Artemis Presenter: Karry Durning, Phil Wood, Suzanne Lawes

1. Hospital Presentation HRT1014 – SAFE/Long Stay Patient Melbourne, October 2010 Artemis Presenter: Karry Durning, Phil Wood, Suzanne Lawes

2. KEY PROBLEM Brief summary of the long-stay patient situation as at March 2010 Daily ward round with medical/nursing leadership ( loss of medical champion) Completion of data base with over 80 case studies looked at and analysed Blog released to senior member of the Hospital for reading. Identification of areas of work to commence • Brief summary of the long-stay patient situation as at October 2010 • Loss of medical champion • Ward round happening 2-3 days a week, inclusive of nurse manager group completing case review and involvement of senior medical staff. Still need to get a larger pool of SMO to join roster. • Ready to pilot standardised MDT and early identification tool in next couple of months • Ward round now consists of talking to the patient and family about their experience

3. Top 5 diagnoses, as identified by the hospital, as at June 2010. 1.PICC Lines- has now been removed since putting in 2 dedicated sessions. Needs to be audited since introduction of service to get visibility on what the delays look like now. Definitely not picking this up now in ward round 2.Multi disciplinary team meeting does not include medical staff and there is no standard approach to meeting. Meeting is often weekly and for short periods of time. Documentation within notes is limited with no formal plan. Meeting often tries to include all patients on ward. We would like to identify patients that are at risk of being long stay and concentrate on their discharge 3.We know that doing the rounds that we can clearly identify patients that are at risk of becoming long stay/stranded patients. Introduction of at risk tool. 4.Lack of robust TPN service that currently does not allow us to wean as early as we can or discharge our patients into the community Diagnosis as at June 2010

4. Getting the patients rounds back to 5 days a week Getting all clinicians to invest the time and see the worthwhile benefits of the rounds and actions. Everyone very busy as just come through a busy winter and changes to senior management. Getting the pilots established and evaluated, getting another win under our belts. Build on the credibility that looking at these patients as a priority does make a difference. Getting an increase in FTE for the TPN role What are the major issues the project currently faces ?

5. INTERVENTIONS What interventions did we undertake and why? Continue with the long stay rounds as we know this does reduce numbers. Still trying to embed this within normal practice and introduce more medical and nursing personal to the roster. Implemented the regular sessions for PICC line insertion Need to introduce the tool to indentify patients at risk of staying Need to implement new standardized MDT meeting prioritizing patient from the early identification form. Work on business case to improve the TPN service What is the goal of these intervention(s)? (What measure are we targeting?) Reduce our long stay patients by 20% Reduce the wait time for PICC lines to within 72 hours. Need visibility within the hospital of patients waiting at operational meeting. This needs to be expanded to all diagnostics Increase planning for complex patients and decrease ALOS by better discharge. Reduce length of stay for TPN patients.

6. What changes did and are we implementing? Now talk to the patient and family regarding their experience Regular PICC sessions Arranging pilot with orthopaedics/surgery/medicine for standardised MDT Arrange pilot of introduction of Early identification form within some surgical wards

7. Daily Monitoring 7

8. Daily Monitoring

9. Cumulative Long Stay Bed Day comparison… (2009/2010 Vs 2008/2009)

10. How does 2009/10 compare to 2008/09? Overall (all patients) 5% increase in discharges 1% increase in bed days A decrease in length stay Long stay 4% decrease in discharges 5% decrease in bed days

11. Ward rounds and case reviews- rescuing patients at risk. Reviewing patients journey as well as the notes. Being visible around the hospital that these patients matter Introduction of regular PICC line insertion days The “BLOG” became visible to everyone What significant innovations have been associated with this project ?

12. SUSTAINING EFFORTS What are our plans for continuing and sustaining the progress made? Increase frequency of the ward rounds and maintain the process. Implement pilot areas and evaluate .Cascade out to all clinical areas within Waikato Hospital Look at data sets and evaluate within an academic field. Get written up What are your next steps? Introduce Pilots of MDT and early identification tool Write Business case for TPN CNS

13. LESSONS LEARNT What we would recommend to other organisations? Introduce the daily rounding, start to get other clinicians involved. Include the patient conversation, you learn heaps Keep visible Maintain a blog, well worth it for the person having the experience of the clinical review, you will pick up more trends and it does make colleagues sit up and look. Keep track of the data Remove rocks, little ones help