Whole of Northern Adelaide Local Health Network (NALHN) Pilot Presenter: Margot Mains

1. Innovation Poster Session HRT1215 – Innovation Awards Sydney 11th and 12th Oct 2012 Whole of Northern Adelaide Local Health Network (NALHN) PilotPresenter: Margot Mains Northern Adelaide Local Health Network 3-3c_HRT1215-Session_MAINS_NthADEL_SA

2. KEY PROBLEM The northern Adelaide area is one of the fastest growing population areas in South Australia with the NALHN population projected to grow by 23.6% (81, 557) by 2016 (projected state growth 13.9%) By 2026 a quarter of the states population will live in the NALHN Combined with a need to increase self sufficiency and the pressures associated with winter demand, NALHN undertook the ‘Whole of NALHN Pilot’ (WNP).

3. AIM OF THIS INNOVATION Improve timely access to services, patient care and patient demand Provide a timely move to a definitive point of care Provide patients with the right care, in the right place at the right time with the right outcome. Secondary Goals Refocusing the ED on its core business of assessment and triage Utilise MH and LMH as one hospital, two sites Utilise Primary and Community Health Care and Hospital at Home Re-engineer inpatient ward activity Enhance and redesign patient discharge systems Deliver the right care in the right place at the right time with the right resources and the right outcomes.

4. KEY CHANGES IMPLEMENTED Initiatives implemented across NALHN included: Event Led Discharge Prioritisation of bed cleans Introduction of Home Based Wards Introduction of an ED Navigator role Increase use of Hospital at Home Intensivist cover at Modbury Hospital

5. KEY CHANGES IMPLEMENTED cont’d Initiatives implemented cont…. Introduction of the two hour rule within ED Estimated Discharge Date The transfer of sub-acute patients from LMH to MH Advanced care paramedics Extended support services including pharmacy and radiology Extended Nurse Practitioner availability

6. KEY CHANGES IMPLEMENTED cont’d

7. OUTCOMES SO FAR CapPlan data indicated reduction in bed occupancy, patients waiting for beds in ED and outlier rates at both LMH and MH resulting in increased bed capacity at both sites during WNP. Prior to WNP, LMH bed management report showed minus 27 beds; during WNP a positive bed stock was recorded . Shifts in ED Data demonstrated: Increase in the % of patients seen within 4 hours Increase in the % of patients seen within their allocated threshold times Decrease in the number of patients waiting for treatment in ED corridors Decrease in the number of patients that did not wait/left before treatment was completed Decrease in the time from patient’s admission to arrival to the allocated ward.

8. OUTCOMES SO FAR

9. OUTCOMES SO FAR • Verbal feedback provided during the week of the WNP included: • “I haven’t seen ED like this for 18 years.” • “We’ve had 19 patients in the Transit lounge this morning.” (compared to an average of 6) • “We have less than one page of emergency surgery for today. We normally have three." • "The hospital seems to be running a lot smoother.” • “I am aware of my estimated discharge date.”

10. LESSONS LEARNT The program plan for the WNP followed the Improving Care methodology with Planning, Diagnostic, Intervention, Evaluation and Continuous Improvement stages The consultation framework of CEO engaging senior clinicians and those clinicians engaging their respective teams was very successful in engaging large numbers of staff The WNP trialled over 50 different initiatives within a one week period. With diligent planning, widespread consultation and clinician engagement, a large number of initiatives can be successfully implemented and evaluated.