Carol Parker & Sharan Ermel - Bendigo Health - Transition Care Quality Service Review
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Transcript of Carol Parker & Sharan Ermel - Bendigo Health - Transition Care Quality Service Review
TRANSITION CARE QUALITY SERVICE REVIEW IN THE LODDON MALLEE REGION
CONDUCTING A QUALITY SERVICE REVIEW
Sharan Ermel Carol Parker Collabora@ve Health Educa@on and Research Centre
Introduc@on
Service review
• Performance • Quality • Understanding • Improvement • Con@nua@on • Replica@on
Processes
• Nego@a@on of evalua@on plan
• Data/evidence collec@on & analysis
• Dissemina@on of results • Inform decisions • Increased understanding
Introduc@on -‐ con@nued
Products of review • Evidence • Conclusions • Recommenda@ons
Transi@on Care Program -‐ Background Transi@on Care Program (TCP) • Joint Commonwealth/State funded na@onal program aimed at:
• Minimising the number of older people experiencing inappropriate extended hospital lengths of stay and/or
• Being prematurely admiVed to residen@al care • Program for the provision of flexible care under the Aged Care Act (1997)
• Established 2004-‐05 • Na@onally -‐ 599 flexible care places allocated
• In Victoria • 2009 -‐ 674 places → 837 in 2011
• Currently: • 4000 places na@onally, • 1000 opera@onal in Victoria
• 364 regional • 636 metropolitan based
• NOT a subs@tute for hospital based care, nor a subs@tute for ongoing community-‐based aged care.
Transi@on Care Program – Background(2) Bendigo Health • 2007 – 10 places • 2008 – 27 places • 2010 – 58 places
• Bendigo – 32 places • Swan Hill – 8 places • Echuca – 10 places • Maryborough – 4 places • Kyabram – 4 places • Castlemaine – 4 places (Sept)
• 2013 – 85 places Mildura – July 2010 • 12 places
Loddon Mallee Region Popula@on • 308, 782 (2011)
• 359, 206 (2021)
65yrs + • 17% (Victoria = 14%) 2011
• 20.8% (Vic = 16.7%) 2021
Need for assistance core ac@vity: • 5.8% (Victoria 5%)
Residen@al aged care availability: • High level: 37.6(Vic 42.2) per 1000 eligible • Low level: 49.2 (Vic 45.7%) per 1000 eligible
NEGOTIATION OF EVALUATION PLAN
Ques@ons to consider Key stakeholders ? Availability?
Funding ?
What evidence is required?
What measures are available?
Who is going to conduct the review/evalua@on?
What is the purpose of the evalua@on?
Project aim
• Review and evaluate Loddon Mallee TCP service delivery
• Formulate recommenda@ons to assist the provision of best prac@ce clinical care and to best enable applicable Transi@on Care standards to be met
Governance structure
Steering CommiVee established
Project Objec@ves 1. Review and evaluate:
– Exis@ng client service delivery of Loddon Mallee TCP services against: • Transi@on Care Program Guidelines 2011 -‐ Quality Standards
• Contracts for the Provision of Transi@on Care Program Services
• Na@onal Safety and Quality Health Service Standards 2011 – Regional administra@ve & repor@ng processes
2. Make recommendaFons to assist TCP services
3. Provide informaFon and advice to Bendigo Health regarding: • Addi@onal support and systems that may be required in its role as
Regional Manager of the TCP Service
4. Benchmark
Collec@on of evidence Mixed method approach
• Interviews of key stakeholders and TCP staff • Focus groups • Compliance with TCP Standards, Bendigo Health contract,
NSQHSS
• Compliance with repor@ng and administra@ve requirements
• Benchmarking – Staffing
– Occupancy – Discharge des@na@on and length of stay
Interviews and focus groups Open ended quesFons – exploraFon of themes
• Service strengths and weaknesses • Training opportuni@es • Resource requirements • Staffing requirements
• Impediments to service delivery
• ICT deficits and technical support requirements • Unmet need
Evidence -‐ standards
• Transi@on Care Program Guidelines 2011 -‐ Quality Standards
• Contracts for the Provision of Transi@on Care Program Services
• Na@onal Safety and Quality Health Service Standards 2011
DATA COLLECTION AND ANALYSIS
Interviews and focus groups
• 20 interviews
• 4 focus groups • 45 TCP staff and stakeholders • 12 health agencies
Evidence – rich data
QualitaFve data
-‐ Transcribed
-‐ Collated
-‐ Themed
-‐ Triangula@on of results – further evidence
Results: interviews & focus groups
• Service strengths
• Service weaknesses • Training opportuni@es • Staff requirements and resources
• Impediments to service delivery
Results: interviews & focus groups
Service Strengths
• Capacity • Communica@ons
• Flexibility • Partnerships • Posi@ve Program
• Team • Video Conferencing
Results: interviews & focus groups Service Weaknesses
• Aged care assessment process
• Accessing educa@on/informa@on
• Administra@on and support • Care demands
• Communica@on issues
• Consistency • Costs • Facility constraints • Funding • Managing wai@ng lists
• Soqware limita@ons
• Staffing and resources • TCP awareness
Results: interviews & focus groups Training opportuniFes
• Needs assessment and analysis • Specific therapist focussed forums
• Regional coordinator forum • Mentoring
• Allied Health Assistant training • U@lisa@on of broader regional educa@on opportuni@es • Work shadowing
• Short, sharp clinical updates
Results: interviews & focus groups Staff requirements and resources
• Back fill for part @me TCP staff. Risks include: • Con@nuity of care • Outcomes
• Bed occupancy • Repor@ng requirements
• Therapeu@c staff mix and availability
• TCP manual • Equipment
Results: interviews & focus groups Impediments to service delivery • Aged care assessment process
• Addressing bed vacancies
• Succession planning • Suitable and available backfill
• Repor@ng
• Therapeu@c services available • TCP awareness
• Travel distance
• Bed based versus community beds
• Complex clients
• Service changes • Costs
• Part @me staff
• No access to restora@ve care beds
• Border regions
• Referrals • IT issues
• Bed blockages
• Limited TCP places
Data Collec@on -‐ Quan@ta@ve (1)
Data Collec@on -‐ Quan@ta@ve (2) Loddon Mallee Region • Occupancy • Readmission • Death • Discharge des@na@on
• High care • Low care • Home
• Average length of stay • Quality ac@vi@es • Client sa@sfac@on • Data • Mee@ng aVendance
PRODUCTS OF REVIEW
• EVIDENCE • CONCLUSIONS • RECOMMENDATIONS
EVIDENCE -‐ TCP Guideline Compliance
Australian Government Department of Health and Ageing ‘TransiFon
Care Program Guidelines 2011 Quality Standards’
• Standard 1 -‐ Op@mising independence and wellbeing
• Standard 2 -‐ Mul@disciplinary approach and therapy focused care
• Standard 3 -‐ Seamless care
EVIDENCE -‐ NSQHSS Compliance (1) Review and evaluaFon against the ten NaFonal Safety and
Quality Health Services standards (NSQHSS): • Governance • Partnering with consumers
• PrevenFon and controlling healthcare associated infecFons • Adherence to infec@on control guidelines • Educa@on to clients/carers/families
• Medica@on safety
• PaFent idenFficaFon and procedure matching • Health agency procedures adhered to regarding iden@fica@on bands • Pre-‐procedure iden@fica@on of pa@ents
EVIDENCE -‐ NSQHSS Compliance (2) • Clinical handover
• Key handover points iden@fied • Handover tools: ISBAR/ISoBAR • Referral processes
• Blood and blood products • PrevenFng and managing pressure injuries
• Pressure risk assessments
• Repor@ng of injuries • Educa@on
• Recognising & responding to clinical deteriora@on in acute health care
• Preven@ng falls and harm from falls
EVIDENCE – Quan@ta@ve Benchmarking: Victoria
Health Area (Bed Numbers) Occupancy
(%)
Length of Stay
(days)
Total for Loddon Mallee Region 89.7 66.3 Total for Loddon Mallee Region without Bendigo 87.7 62.6 Total for Region B (42) 73.2 52.7 Total for Region B without Major Regional Hospital 71.5 Total for Region C (63) 78.3 52.4 Total for Region C without Major Regional Hospital 73.3 Total for Region D (73) 89.7 60 Total for Region D without Major Regional Hospital 82.9
CONCLUSIONS -‐ Issues
• Par@cipa@on • Delayed assessment for eligibility • Small numbers of beds – part @me coordinators • Backfill, service con@nuity, bed occupancy • Regional coordina@on • Template for standards, contract and NSQHS
standards • Compliance with repor@ng • Benchmarking
CONCLUSIONS -‐ Overall
• Valued and valuable program. • Resourcing issues need to be considered. • Consider transparency and consistency of processes.
RECOMMENDATIONS (1) Resource and staff requirements: 1. Considera@on of a regional coordinator 2. TCP succession planning and backfill for leave resolu@on
Impediments to service delivery: 1. Aged Care Assessment process 2. Alterna@ve models of aged care assessment
explora@on
Training opportuniFes Educa@on and training needs analysis to be undertaken
ICT Deficits and Technical Support Requirements Standardised appropriate and accessible TCP soqware
RECOMMENDATIONS (2) Unmet needs: • Development of a prac@cal, user friendly
TCP guide/manual
• Development of consistent TCP communica@on and repor@ng processes
• Protected networking @me between TCP Coordinators
Review of previous report and recommendaFons: • Reconsider TCP becoming a standard agenda item on regular
Director of Nursing mee@ngs
• Reconsider invi@ng Aboriginal Liaison Officer to provide VC educa@on to regional TCPs
DISSEMINATION OF RESULTS
Audience Commissioner of review Stakeholders Informants Community User groups
Consider: Risks Confiden@ality Ownership
Method WriVen
– Formal report – Execu@ve summary – publica@on
Audio visual Media
Review process lessons
Stakeholder engagement – broader (ACAS etc) Balance
Self report – content of responses
Scope of review
Access to data
References Department of Health (2012) Local government area profiles: Loddon
Mallee Region. Department of Health, Melbourne Australian Commission on Safety and Quality in Health Care (20110
Na>onal Safety And Quality Health Service Standards. ACSQHC. Australian Government Department of Health and Ageing (2011) Transi>on
Care Program Guidelines 2011 Quality Standards. Department of Health and Ageing, Canberra
Australian Government Department of Health (2008) Na>onal evalua>on of the Transi>on Care Program. Australian Government Department of Health, Canberra [online] hVp://www.health.gov.au/internet/main/publishing.nsf/Content/ageing-‐transi@on-‐na@onal-‐evalua@on-‐summary.htm
Australian Government (2011) TCP Handbook. [online] hVp://www.health.gov.au/internet/publica@ons/publishing.nsf/Content/
ageing-‐transi@on-‐handbook.htm~ageing-‐transi@on-‐handbook02.htm