Louth Meath Hospital Group

Reconfiguration Programme

2011

TransformationBackground2009 - 2011

HSE NE Transformation is committed to management of quality & risk issues identified in the Teamwork report 2006

Making the best use of available resourcesRaising services to safe levels of practice and beyondIntegrating PCCC & Hospital Services

Directorate of Clinical Strategy & Programmes 2011

The Directorate of Clinical Strategy & Programmes has been established to improve and standardise patient care

throughout the organisation by bringing together clinical disciplines and enabling

them to share innovative solutions to deliver greater benefits to every user of

HSE services.

Directorate of Clinical Strategy & Programmes

The work of the Directorate is based on three main objectives;

To improve the quality of care we deliver to all users of HSE services

To improve access to all services

To improve cost effectiveness

Proposed Programmes 2011 For the Louth Meath

Heart Failure, OLOL - Commenced Acute Medicine, OLOL Stroke, OLH/OLOL COPD Outreach, OLOL & Pulmonary Rehab, OLH/LCH Diabetic Foot-care, LCH/OLH/OLOL MSK Ortho Rheumatology Waiting List Initiative, OLH Dermatology Waiting List Initiative, North East Regional Rheumatology Critical Care, OLOL Emergency Care, OLOL

Acute Medicine Programme

A Clinician-Led initiative between, Royal College of Physicians of Ireland (RCPI), the Irish Association of Directors of Nursing and

Midwifery (IADNAM), the Therapy Professions Committee (TPC), the Irish

College of General Practitioners (ICGP) and the Directorate of Clinical Strategy &

Programmes, HSE.

Acute Medicine Programme

The programme recognises the essential role of large and small Hospitals, General

Practitioners (GPs) and Community Services. It provides a framework for the delivery of

acute medical services which seeks to substantially improve patient care.

Standardised Safe Quality patient care •24 hr AMAU•5 bed CDU

•Specialty Cohort Plan•Integrated Discharge Planning

•Medical Care pathways & PPG’s

National Early Warning Score

•Complete

Key Operational Objectives 2011

Hospital ModelsLCH Medical Model agreed

Population Health – QCCD Capacity AnalysisLouth Meath Hospital Reconfiguration Plan

Key Operational Objectives

Navigational Hub / Bed Bureau and Case Manager

Patient Flow / Case Managerpro-active bed management

OPD

Lean project to assess OPD Medical Specialty capacity and processes

Critical Care

ICU / HDU / CCU Capacity from 11 to 23Capital project for 5 additional level 3 beds

June completion date.

Lean Healthcare Review of the Operational Processes in Management of the Medical

Patient pathway

A multi-disciplinary group from Our Lady of Lourdes participated in a value stream mapping exercise to identify non-value added activities. Five core projects progressed using a Plan Do Check Act (PDCA)

EDD Visual Whiteboards Blood specimen turnaround time Cardiology diagnostics scheduling Discharge Lounge

A Review workshop (17th October 2011) demonstrated improved efficiencies and further opportunities to progress.

Louth Meath Hospital Transformation and Acute Medicine Project Organisational Chart

AMP Project TeamsPhase I

AMAU / AMU & Speciality CohortCDU / ED Patient Flow

Bed Allocation Patient Flow Critical Care

OPD Integrated Discharge Planning

Phase IIOrthopaedic Triage Initiative

COPD

Cross Site Project Teams

Stroke ThrombolysisAcute StrokeStroke Rehab

Cohort IsolationHealth Care Records Management

PCCC Admission AvoidanceCardiology

LCH Project Teams

MIUPalliative Care

Louth Meath Hospital GroupSenior Management Team

Louth Meath Acute Medicine Programme Implementation Group

Project SponsorsGroup GM

Clinical Director TransformationAcute Medicine

ProgrammeProject Team

HSE North East UnionAlliance

OLOL MAU Acute Stroke Unit / Thrombolysis ICU and CCU Community Response Team ( CRT )

LCH Stroke Rehab service Palliative Care Unit Step down beds Day Medical Services Surgical Services Minor Injuries Unit Out Patient Initiatives

Progress Report on Service Changes -to date

Capital Refurbishment of old ED facility is complete

Permanent MAU opened 25th June 2011

Referrals from ED and GP’s

Focus on rapid ambulatory assessment, prompt access to diagnostics and treatment initiation with expected low rate of inpatient admission

Transition to an Acute Medical Assessment Unit

Medical Assessment Unit (OLOL)

Average Daily Attendances to OLOL MAU 2010/2011

85% of Attendances Discharged Home

Average Daily Attendances to OLOL MAU

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J an Feb March April May J une J uly Aug Sept Oct Nov Dec

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2010

2011

Acute Stroke Thrombolysis introduced 23rd May 2011

New Acute Stroke Unit opened 2nd Floor of new build on the 14th March 2011

Accommodation includes single and double room accommodation – all rooms are en-suite

Multi-disciplinary Stroke Team in Place

Acute Stroke Services (OLOL)

New CCU opened Sept 2010, 3rd floor of the new

ED building Incorporating facility for 8 CCU beds 5 Step down Cardiology beds 5 Beds are Operational

Capital project for 5 additional level 3 ICU beds

complete 5 level 3 Beds & 3 Level 2 Beds - Operational Physical Bed Capacity of 15 in place

ICU and CCU (OLOL)

PCCC Admission Avoidance/Early discharge Initiative established in February 2011 including Nursing, Home Support, Physiotherapy & OT

An average of 3 referrals daily from the ward areas

Community Response Team – Louth

Stroke Rehab Service (LCH)

8 stroke rehab beds taking admissions from OLOL ↑ 11 beds

95% of patients discharged home to date

€300,000 refurbishment project complete

Facilities include a dedicated AHP rehab facilities & an independent living area

Palliative Care Support BedsPhased opening of 10 beds – 2 beds operational to date

Admission Criteria End of life care planned respite care convalescencerehab continuous Nursing Care

Further expansion of rehab services is planned.In the interim step down beds are available for Step down patients who are unable to go directly home from OLOL requiring further care for 1-6 weeks

Palliative Care Support Beds & Stepdown (LCH)

Elderly Day Assessment Service transferred to LCH Sept 2010

Integrated Acute / Community ED Avoidance initiative

Consultant provided

One stop assessment service incl; Diagnostics & AHP

Ring-fenced appointments for urgent GP / Community Response Team referrals

9 x New referrals weekly

Nurse Led Venesection service for Louth Hospitals – Total 550 Patients attending the service

Day Medical Services (LCH)

Day services - Surgical, Gynaecology Day Services Elective Endoscopy

Inpatient Services – 8 intermediate surgical beds

Colposcopy service

Selected as candidate hospital for national Colo-rectal screening service

Surgical Services (LCH)

Out-patient Services

CAWT Projects being progressed Ophthalmology – Provision of Cataract & Intra-

macular injections ENT – Waiting List Initiative GUM – Out Patient Clinic

Patient satisfaction questionnaire March 2011 Patients seen 0-35 mins = 88 % Care carried out by professional, skilful & competent staff

= 98% Did you receive adequate information on your treatment =

98%

Average LOS in Dept < 1 hour

Average daily attendance 25-30 patients

Minor Injury Unit (LCH)

Questions