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Lessons Learnt Workshop May 4-5, 2004 - Sydney

The Health Roundtable. New Zealand. Lessons Learnt Workshop May 4-5, 2004 - Sydney. Index of Presentations. Improving the Journey for Chronic Complex Patients. Index of Stream 1b Presentations with Quick Links Workshop Aims and Honour Code

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Lessons Learnt Workshop May 4-5, 2004 - Sydney

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  1. The Health Roundtable New Zealand Lessons Learnt WorkshopMay 4-5, 2004 - Sydney

  2. Index of Presentations Improving the Journey for Chronic Complex Patients • Index of Stream 1b Presentations with Quick Links • Workshop Aims and Honour Code • Session 1b. Improving patient discharge alternatives If you view this document as a “Slide Show”, clicking on the hyperlinked text (the turquoise and underlined text) will take you to that particular page in the report

  3. 2. Persuasion 3. Decision 3. Decision 2. Workshop Aim AIM: SHARE INNOVATIONS TO IMPROVE HEALTHCARE Looking for differences! How to speed up action? 1.Knowledge 5. Confirmation The Roundtable Process 4. Implementation

  4. 2. HRT Honour Code • All those who participated in the workshop and who have received this set of slides agreed to be governed by the following HRT Honour Code • No participant shall criticise the performance of other member hospitals, or use any of the information to the detriment of a fellow member. • No external distribution of data or conclusions based on Health Roundtable workshops or data is made without the consent of each person contributing materials.

  5. Stream 1 - Improving the Journey for Chronic Complex Patients

  6. Session 1bTopic: Improving Patient Discharge Alternatives Transition Care – the City Views Project + long stay flaggingPresenter: Ingrid VogelzangHospital: Flinders Medical Centre 4-5 May 2004Sydney

  7. KEY PROBLEMS • 30% of long stay patients across three metro hospitals require long term residential care placement – many patients & families need time to make decision and find a place in an acceptable facility • Average of 50 non-acute long stay patients being accommodated in acute hospital beds at any one time contributing significantly to bed block and dangerous ED waits • Acute sector is an inappropriate setting for many such long-stay patients and contributes to adverse events • Transitional Care & Step Down are poorly defined terms and models without efficacy information

  8. INNOVATIONS IMPLEMENTED • Short term Transitional Care program developed and implemented by consortium of 3 hospitals and an aged care provider with DHS approval and support • New 36 bed facility set up, equipped and funded • Combination of rehabilitation and aged care provided • Possibility of boosting rate of discharge home from the new facility

  9. INNOVATIONS IMPLEMENTED • Evaluation in the form of a 6 month randomised control trial to establish program efficacy and safety Transitional Care (intervention) group vs Standard Care (in hospital) group • Criteria for evaluation are: Safety, Outcomes (for patients and principal caregivers), RCS levels, Cost, Efficiency, Length of stay, Discharge destinations, Satisfaction, Staff recruitment/retention

  10. HOW WE DID IT • Project Started • 24th July 03 • Project Champion: • Deputy CEO - Hospital 1 • Director of Rehabilitation and Aged Care - Hospital 2 • Executive - ACH Residential Aged Care Group • Team Composition - core group included: • Executive staff from Hospitals 1 & 3 • Specialist in Rehab & Aged Care Hospital 1 • Rehabilitation and Aged Care Director from Hospital 2 • Executive staff from residential aged care provider (ACH)

  11. Resources Required: • Expertise • Residential aged care service provision (ACH) • Medical – GP, Rehab & Aged Care Specialist (??fte) • Allied health (3fte) • Aged Care specialist nurse (1fte) • Research/Evaluation skills • Recurrent “Transitional Care” program funding (18 months initially (lease, Med & AH staffing, utilities, bed licenses, management fees etc) - $676,000 • Buy-in from CDHA (Residential Aged Care subsidies) • Patient bed day contribution • Special Funding: • Equipment - $342,000 • Evaluation - $ 75,000 • Contingency - $ 90,000

  12. OUTCOMES SO FAR • The service has been acceptable to families and staff at Hospitals 1 & 2 It has been less acceptable at Hospital 3 because of the travel distance involved for families. Two patients have requested transfer out of City Views because families were dissatisfied with the model. • Functional improvements in mobility and transfers occur at City Views but this does not translate into a change in Resident Classification Scale (RCS). • A proportion of the patients have returned home (11 of the 116 discharges to date) however rate is no better than control group rate

  13. OUTCOMES SO FAR • The service has improved length of stay in both Hospital 1 & 3. When compared with the control group those transferring to City Views have significantly shorter times in hospital (median LOS 32 days vs 43 days, p<0.001). • However those remaining in hospital find a permanent bed more rapidly than those transferred to City Views. More work is planned to improve the placement procedures at City Views • As currently constituted City Views succeeds primarily as a hospital substitution program

  14. LESSONS LEARNT • Additional funding needed for provision of equipment and to increase residential care nursing ratios to deal safely with the turnover of 17 admissions per month (average). • Need to negotiate with CDHA to ameliorate the current 8 hours/patient residential care placement documentation (approx 1fte position) given the transitional nature of the facility • Increase bed numbers to at least 42 to enable Residential Aged Care provider to break even • Establish clear lines of authority for facility management within the joint funding model.

  15. Long Stay Flagging

  16. Total Patient Excess Days >14 2000 1800 1600 School Holidays 1400 1200 Number of days>14 1000 LS pt to NHS 800 NHS taking more pts FMC Home support 600 RGH VRE H@H additional staff from 20/7/02 400 8 medical beds and 4 surg beds closed since 6 July 200 0 14/06/2002 16/06/2002 18/06/2002 20/06/2002 22/06/2002 24/06/2002 26/06/2002 28/06/2002 30/06/2002 02/07/2002 04/07/2002 06/07/2002 08/07/2002 10/07/2002 12/07/2002 14/07/2002 16/07/2002 18/07/2002 20/07/2002 22/07/2002 24/07/2002 26/07/2002 28/07/2002 30/07/2002 01/08/2002 03/08/2002 05/08/2002 07/08/2002 Date Excess Days

  17. Total Patients and Excess Days >14 2500 100 90 2000 80 70 1500 60 Number of patients Excess days 50 1000 40 30 500 20 10 0 0 01/02/2003 01/03/2003 01/04/2003 01/05/2003 01/06/2003 01/07/2003 01/08/2003 01/09/2003 01/10/2003 01/11/2003 01/02/2004 01/03/2004 01/04/2004 01/06/2002 01/07/2002 01/08/2002 01/09/2002 01/10/2002 01/11/2002 01/12/2002 01/01/2003 01/12/2003 01/01/2004 Date days pts

  18. LESSONS LEARNT • Modify model to nursing-led rather than allied health led • Increase access to discharge planning and placement expertise within the program to reduce LOS, increase turnover and therefore maximise the capacity to assist acute sector • Include funding of substantial back-up from hospital clinical unit (staff, resources, access to beds) or re-organise model of care to achieve this aim within the current boundaries.

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