Managing Demand

1. The Health Roundtable New Zealand Managing Demand Presenter: Grainne O’LoughlinHospital: Athene Main Contact: Phillip Fay, Manager Occupational Therapy Department pfay@stvincents.com.au 02 8382 3360

2. KEY PROBLEMS • Acute Occupational Therapy (OT) Service has insufficient staffing to allocate an OT to each hospital service. • Staff are allocated to the areas of highest activity (neurosurgery, neurology, geriatrics, orthopaedics, gastro) • All other referrals are managed by referral to the Occupational Therapy Department and are picked up by either the occupational therapy manager or a part time therapist (3 days/week) • During periods of sick/annual leave or vacancies due to resignation, patients from the high activity areas are also picked up by the manager or outlier therapist.

3. Key Problems (contd) • Referrals received via the department phone (leaving phone messages or speaking to someone), or by paging the OT manager. • several complaints about unacceptable waiting times for patients to be seen by an OT • A review of the referrals discovered there was insufficient information to determine a priority for some patients. • OTs assumed that their own service area was a priority over these other patients who were referred.

4. Implementation of a triage referral system in OT to facilitate effective patient prioritisation. STEPS TAKEN: • Established Clinical priorities • Established a daily triage intake book where all referrals are entered. Department manager assigns/checks twice a day which patients have been picked up • Assigned triage categories Referrals were assigned a triage category according to i) clinical priority – patient’s need for assessment and treatment, ii) potential delay in discharge, and iii) discharge issues.

5. Steps Taken (contd) • Established performance targets. Five triage categories were developed with definitions for each category: Priority 1 – Immediate (within the same day) Priority 2 - Very Urgent (within 24 hours) Priority 3 - Urgent (within 48 hours) Priority 4 (within 72 hours) Priority 5 - Non Urgent(more than 72 hours)

6. Implementation of a triage referral system in OT to facilitate effective patient prioritisation. • Design of a new referral form designed so that referrers had minimal writing-just tick boxes. Three key categories of information were required to enable proper triaging of the patients.: i) Patient demographic information ii) Expected discharge date iii) Type of OT assessment required. • Distribution of & Education on form to wards The new fax referral system was promoted to the wards. Information was provided on how to fill in the form and where to send the form to. Each team was informed by the OTs during their multidisciplinary team meetings. The OT provided a brief education session during the meetings to inform the team members on how the new referral system works.

7. RESULTS

8. Results

9. Results

10. HOW WE DID IT • A more sensitive referral system was developed based on a Triage System. Patients were prioritised according to their clinical needs as well as the impact on discharge. • It was found that the OT response time to referrals is within an acceptable time frame. • It was found that the triage categories appear to be appropriate. Pressure care was added to triage category 2 (urgent – seen within 24 hours). Limitations • Data on delays in response time during periods of decreased staff (due to sick/annual leave or resignations) and major public holidays was not collected. • Referrers did not always fill the form out completely which resulted in patients not being correctly triaged. • Weekend impact not measured (no weekend service) • ACHIEVED OUTCOME. • All referrals to Occupational Therapy department will now only be accepted via fax referrals on the referral forms (Until online referral system is introduced) • IMPACT • New referral system includes the collection of data required to triage the patients. This enables a better response time and prioritising of patients.

11. Lessons Learned/Recommendations to others • Review Triage systems to ensure patients are being seen in order of need rather than in order of Therapists preference i.e their own allocated caseload/specialty • Ensure all staff participate in triage meetings and patient allocations including ‘specialists’ • Review where the gaps and delays are and discuss with the team strategies to prevent these delays • If patients not able to be seen in adequate/safe time frame – then there is justification for submission for additional resources or decisions need to be made about categories of patients that can no longer be serviced • Need to pursue online referral system capability on the Intranet through IT. Fax system is cumbersome for all users.

12. Acknowledgements • Cindy Tan • Philip Fay • Christina Thompson • Robyn Fitzpatrick • Lesley Chiu