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Improving Patient Flow: Implementation of Short Stay Units for Medical Admissions

This presentation addresses the significant under-achievement of the Department of Health's targets for timely patient admissions in the Cougar Hospital. In March 2004, patients faced an average 17-hour wait in the emergency department (ED). To remedy this, a Short Stay Unit (ESSU) and an Inpatient Medical Unit (MSSU) were established, facilitating rapid assessment and management for medical patients. The innovative changes have led to improved patient flow, reduced length of stay from 8.0 to 5.7 days, and increased admissions within an 8-hour window to 69%.

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Improving Patient Flow: Implementation of Short Stay Units for Medical Admissions

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  1. Short Stay Unit for Medical PatientsPresenter: Colleen White/Ibolya NyulasiHospital: CougarColleen White (C.White@alfred.org.au 03 9276 6051)Ibolya Nyulasi (I.Nyulasi@alfred.org.au 03 92763063) Lisa Somerville (L.Somerville@alfred.org.au 03 92763526) 5-6 December 2005 - Melbourne

  2. KEY PROBLEM • Significant under-achievement of DHS target ‘Percentage of patients admitted within 12 hours from ED’ (average 60%), with a target of 80-85%. • In March 04 Cougar patients were averaging a 17 hour wait in ED for admission to ward. • Only A1 hospital without ‘Short Observational Unit’. • New target of 80% admitted within 8hours implemented June 05.

  3. SOLUTION • Short Stay Unit in ED (ESSU) 6 beds and on inpatient medical unit (MSSU) 8 beds commencing October 04. • Allied Health staffing: PT – 4 hours/day OT – 4 hours/day SW – 4 hours/day Nutrition – 1.5 hrs/day SP – 1 hour/day • Funding provided by DHS with internal business case process for AH resources. • Focus to improve access and patient flow within ED and improve patient outcomes by providing rapid model of assessment/management for general medical patients.

  4. INNOVATIONS IMPLEMENTED - AH • Timely and comprehensive AH assessment • Dedicated, experienced ‘Aged Care’ AH team • Blanket referral – all patients seen by AH • Multi-disciplinary and interdisciplinary screening within 24 hours (using screening tool) • 7 day service, specific AH KPIs • 8 beds co-located with dedicated MD team

  5. OUTCOMES SO FAR LOS for admitted general medical patients dec by 3.7 days (from 8.0 to 5.7) 69% of ED patients admitted to ward < 8 hours More streamlined transfer to sub-acute MSSU • ALOS 27- 46 hours (with aim <48 hours) • Occupancy 76% • Average patients/month 80 • Discharge destination: Home 40%, Sub acute 25%, other IP units 28%

  6. LESSONS LEARNT • Strong organisational buy-in/commitment to project was crucial. Also strong AH management support to clinicians. • Interdisciplinary model not relevant to all AH disciplines. • AH team that are experienced and have established good working r’ships is vital; difficult to maintain model of care with ‘external’ w/end staff. • Under-estimated ‘CSM’ time/requirements. • Ensuring consistent approach (eg data capture) more difficult across 5 AH disciplines. • Future development – expand model of care to general medical units/patients.

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