TRANSFORMATION

1. TRANSFORMATION IN PRACTICE Marie Keane Director of Nursing

2. Performance Measurement Framework – Balanced Scorecard Financial To succeed financially – how do we remain within our allocated budget and ensure value for money? Patient Satisfaction To ensure the highest standards of quality of diagnosis, treatment and care – how do we ensure patient satisfaction? Internal Processes To ensure effective and efficient delivery of services – what key patient administrative and business processes must we improve and excel at? Employee Dev. & Growth To retain our status as a leading edge healthcare provider, contribute to service and medical developments – how do we sustain our ability to adapt and change? 2

3. Medical Short Stay Unit 3 Clinics a day project

4. GUIDING PRINCIPLES • Improving Access • Improving Quality • More Efficient Resource Utilisation

5. OUT PATIENTS DEPARTMENT

6. OPD – Important Gateway • Over 135,000 patients seen each year • 27,000 new patients each year • 108,000 return patients • 100 clinics per week • All disciplines/specialities are covered

7. Background • 70% Clinic space only utilised • Appointment times were not being adhered to • Clinics were not starting or finishing on time • Some clinics were overbooked – others were under-booked • Waiting times for some specialties were 12-24 months

8. Background cont’d • Lack of discharge planning in some of the specialties • The ratio of ‘new’ patients to ‘return patients was low • High rates of patients not attending (D.N.A’s - 22%) • Continuing complaints from patients.

9. The ‘Solution’ • Extend the ‘clinic day’ - 8am - 6pm • Change to three clinic sessions per day viz 8am -11am, 11.30-2.30, 3pm-6pm (was 9.00 to 12.30and 2.30-5.00 over two sessions) • Patient Attendance by appointment times • Additional consulting rooms provided

10. What was involved ? • 16 New rooms were added as part of a refurbishment of O.P.D. • 100 Clinics needed to change – medical, nursing and secretarial staff and patients • 35 ‘New’ clinics spaces were created • All stakeholders consulted and brought on board

11. What was involved? (cont’d) • Templates of existing clinics were developed and new ones designed to suit each speciality, giving number of New/Return Patients per Clinic • High level of communications with all stakeholders • Started October 2006 on pilot basis

12. Critical success factors • Co-operation and goodwill of all staff – senior management support • Improved physical infrastructure – showed that we were serious • Good communications – to avoid confusion, misunderstanding etc • Dedicated project resources • Streamlining services for the patients • Continuous auditing of how clinics were progressing

13. Present position • 35 Additional ‘new’ clinics with no additional resources • Continue to monitor the changes in O.P.D. • Review work practices and procedures • Expansion of Nurse Led Clinics • Continued involvement of all staff • Continued emphasis on education & and informing patients of what is required of them • DNA Policy • Focus on discharging Patients to G.P

14. OUTPATIENT ACTIVITY

15. Benefits • More patient-focused service • Patients are seen in a more timely manner • Clinics are running to time • Extra space and time slots allows for new consultant Appointments • More efficient use of medical, nursing and clerical resources • Positive feed-back from patients – Patient Satisfaction Study completed • Better working environment for staff – less overcrowding

16. WAY FORWARD: • OPD need to link with A&E to provide rapid access for patients • Extend Clinics to 8pm • ↓ DNAs - <5%. (Policy Implemented) • ↓ Waiting Times For Appointments • ↓ Returns Attendance • ↑ New Attendances • Web site displaying the OPD clinic sessions per Consultant to be completed • An active approach to discharge planning from OPD to G.P.

17. WAY FORWARD continued.. • Options for closer ties with the Community need to be examined. • Standard Referral from G.P. • Auditing and Monitoring of adherence to practice changes. • Extend Nurse Led Clinics. • Patient education through appropriate use of TV, DVDs and information leaflets. Access • Focus on Healthstat Integration & Dashboard Results Resources

18. St Patrick’s Short Stay Unit (SSU)

19. CHALLENGE • Reducing Patient Waiting time in E.D • 31 Bedded Medical Ward • 20 (Approx) Long Stay Patients • Average 1-2 Discharges per Day • In need of Refurbishment

20. DESIRED OUTCOMES: Protection of Ward, despite 40 +++ in E.D. Reduced LOS. Patient Pathway measured in hours. Timely access to diagnosis. Change in culture, more efficient in tests. Integrated Discharge Plan. Establish LOS. Improved MDT/Education ownership. Micro-management approach. Increased awareness of nursing staff re short stay. Extended nursing roles – Phlebotomy out of hours, Cannulation out of hours, ECG out of hours. Rigorous Audit. Allocated Medical staff. Bed Management focus on Case Management. Nurses → E. D. Increased staff morale. Mixed bays. BACKGROUND

21. Opened 27th July 2009 • 30 Inpatient Beds –including MRSA 4 bedded Cohort • 3 Bedded Trolley Area for Rapid Diagnosis. • Open 24 Hours Per Day 7/52.

22. EMERGENCY MEDICAL PATIENTS (Short Stay) • Emergency Medical Patients within an expected 3 Day LOS • An Agreed Pathway/Protocol. • Emergency Department Patients Assessed In Trolley Area.

23. Short Stay Unit • UNPLANNED OUTCOMES • Impact on Core Ward Activity. • Impact on Specialisation, therefore impact on training nurses. • Increased Long Stay Patients throughout hospital. • Decrease staff morale/satisfaction in other wards. • Loss of Private Income for Hospital. • ↑ Patient Dependency in Wards/Admission Lounge. • Nurses in St. Patrick’ s Ward have attained what all nurse in wards should attain – Teamwork ↑………

24. SUCCESS FACTORS • Senior Clinical Decision Making. • Access To Diagnostics. • Multi Disciplinary Team Approach • General Services Support – Portering, Cleaning, Catering. • Guarantee approx 33% Ward Bed Turnover.

25. STATS • 27/07/09 – 29/10/09 95 Days Open • 837 Patients through the unit (includes trolleys) )Approx 7-8 patients daily) • Overall LOS 4 days • 3.8 days if long term care patient excluded

26. REVIEW OF LENGTH OF STAY PER DIAGNOSIS FOR PATIENTS ADMITTED TO THE SHORT STAY UNIT