Electronic Patient Journey

Boards

Where is Queensland up to?

July, 2014

Susan Moller - Principal Project Officer, CARU

Multi-disciplinary Meeting – Medical ward, Mackay Hospital.

Multidisciplinary Meeting – Neurosurgical ward, RBWH

„Adolescent MH – RBWH Discharge Planning –

Adult & Adolescent Mental Health wards, RBWH

•Designed by clinicians

•Popular, intuitive, well received

•Installed into 2 medical wards

•Reduced data duplication for handovers

•Enhanced communication and discharge planning.

“Ward at a Glance”

2009 - Developed at The Prince Charles

Hospital EMU.

• Medical, Surgical, Maternity, Mental health,

Paediatric & Sub-acute sites included

• Metropolitan, Regional and Rural sites

• Aligned with the „Criteria Led Discharge‟ initiative

• Qualitative and Quantitative outcomes measured

2011 – Statewide trial of EPJB‟s in 50 wards

in 10 hospitals

What was measured?

Quantitative

•Average Length of stay (ALOS)

•Estimated Date of Discharge (EDD) completion rates

Qualitative

•Views on Communication for Handovers, Discharge Planning etc

•Patient Safety factors

•Time saved?

•Level of Passion

Always being aware that EPJB’s not ‘isolated’ change

Quantitative outcomes Using all DRG‟s by ward „TWB MU1‟

LOS comparisons Pre & Post Electronic Patient Journey Board

MU1 TWBA(installed 3/5/11)

1.3

2.5

1.5

3.4

2.5

2.8

1.2

2.1

2.3

2.8

1.2

1.6

1.3

2.8

1.9 1.8

1.1

1.61.5

2.0

-

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

Chest Pain Non-Major

Arrhythmia

Syncope and

Collapse

HFand Shock Oesophagitis &

Gastroent

Unstable

Angina

Coronary

Atherosclerosis

Resp Infections

W/O CC

Seizure Resp Infections

W Severe/ Mod

CC

TOP 10 DRG's

Nu

mb

er

of

da

ys

May-Nov 2010

May-Nov 2011

Quantitative outcomes Using specific DRG by hospital „Resp Infections‟

Comparison of a specific DRG - Pre & Post EPJB

E62B - Respiratory Infections/Inflammations W Severe or Moderate CC

7.2

6.1

11.5

7.06.8

8.0 8.0

4.7

5.65.9

8.4

7.5

4.9

3.7

7.3

5.24.9

5.4

7.6

3.8

5.0 4.9

5.65.9

-

2.0

4.0

6.0

8.0

10.0

12.0

14.0

BUN Med

(6 mnths)

CBH Gen4

(12 mnths)

CBH CCU

(12 mnths)

CBH Med5

(12 mnths)

IPS 7C

(6 mnths)

MBH Med

(12 mnths)

NAM 2B

(6 mnths)

NAM 3FE

(6 mnths)

ROC Med

(5 mnths)

PCH W1C

(12 mnths)

PCH W1D

(12 mnths)

TOO MU2

(6 mnths)

TOO MU4

(6 mnths)

Hospital / Ward / Time period(Data supplied by the Health Statistics Centre, Qhealth, accessed throughout 2011/12)

Nu

mb

er

of

da

ys

Pre EPJB

Post EPJB- same period

Quantitative outcomes Using specific DRG by hospital - „UTI‟

Comparison of a specific DRG - Pre & Post EPJB L63B - Kidney and Urinary Tract Infections Age < 69 or W Severe CC

5.35.5

7.0 7.0

5.8

6.6

8.3

3.5

4.2

5.2

6.1

7.0

4.3 4.3

8.0

7.4

-

1.0

2.0

3.0

4.0

5.0

6.0

7.0

8.0

9.0

CBH Gen4

(12 mnths)

IPS 7C

(6 mnths)

MBH Med

(12 mnths)

NAM 2B

(6 mnths)

NAM 3FE

(6 mnths)

ROC Med

(5 mnths)

PCH W1F

(12 mnths)

TOO MU4

(6 mnths)

Hospital / Ward / Time period(Data supplied by the HealthStatistics Centre Qhealth, accessed throughout 2011/12)

Nu

mb

er

of

da

ys

Pre EPJB

Post EPJB Same period

Quantitative outcomes Using specific DRG by hospital „SVD‟

Comparison of a Single DRG Pre & Post EPJBO60B Vaginal Delivery W/O Catastrophic or Severe CC

2.21

2.63

2.44

2.172.172.22

2.44

2.11

0.00

0.50

1.00

1.50

2.00

2.50

3.00

MBH-WHU (6mnths) ROC-MAT (5mnths) TOO-HARBI (6mnths) TSV-TOBS (6mnths)

Hospital / Ward / Time period

(Data supplied by the Health Statistics Centre, Qhealth, access throughout 2011/2012)

Nu

mb

er

of

da

ys

Pre EPJB

Post EPJB same period

�Birth Suite – Royal Brisbane & Women‟s Hospital.

Qualitative outcomes:

• Improved efficiencies in Discharge planning

• Improved communication between all staff

• Improved handover processes

• Intuitive & user friendly, minimal training needed

• Improved patient safety & quality of care

• Level of Passion was high, ensuring liklihood of

sustainability

University of Southern Queensland (USQ)

How is Discharge Planning enhanced?

• Mandatory Estimated Discharge Date

• Mandatory Discharge Destination

• Discharge script status – Traffic Lights

• Transport bookings

• Allied Health referral status

• Collective discharge details for multiple patients

• Inter-hospital transfers

• Current demographic details ie addresses, postcodes

• Can effectively plan in advance

The notion that whiteboards facilitated patient flow and discharge planning was

a consistent finding and has been widely recognised……Chaboyer 2009

The EPJB journey -

2012 – Contracts with External provider commenced

- Mandatory fields

• Estimated Discharge Date (EDD)

• Discharge Destination

- “Ward at a Glance” to be a priority

- Traffic Light formatting

- Interfacing with HBCIS, EDIS & „The Viewer‟ now possible

- Whole of Hospital /Health Service now visible

- Remote access by all team members enhanced

Cairns & Hinterland HHS 22

Townsville HHS 22

Mackay HHS 4*

Central HHS 19

Wide Bay HHS 17

Darling Downs HHS 17

South West HHS 6

Electronic Patient Journey Boards in QLD

Sunshine Coast HHS 3

Metro North HHS 93

Royal Children‟s Hosp 8

West Moreton HHS 21

Metro South HHS 61

Gold Coast HHS 16*

Total = 309 EPJB‟s

Original MS „ACCESS‟ software

Patient Flow Manager

C

„WardView‟ at TPCH

Irrespective of Software used,

the underlying principle of

‘visual de-cluttering’ should apply

if use is to be maximised……

Less is more:

Ability to customise:

When staff perceive they are part of

the design and implementation, they

develop ownership……

Lessons learned re installs….

• Privacy concerns

• Geographical space

• Staff traffic

• Ward size

• Screen size

• 24/7, 16/7 or less….

• Ceiling, wall or desk mount

• „Touch‟ versus „non-touch‟

• Viewing comfort

• Landscape or Portrait

• Screen versus Handover

sheets for information transfer

• Workstation access

• Existing processes

• Cost

Key elements for Discharge Planning….

1.People

2.Processes

3.Tools

Is this the demise of the Manual Whiteboard?.........

MU4 ward – Toowoomba Hospital

7C ward – Ipswich Hospital

7B ward – Ipswich Hospital

1F ward – The Prince Charles Hospital

Medical ward – Mackay Hospital

Paterson ward – The Royal Children‟s Hospital

Neurosurgical ward – Townsville Hospital

Oncology ward – Royal Brisbane & Women‟s Hospital

GEM ward – The Prince Charles Hospital

And next….?

•Transit Lounges

•Pharmacies

•DEM‟s

•Operating Theatres

•Bed Management units &

•Residential Facilities

are being included.

Since 2014, not confined to

only „Inpatient areas‟

6AS –

RBWH

Susan Moller & Brent McMillin

Clinical Access & Redesign Unit,

Department of Health

Enquiries:

Susan.Moller@health.qld.gov.au

Brent.McMillin@health.qld.gov.au

6AS - RBWH