ingrid ridler - mercy hospital for women - family centered model of care for domiciliary and...
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Mercy Hospital for Women Mercy @ Home May 2014 IIR conference
Patient / Family centered Model of Care for Domiciliary and
Hospital In the Home (HITH) Program
RM has the credentialed skills to visit mother and baby under Stream A and
Stream B.
Stream A: Domiciliary care that services the mother and baby post delivery
(up to 9 days).
Stream B: The baby is admitted to the nurseries for medical care post
delivery and is then transferred home for further medical management to
HITH. E.g.: Weight < 2500 grams, Prematurity prior to 37 weeks, Jaundice,
congenital abnormalities, chemically dependant clients.
OR
The mother is admitted to HITH because of complications arising from the
birth, e.g.: psychiatric conditions, complicated obstetric history such as PE,
breast abscess, wound care, and some gynaecology complications.
Mercy @ Home Model of care
16 April 2013 2
M@H is responsible and accountable for our outcomes, and costs. We
processes each patient using a common platform of measurement called
DoNel program (Clinical care, variances, addresses, LOS, time, type of
care and visit. We barcode and collect this data for every visit.
Stream A: is funded by the department of health services and is called a
Variable Maternity Services Grant (VMSG).
(Funding under review by the Department of Health: activity based funding)
Stream B: Funding is through variable case mix payments called Weighted
Inliers' Equivalent Separation (WEIS).
Funding
16 April 2013 3
1. To be responsive for safe high quality care that is changing, sustainable
and responsive to the patient and their families needs.(eg early
discharge, IV ABS for babies)
2. To provide care that is guided by consumer participation, MH, DoH,
external and internal key stakeholders. (National Safety Quality Health
Standards)
3. Patients will have informed choices to meet their health care needs e.g.:
shared care with GP’s, team nursing, maternity group practice, rotation of
NICU nurses, transition care for the vulnerable, access to multi
disciplinary teams and the vulnerable support network.
MH supports the Victorian Maternity and
Newborn Services health framework
2012-2022 Guidelines of Equity and Access
16 April 2013 4
Jan – Dec 2011: 6018 births Males 3104 Females 3046
Jan – Dec 2012: 5724 births Males 3077 Females 2940
Jan - Dec 2013: 6153 births Males 2959 Females 2760
16 April 2013 5
Mercy Hospital for Women
Births 2011-2013
Mercy @ Home Demographic Area
16 April 2013 6
Service Stats for Mercy @ Home
Use of data to understand our clinical
practise and improve patient care
2011-2014
Bed Days for 2011-2012: 5566
Bed Days for 2012- 2013: 5785
Bed Days for 2013-2014: 5974 ( period 1/7/13- 20/05/14)
Mercy @ Home Bed Days for HITH
16 April 2013 8
Domiciliary Care/ HITH Care
International Overview:
UK Daily Postnatal Visits for 7 days.
Netherlands Daily Postnatal Visits for 7 Days + homecare assistance
USA Private system no PNC with some obstetric nurses for home
births
Canada: discharged 24 hours no domiciliary care. MCH
nurses(variable)
Case Study (picture)
16 April 2013 10
Case study NVD
Mother is discharged home with Twin1, 2700 grams and Twin 2, 3200 grams.
Clinical coordinator does her ward round in the morning and Triages the patient
Allocates the patient to the RM
Case Study
RM has a handover of the patient
Rings the patient with a nominated time frame, collects her clinical pathway along with her bar code reader for entry into the DoNel Program
Activates her Go finder tracking system before she leaves and has between 4-5 visits /day
Visits the patient at home (Mother and babies are visited under the domiciliary care package).
Arrives at the visit to find Twin 2 cold unresponsive and not feeding.
Twin 2 is admitted to MHW NICU unit, ventilated .
Day 3 Twin 2 is transferred to HITH.
Clinical coordinator organises the visit with RM to visit both mother and baby under two separate programmes
1. Person Centred: Every patient under the Domiciliary and HITH
programme is offered a visit within 48hours to meet a KPI of 100%.
M@H are partners in care of both these babies and their mother
M@H Quality Quality Framework for Patient/
Family Centred Care
16 April 2013 14
M@H Quality Framework for
Patient/Family Centered Care
Integrated Care “Common Organisational Unit” who take responsibility for a
patient/family centered unit
Streamline services for Domiciliary and HITH care around the family
The patients clinical journey is organised by the clinical coordinator and is
efficient and effective (daily runs are scheduled with a multidisciplinary
team of clinicians) to meet individually tailored patient/family centered care
using the right midwife and the right resources to meet the patients health
care needs.
With the support of medical governance, autonomous RM’s, MCH support
mother and baby were discharged home.
Safe: “You are Safe” in a single structured unit
Integrated safe home visits for the patient/family are achieved with the
support of Social Workers who coordinate:
Child First Berry Street
DHS Refugee Support Groups Obstetricians
Aboriginal Services Paediatricians
Interpreters Psychiatrists
Vulnerable Children’s support Services Urogynae
Maternal and Child Health Care Child First
Enhanced Care Family Court
Violence Against Women Task force Infection control
Lactation support Diabetic educator
Mother Baby Units Parent Education Programs (DoNel)
M@H Quality Framework for
Patient/Family Centered Care
16 April 2013 16
All patients who receive a visit have a safe home risk assessment
A GPS service with blue tooth facilities is installed in all our rating 5 cars.
A duress alarm system and tracking system is linked to a program at Mercy
to keep staff safe on the road and when visiting.
If required 2 patients will visit the patient e.g.: social worker, aboriginal liaison
worker.
Safety for M@H Staff
16 April 2013 17
Effective and appropriate care, right care, right
time, right outcome for an expandable service
that will partner with patients and their family.
Partnering with consumers and using resources to meet the emerging needs
of our patients with the right care.
Using MH’s strategic plan, our values, policy and guidelines for quality care,
we can respond to the needs of every patient and their families by
streamlining our services to meet consumer needs at the right time.
The significant decrease in the LOS from 8-14 days (1950) to 6hrs-2 days for
a NVD and 4 days for a CS today has resulted in “naturalising” the care
and moving away from “medicalisation” with the right outcome.
With significant cost savings benefits and meeting clinical demand we are
achieving the right health outcome for patients and their families at MH.
For the patient and family:
Active involvement by the patient in the delivery of patient/family centered
care
For the Hospital
Using data to achieve best practice care to improve quality patient outcomes.
Aligning the unit to support the strategic and quality plans for the hospital.
For the Staff
Streamlining the services for a safe and effective home care visit, using the
resources to be effective carers, (looking at workforce/demand/daily)
Outcomes for Mercy@ Home
16 April 2013 19
Futuristic Goals:
“We must move away from a supply-driven health care system organised
around what physicians do and toward a patient –centred system
organised around what patients need”
(Porter M.E, Lee T. H. “The Strategy that will fix health Care”, Harvard
Business Review 2013)
“HITH is a bridge to connected
care”
My Vision: To stimulate innovation and growth and recognise our achievements
Mobile Medical Units for clinical support
Introduce Face time for all mothers babies and clinicians at MH
Tele medicine: Mobile access to all medical resources via a tablet. Having access to our programs such as BOS, DoNel, SPI, CPF, visual aids for assessment (trial in progress)
Remote patient monitoring bringing the hospital to the home
John Hopkins in Maryland, (Psych patients)
Eg:1million Americans receive remote cardiac monitoring decreasing readmission rates, freeing up beds. (2012 American Telemedicine Association)
200,000 children in India receive Primary Health care through a program called “Smile on Wheels”
Thank You
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