making numbers real: the discharge journey tania geyer, di norris, liz prowse noarlunga health...
TRANSCRIPT
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Making Numbers Real: The discharge journey
Tania Geyer, Di Norris, Liz ProwseNoarlunga Health Services(now part of Southern Mental Health, SA)
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NUMBERS… (blah blah blah)
KPI #5 = N/A
KPI #9 = KPI #12 = 65%
KPI #3 = 27%
KPI #7 = 5%
KPI #2 =
KPI #8 = 50%
KPI #11 = mc2
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KPI # 12: Follow-up within 7 days of discharge
Why focus on this indicator?
• An across service indicator (involves inpatient and community)
• Clinical relevance
• We didn’t seem to be very good at it
• Tapped into a number of processes around discharge and transfer of care
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Baseline Rates of Follow-up
Us: 48%
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Identified Need of Attention from Benchmarking Results
• It’s a clinical problem not just a number!
• High time of risk
• Consumers falling through the gaps
• Missing link between inpatient and community follow-up
• Communication issues
• Links with other KPI’s – length of stay and 28 day readmission
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What did we do?
• Discussion/communication with Team Leaders and clinicians
• Working group with significant buy-in from inpatient and community with project support– Recognition and understanding of the
KPI and clinical implications– Focus on the KPI measuring the
consumer experience of discharge
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Development of procedure• Developed by working group – high level of
engagement from teams• Move into line with general health follow-up,
e.g. phone call day after surgical discharge • Examples of procedure points:
Inpatient– Confirm follow-up with consumer– Document actions on discharge checklist and
journey board– Make contact and complete documentation
Community– Inpatient admission report become part of
morning handover– Confirm nature of discharge contact
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Implementation and Roll-out of procedure
• Paper based collection initially
• Enhancement of computer system to collect contacts made by inpatient staff to discharged consumers
• Training
• Recommendation to change the KPI to collect any contact made within 7 days
• Examining and improving discharge/transfer of care practice – inpatient Journey Boards
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Journey Board - Goals
• Make the Consumers Journey visible to the whole team by using visual management techniques
• Introduce a standardised communication tool in all Southern Mental Health units
• Improve communication between inpatient wards and the community teams
• Facilitate making barriers to the journey visible
• Collect data regarding real barriers rather than perceived barriers to improve treatment and discharge plans
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Baseline Rates of Follow-up
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Referral Triangles
1. When SW/Psychologist/OT was needed2. When referred to SW/Psychologist/OT3. When the Psychologist, SW or OT has seen the Consumer
21/7 21/7
23/7
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Process: Only rub out referral triangle if you need to re-refer.
Green – good to go
Yellow – more to do
Red – not good to go
Referral Triangles - System
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Q2 The introduction of the Consumer Journey Boards has improved the visibility of the Consumers Journey
0
10
20
30
40
50
60
StronglyAgree
Agree Disagree StronglyDisagree
Unsure N/A
Q7 Has the Consumer Journey Board made your job easier?
0
5
10
15
20
25
30
35
StronglyAgree
Agree Disagree StronglyDisagree
Unsure N/A
A total of 133 surveys were distributed to both inpatient andcommunity staff SMH, 81 surveys were returned for a 61%
response rate.
Evaluation Summary
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(95% of the general hospital staff surveyed were enthusiastic about encouraging other areas to implement journey boards only 2% disagreed 9% were unsure)
Q10 Would you encourage other areas to implement Consumer Journey Boards to enhance patient f low and communication?
05
10152025
303540
4550
StronglyAgree
Agree Disagree StronglyDisagree
Unsure N/A
Evaluation cont..
• SMH staff showed a positive response with 65% agreeing that they would encourage other areas to implement journey boards, 23% were unsure or stated the question was not applicable and only 12% disagreed.)
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Comments from General and MH Staff
• Easy access to information• Keeps control of work load• Gives a snapshot and an overall
picture of journey • Identifies the allocation of workload
Evaluation cont..
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3 Year Comparison
Us: 48% to 59% to 68%
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And…
• Monthly monitoring, by each site and as a region
• Adding collection to residential rehab. centre
• Closing the loop/following up
• Further system enhancements, e.g. new discharge screen
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• Journeyboarders – particularly Anna Szynkar and Denise Wright (Flow Coordinators)
• Inpatient and community staff of Southern Mental Health, in particular those based at Noarlunga
• Information and project staff
• Consumers and carers of our service
• All Adult Benchmarking participants
Acknowledgements
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