based on evidence and best practice guidelines will….. • Improve patient outcomes • Reduce length of hospital stay • Enable standardised care

4. INNOVATIONS IMPLEMENTED • First hospital to pioneer Milliman Care Guidelines (evidence based) in Australia as a model of care • Implemented the “Exceptional Models of Care” Project (EMC@M)

5. Why Care Guidelines? • Milliman Care Guidelines are: • Primarily focused on patient outcomes • Communicate best demonstrated practice - Not mean, mode, or minimally acceptable • Based on international research • Developed by a multi-disciplinary team of clinicians • Right care, right time, right place • Suited to non complicated patients and also provide alternatives for complex cases • Can be used to develop carepaths - focusing on clinical outcomes not length of stay (LOS)

6. EMC@M Process... • A multi –disciplinary working party utilised gap analysis methodology to ascertain the differences between current practice and evidence based best practice • Carepath and Patient information booklets were developed based on gap analysis results • Variance management systems were developed • Workshops / Education provided for all staff

7. Where we began …. • Pilot of EB guidelines: ( July – Sept 2003) • Target Group: Total Hip and Total Knee Replacement Patients at Mater Private Hospital • Sample size for Pilot: n=50 • 4 Orthopaedic surgeons involved • Methodology: Comparative Analysis

8. RESULTS • Improved patient outcomes / satisfaction • 90% of patients contacted at pre admission • Nursing documentation decreased 44% • Variance recording increased to 100% • Strengthened relationships with community care providers • Reduction in ALOS: • TKR decreased 17% • THR decreased 27%

9. Improving LOS ( THR) ….. *NB: QLD THR ALOS = 13.95 daysMHS THR ALOS = 6.2 days

10. The Journey Continues (2003 – 2006)Carepaths Implemented: • Mater Adult / Private Hospitals : THR/TKR, Hysterectomy, Mastectomy, Radical Prostatectomy • Mater Children’s Hospitals: Femoral Osteotomy - underway • Mater Mother’s Hospitals: Caesarean-Section

11. Mater Adult’s Hospitals Results (MAH/MPH/MPH-R) • THR/TKR & Hysterectomy Models of Care in place @ MAH and MPH • Reduced LOS results maintained for THR &TKR • Standardised care across public and private facilities • Multidisciplinary services integration bridging the gap between hospital, rehabilitation and community services • Patient satisfaction surveys: improved satisfaction and identification of care improvements needed • Evaluation (12mth) outcomes for Hysterectomy pending – ALOS reduced from 4.5 to 3.5 days

12. Mater Mothers Hospital Caesarean Section • The multi disciplinary working party has rolled out the C-Section Model of Care in the MMH in September 2004 and in MMPH in October, 2005. • RESULTS: • LOS has decreased (public) from 4.8 to 4.3 days • Development of standardised pain score • Review / standardisation of wound and bladder care policies • Improved integration of multi-disciplinary involvement • Early and ongoing monitoring of psychosocial issues (eg PND and DV)

13. EMC@M Quality Benefits • Carepaths focus on the involvement and coordination of multi-disciplinary teams • Coordinated discharge planning • Extends patient care to outside the hospital campus • Early engagement and ongoing education of patients throughout the continuum of care • Focus on achieving recovery milestones as opposed to LOS • Streamlined documentation

14. HOW WE DID IT • “Exceptional Models of Care” (EMC@M) is a project of 2years + duration … continually refining our methodology • MHS is committed long term, to ensuring that all ongoing models of care are evidence based, best practice and clinically relevant to our clients needs

15. RESOURCES USED: • Project Sponsors: Executive Directors • 1 FTE Project Manager • 2 FTE Carepath Project Coordinators (members of the Clinical Safety and Quality Unit) • 0.5 FTE Administration Officer • Strong links with integrated services of CSQU, Project Exceptional, Casemix, DONS, Nurse Unit Managers, Clinicians

16. KEY SUCCESS FACTORS and LESSONS LEARNT • Executive Support is imperative • Coalface ownership and relationship building …’’board to ward’’ • Integration of strategy into everyday health care delivery (change management, communication, acceptance) • User Group forums – ‘’having a voice’’ • Sustainability planning and realisation • Evaluation and feedback processes are vital

17. Long term commitment… • MHS is committed long term, to ensuring that all ongoing models of care are evidence based, best practice and clinically relevant to our clients needs. Exceptional Care… at the right time in the right setting.

18. Contact Details: Giselle Caswell – Project Manager EMC@M Project Exceptional – Mater Health Service e:giselle.caswell@mater.org.au m: 0404 821 794 t: 07 3840 3405 Carepath Project Coordinators(Bettina, Susan, Carol, Jenny) Clinical Safety and Quality Unit – Mater Health Service e:carepath@mater.org.au t: 07 3840 1643 t: 07 3840 8186