Patient access improvement toolkit Patient access improvement toolkit
Introduction This tool provides a brief summary of information from the attached toolkits and guides provided for the Patient Flow Collaborative teams. The summary concepts are designed to provide operational managers with a focused checklist of effective access strategies. Concepts are broken down into three categories: Escalation These concepts can be used during access block and when escalation policies have been put into action (see No. 7) Short term Can be implemented fairly quickly, 0-12 weeks Long term Can be implemented 12 weeks plus. Use the navigation bar on the left hand side to click through the seven strategies.
Key system strategies • Remove bottlenecks – identify bottlenecks in patients process and remove • Remove process steps and queues that add no value to patient care • Reduce queues – reduce queues where identified by matching capacity and resource to demand • Reduce variation – reduce variation in planned presentations, treatment and patient processes including waiting times • Reduce handovers – reduce the number of handovers of care • Standardise practices to promote safety and quality by using care bundles, protocols etc. • Optimise patient flow through the care journey
Menu Clinical innovation areas
1. Emergency care • Fast track low acuity patients • Provide Out Patient Department appointments and ready access to diagnostics for the next morning to promote discharge from Emergency Departments • 1-2 hourly rounds (computer) by the person in charge of the coordination of Emergency Department • Provide diagnostic appointments and outpatient appointments for Emergency Department patients each morning • Use Hospital in the Home (HiTH) as a bridge to plan semi-urgent care (e.g. TURP) • Enable Emergency Departments to directly admit to Acute or Sub-acute beds • ‘Inpatient unit’ admission whilst in Emergency Department if ready for inpatient care • Manage delays through tracking systems • Implement the “5 key themes” for effective emergency care • Clarify and promote the role of ED floor consultants in management of patient flow.
2. Inpatient care • Short term • Implement twice daily medical/nursing care team review of flow delays for every inpatient • Prioritise patients waiting for diagnostic tests • Use a Care Bundle for length of stay management, including: • Care plan discussed with patient • Discharge medication • Follow up arrangements – e.g. OPD etc. • Day/time of discharge communicated to patient/carer • Discharge letter to General Practitioner completed and sent • Transport plan completed with patient and transport provider • (see Care bundle graph tool) • Embed Length of Stay management planning: • Inform patient of estimated length of stay (LOS) • Agree transport at earliest opportunity • Prepare discharge medications at least one day before discharge • Effectively monitor and manage delays in LOS • Promote review each day • Early discharge to HITH and medi-hotel • Prioritise semi-emergency access to Operating Room (e.g. #NOF/TURP) • Prioritise access to Out Patients Department for early discharge • Streamline access to consultant referrals (i.e. < 24 hours) • Prioritise access to OPD for early discharge and next day review via OPD
2. Inpatient care • Long term • Implement 8 am medical meetings (white board rounds) • Implement 9 am ward meetings • Implement ward based length of stay management and capacity and demand planning (see toolkits) • Implement delay tracking systems • Implement unit based capacity and demand management systems • Streamline inpatient access to diagnostic tests and to operating room.
3. Operating theatres • Short term • Prioritise emergency, semi-emergency and elective cases • Ensure links between bed management, theatre, relevant investigation and ICU are made (if relevant) • Ensure there are ward based medical staff on operating days to facilitate early review and discharge of patients • Ensure preadmission maximised – including medication, tests and other relevant advice • Eliminate schedule conflicts for medical staff in OR. (A receiving team registrar cannot be performing an elective surgery list etc). • Long term • Monitor and track: • - Start and finish times • - Cancellations by hospital • - Cancellations by patient • - Patient transport to and from theatre • Promote day surgery as the norm.
4. Outpatients • Short term • Eliminate all unnecessary follow up appointments by investing time in discharge process – referrals to General Practitioners (proformas/chronic disease Mx plans) • Validate Out Patients Department lists every 13 weeks • Provide single point of contact for making and cancelling cancelling appointments • - Monitor FTA • - Consider courtesy calls 1-2 days prior appointments for high “FTA type” clinics • Provide emergency slots in the morning to promote effective Emergency Department and inpatient length of stay • Promote nurse managed discharge from clinics. • Long term • Review capacity and demand • Provide waiting times data • Promote protocol referral processes • Promote telephone follow up and telephone Out Patient Department appointments when no medical examination is required.
5. Surgical flow including pre-op and waiting list management • Short term • Promote early comprehensive pre-operative assessment • Confirm operation date by phone day before admission for every patient • Schedule admissions whilst accommodating emergency demand predictions • Validate/audit and manage the waiting list queue every 13 weeks by phone. • Long term • Manage elective demand per 3 month targets • Schedule demand and annual leave holidays, conferences per speciality over 12 month period • Manage leave plans for medical/nursing staff • Streamline elective processes to minimise steps • Provide a skilled, trained elective team, which includes administration, nursing and medical duties • Elective additions to waiting lists only after review of availability and capacity of services (i.e. service available, patient ready for care).
6. Managing flow • Essential management of patient flow across the organisation demands effective processes and clear live data. Processes should be in place to provide short term and long term management of capacity and demand. Data should be live and predicted for future trends • Structures of patient flow management should include frontline staff reporting to a senior manager who has a clear view of organisation demand and access to resources to resolve issues ( Chief Executive Officer delegation) • A live I.T. bed management delay tracker and capacity and demand data should be available across the organisation to promote patient flow • One of the most important pieces of information is capacity of the whole hospital and demand waiting to enter services. The traditional role of site (after hours) manager/bed managers needs to include: • Management of all patient flow demand for inpatient services • Integration of emergency and elective demands and targets • Length of stay management including admission, length of stay and discharge processes.
7. Escalation plans Identify the single point of accountability e.g. General Manager to stop other duties and focus on the issues at hand. During escalation, due to bed block and bypass, simple effective innovation can assist management of patient flow. Short-term actions can include: • Review all inpatients by the patient’s clinical team • Executive grand round of all patients. This team should include Executive General Manager, Senior Clinical Lead and Senior Nurse Lead • Tracking of all in patient delays should be enforced on all wards • Predicting Emergency Department admissions over the next 24 – 48 hours to plan bed requirements • Increase Emergency Department staff for expediting treatment of low acquity patients • Arrange one hourly Bed Manager and Lead Executive meetings • Agree and review tasks every 2 hours until situation reversed.
Acknowledgements Jenny Bartlett Chief Clinical Advisor, Office of the Chief Clinical Advisor Lee Martin Manager, Clinical Innovation Patient Flow Collaborative Marcus Kennedy Clinical Lead, Patient Flow Collaborative Patient Flow Collaborative Team Rochelle Condon, Improvement Lead Ruth Smith, Improvement Lead Fiona Dickson, Improvement Lead John Walker, Communications and Logistics Lead Prue Beams, Data Consultant
Contacts Support to implement these system wide initiatives is available via the Patient Flow Collaborative team who can be contact via: Clinical Innovation Agency Email: email@example.com Phone: 9616 7022 Patient Flow Collaborative Team Lee Martin 9616 7859 Manager, Clinical Innovation Patient Flow Collaborative Director Rochelle Condon 9616 9026 Improvement Lead Ruth Smith 9616 9025 Improvement Lead Fiona Dickson 9616 9030 Improvement Lead Prue Beams 9616 7742 Data Consultant John Walker 9616 9037 Communications and Logistics Lead