Bedside Patient Interviews: A Tool to Reduce Unplanned Re-admissions
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Transcript of Bedside Patient Interviews: A Tool to Reduce Unplanned Re-admissions
IMPROVING FLOW IN the NW HSDA TO PROVIDE
“CARE IN THE RIGHT PLACE”
Penny Anguish, NW COO On behalf of the NW CitRP Steering Group
Quality Forum – Vancouver February 26, 2014
Northwest Health Service Delivery Area
Participating Communities… Hazelton Prince Rupert
Kitimat
Terrace Smithers
The (Burning) Quality Issue
Admitted patients in the Emergency Department….
Inpatient congestion the norm in our rural community hospitals….
Many patients waiting for an alternate level of care (ALC)….
~20 - 25% of the acute beds had people waiting for residential care, usually for > 9 months….
Far too many “awful shifts”…..
The Quality Initiative: “Care in the Right Place”
Overarching Goal o Smooth and timely transitions of patients
to the right level of care to optimize use of acute care and community resources
Planned Outcomes o Reduced acute care occupancy rates o Reduced ALC and ALC to residential care
placement in particular
Key Interventions
Typical “FLOW” strategies o Unit white boards o Daily FLOW huddles o Interprofessional care planning o Optimizing use of community resources o Daily management with a focus on
timely results for the people that need to act
But change leadership at all levels mattered most…..
Steering Group and Local Team Accountability
NW Senior Leadership Team
NW CitRP Steering Group
Prince Rupert Improvement
Team
Kitimat Improvement
Team
Terrace Improvement
Team
Hazleton Improvement
Team
Smithers Improvement
Team
NW
QI Lead
NH Executive
Execution Strategies
Project charter (2 page summary) o Developed collaboratively o Provided clear goals for teams
Steering Group Action plan o Pulled goals from charter o Basis for development of local plans
Reporting results o Daily and monthly reporting o Increased accountability o Communicated success
What Worked / What Changed
One team’s story: Prince Rupert
<Insert video link>
Results
Results
(450)
(350)
(250)
(150)
(50)
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P1 P2 P3 P4 P5 P6 P7 P8 P9 P10 P11 P12 P13 P1 P2 P3 P4 P5 P6 P7 P8 P9 P10 P11
FY2012/13 FY2013/14
ALC
Patie
nt D
ays
NW Acute Facilities ALC Patient Days (QC & Haida Gwaii Excluded) Variance from Prior Year Period
ALC Days Variance Prior Year Baseline
Pd 9 Care in the Right Place Starts
Results
Results
Oct 2012 Nov 2012 Dec 2012 Jan 2013 Feb 2013 Mar 2013 Apr 2013 May 2013 Jun 2013 Jul 2013 Aug 2013 Sep 2013 Oct 2013 Nov 2013 Dec 2013 Jan 2014
628.88 628.88 628.88 628.88 628.88 628.88 420.54 420.54 420.54 420.54 420.54 420.54 420.54 420.54 420.54 420.54
334.79 334.79 334.79 334.79 334.79 334.79 126.46 126.46 126.46 126.46 126.46 126.46 126.46 126.46 126.46 126.46
481.83 481.83 481.83 481.83 481.83 481.83 273.50 273.50 273.50 273.50 273.50 273.50 273.50 273.50 273.50 273.50
571.00 505.00 486.00 531.00 423.00 375.00 338.00 387.00 321.00 291.00 213.00 254.00 283.00 229.00 215.00 204.00
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
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Special Cause FlagIn
div
idual V
alu
e
Calendar Month
NW HSDA - ALC Placement Patient DaysBase for LimitsAverage MR
A. 1 Beyond Control LimitB. 9 On One Side of Average
D. 14 Alternating Up & DownE. 2 of 3 Beyond 2 Sigma
G . 15 Within 1 SigmaH . 8 Outs ide 1 SigmaX. Excluded or Miss ing Data
Last Center Value 273.5Last Data Value 204Sigma for Limits 49.01
Care in Right Place Starts
Residential Care Waitlists: New Referrals
???
Key Learnings
There is untapped capacity in the system if you are looking for it
Initial assistance (FLOW Coordinators and QI Lead) key in LITs getting started
Rich communication to physicians mitigated early resistance from this group, sharing results fosters physician engagement
Engaging staff through LITs using QI process/strategies is a must
Daily management is key to sustainability
Next Steps
Solidifying daily management accountability to point of care managers (acute and community)
Acting on data analysis of Emergency Department activity (high user care coordination and CTAS 3 admission avoidance)
Shifting acute care to a rehabilitative approach (our care of the frail elderly)
Further optimization of community resources/residential care avoidance strategies