26/27 June 2008 - Brisbane

1. The Patient Flow InitiativePresenter: Annie ThompsonHospital: Fremantle Hospital and Health ServiceMs Jenny Brenton 08 9431 3333 26/27 June 2008 - Brisbane

3. Clinical Management Structure • Clinical Services/ Allied Health • Director of Nursing and Patient support • Director Operations (flow and business) • Clinical Director Surgical Services • Clinical Director Medical Services • Clinical Director Critical Care Operations • Director of Operations Kaleeya • All Clinical Directors have nursing reporting though but not to them as well as varying degrees of responsibility re finance, governance, practice and services.

4. Improving service delivery through flow strategies. • Ongoing access (front and back door) issues prevent a consistent through put of patients across all services thus impacting on the organisations ability to meet BQB data bench marks in relation to • LOS • Elective Surgery Waitlist targets- Long wait patients • Access block in Emergency Department Poor patient flow has “nock” on effect through out organisation.

5. Improving Patient Flow • To identify policy and practices and that prevent the organisation from achieving BQB bench mark figures • Identify strategies and practices that could be utalised to enhance management of patient journey to reflect BQB benchmarks. • Realign all staff/services involved with admission & discharge from within other directorates to same directorate (only directorate with line management of all disciplines of staff, clerical/nursing/allied health) and produce a cohesive team approach organisation wide to manage patient access issues.

6. Changes • Bed Allocations, Discharge Coordinators, Transfer Coordinators Complex admissions nurse • The team in flow work to ensure that bed days are optimised • RAD- intervene to give extensive assessment and interventions across allied health discipline • Discharge coordinators work with consultants and patients & families to id those patients suitable for HITH/RITH/CAP/ACAT.. • Criteria lead discharge. Discharge planning that begins at admission • Transfer Coordinator assesses all patients presenting to ED and identifies if they can be cared for in other Hospital settings and liaises with teams to facilitate same. • Transfer lounge- all patients for discharge/ inter-hospital transfer will be sent to Transfer Lounge to wait collection/or transport ( rather than waiting on ward) nursing staff can expedite discharge meds and plan services from here.

7. Cont.. • Bed Management team- allocate all patients from DOSA/Elective/ ED admission/ give ICU and OR go-ahead ED liaising back through staffing 07:00-23:00 7 days a week • Nurse ManagerWaitlist -waitlists are managed appropriately ensuring that patients are not placed upon the lists until readyfor care. Review of and identification of issues re appropriateness of patients and waitlist practices, liaising back though the NDPF and Clinical Director Surgical Services to put in place strategies to resolve problems or behaviours. • Ready for care- Only patients who ready for procedures “today” can be placed upon waiting list as ready for care- those requiring tests and workup will not be placed on Surgery wait, they are managed and followed up by the complex admissions nurse in DOSA.

8. KPI to reduce long wait patients (>500 days) on surgical waitlists

9. Access Block target is 45% (DOH)

10. Creating revenue

11. EVALUATION/ FUTURE • A great suite of initiative practices, best outcomes for patients right ward, right time right Consultant • Improved access to all services • BQB data demonstrates multi fold improvements • Future….. • Clinical IT changes to support more effective bed management models for ED surveillance and bed flow management. • Changes to support Out Patient Clinic wait to appointment times/appropriateness of patients (utilising CPAC) • OPD access re design strategies & implementation, eg GP follow up post surgery, group clinics for identified patient cohorts and nurse lead clinics