st mary’s patient pathway project stephan brusch – service development manager westminster pct...
TRANSCRIPT
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St Mary’s patient pathway project
Stephan Brusch – Service Development Manager Westminster PCT
Mark Sheen - Community Nurse SpecialistKensington and Chelsea Learning Disability Service
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SETTING THE SCENE
• High rates of poverty and deprivation centred in specific wards
• Indices of deprivation (2004) Westminster 39th and K&C 166th out 354 English districts
• Up to 18 year difference in life expectancy for people living in the wealthiest and poorest wards
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SETTING THE SCENE cont….
The project involved: • St Mary’s NHS Trust
• Westminster Learning Disability Partnership
• Kensington and Chelsea Learning Disability Service
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PAST WORK AND CHALLENGES
• St Mary’s Disability Group
• Teaching, video’s, accessible information
• Limited effectiveness• Difficulties in effecting
a systems change
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Opportunity
• Established link with the Modernisation Board at St Mary’
• Body that oversees Transforming St Mary’s
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What is Transforming St Mary’s?A programme of coordinated projects addressing the use of new technology, new roles and new processes
The programme uses a structured approach to project and programme management, and each project reports to the Transforming St Mary’s Board Programme Board
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Aim - To improve service efficiency and effectiveness of the trust, for the benefits of staff and patients
•Objectives – To ensure patients are treated in the right place at the right time by the right staff, to provide safe, high quality care.
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•What are the projects?•IT•Picture Archiving - electronic capture & storage of X-rays •Order Communications - electronic ordering & reporting of diagnostic tests •Electronic Discharge Communication - electronic GP discharge letters•Choose and Book - direct booking of out patient clinics from GP surgeries•Roles•St Mary’s 24 / 7 – redesigning roles e.g. Outpatient Clinic Assistants•Processes•Improving the Patients Journey – streamlining processes and procedures from pre-assessment to discharge
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Improving the Patients JourneyAims •To streamline, standardise and improve the processes and procedures of pre-assessment, admission and discharge•Objectives•To reduce length of stay for patients•To increase % of patients who receive pre-operative assessment•To increase % of patients who are given an expected date of discharge
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Why did we get involved?
As part of Improving the Patients Journey (IPJ) project the trust was redesigning the patient journey from pre-assessment to dischargeA proposed pathway was designed. What impact did this pathway had on vulnerable patients?
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The St Mary’s project:
• A defined patient pathway agreed by community and hospital staff.
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Project Objectives- The Outcomes:
• Improved patient experience for people with learning disabilities and their carers
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Project Objectives- The Outcomes:
• Decrease the number of inappropriate admissions by increasing the number of people who can be treated in the community.
Community
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Project Objectives- The Outcomes:
• Length of hospital stay in line with the general population
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Auditing Records:
• We looked at records of people who stayed at St Mary’s.
• We wanted to see what worked well and what didn’t work well.
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Consultation:
We arranged a workshop and looked at the following areas:
• Going into hospital • Staying in St Mary’s• Leaving St Mary’s and
A&E
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This is what came out of the mapping exercise:
• Pre-admission• Inpatient stay • Discharge and A&E
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Pre-admission
Training
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Pre-admission
Ensure people have access to primary care
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Re-launch communication tool
Pre-admission
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Ensure that St Mary’s can identify people with learning disabilities and their support needs.
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Inpatient stay
Better information when arriving at St Mary’s .
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Better training and information on consent and best interest.
Inpatient stay
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Better information while staying in hospital.
Inpatient stay
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Better triage in A&E
Accident and Emergency
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Training
Accident and Emergency
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Better communication at discharge.
Discharge
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• We included everything in an action plan and set priorities.
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Next Steps:• Transforming St
Mary’s Programme Board
• Partnership Boards
• St Mary’s Disability Group
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Reflective Learning Points• Gather data and link to national evidence (audit
and user involvement).• Moving away from focussing on patterns
(people’s behaviour) to influencing processes • Mainstreaming (transferability to other vulnerable
groups, process mapping)• Being politically astute (create win-win situation)• Be a strategic Health Facilitator