Presentation title Presenter’s name

Department/Unit/Ward

Service line

Facility/hospital

Date

After-Hours Task Management

using portable devices.

Susan Moller, Mary Fenn, Sal Tuigamala,

Sonia Chanchlani, Julian De Looze,

Metro North ITS, Smart Devices team,

AHNM’s, RMO’s & wards of RBWH and Telstra Health.

On Evenings, Nights, Week-ends & Public Holidays

• Far fewer Doctors

• Ward RMO’s are junior & less experienced

• Possible mal-distribution of workload

• Fewer & limited support services

• No ward NUM’s or CNC’s

• 73% of MERTS occur after-hrs

• ED presentations & IHT’s do not stop

• Complex patients arrive in wards on W/E’s..

• stress/anxiety/burnout/sick leave/PTSD

RBWH - What happens after-hours?

http://qheps.health.qld.gov.au/rbwh/safety/twentyfourseven

Doctors feedback included...

• “Overwhelming workload”

• “Handovers are poorly conducted in general”

• “Important bloods are delayed, people are definitely not seen within acceptable time frames… antibiotics & meds are missed due to time pressure..”

• “You feel awful providing inadequate health care”

• 49% of nurses believed after-hours medical officers were less responsive than during the day? They felt this was related to

• drop in staffing levels,

• competing patient flows

• acuity demands and

• skill mix after-hours.

Sample of A/Hr’s staff comments..

But workloads were invisible!

Focus of the 24/7 initiative

Patients of Concern

Handovers

Task Management

Staffing & Skill mix

RBWH – before..• Traditional desktop paging and switchboard service.

• Invisible workloads

• Inefficiencies – Phone tag between Dr’s and ward staff

• No ability to load share

• Limited ability to convey clinical information

Convert shift details to a

coded format, mapping

each role and shift to a

specific device……

Implementation..✓ Commenced in August 2016

✓ Procurement – Contracts and device selection

✓ Configuration of RMO roles, wards, shifts and emails.

✓ Extensive testing of devices, emails, Wi-Fi coverage

✓ Phase 1. Feb 2017– 9 wards and 6 Medical roles Go-Live

✓ Phase 2. July 2017 – to 20 wards and 10 Medical roles

Phase 3. 21st Aug 2017 – Mat/Gynae wards and O&G RMO’s.

Phase 4. 28th Aug 2017 – Mental Health services join.

So how does it work?

The iPad storage • Within a ‘Doctors only’ area

• Keypad access

• Infection control covers

• Checked daily by AO

• ‘Feedback & Comments’ book

Week One..?

• Scrolling of screen - resolved

• Personal iPhone access – allowed

• Weekend to weekday issue – resolved

• Repeat logins, long passwords - resolved

• Configuration & routing of Med A emails - resolved

• Readmission error with tasks reappearing - resolved

• RMO’s - some wards are paging & others on are iPad – resolved

• Onsite support – for first 7 evenings/nights – supported

• Wifi access and 4G speed – ongoing

• Biggest problem……Non-pilot wards accessing system !!

Nurses feedback

▪ Transparency – “We can see that the medical staff have received and acknowledged the request”

▪ More clinical detail can be entered compared with Paging

▪ Now we enter ALL tasks – better indication of our ward needs.

▪ Fewer phone calls made trying to verify if task received

▪ No need to know which Dr to call – is assigned automatically.

▪ Easy to use – very straight forward.

▪ “I can book tasks that need to be done at a later time…”

▪ We can add extra text as needed.

Bonus’s – Apps & iBooks

• QHEPS

• The Viewer

• CIMHA

• PACSViewer

• UptoDate

• CKN

• Streamline

• IT HelpDesk

Workloads are now visible… 2,672 tasks for July

0

100

200

300

400

500

600

Medical Intern Medical RMO A Surgical Intern Surgical JHO/SHO Surgical RMO B Surgical RMO C

Number of Tasks by Role for July 2017 (9 wards only)

0

100

200

300

400

500

600

23HRS 4C 8BN 8BS 9AN 9AS 9BN 9BS GEMW

Number of Tasks by Ward - July 2017

0

50

100

150

200

250

300

350

400

450

Task by Reason - July 2017

Sustainability?

✓After-Hours Nurse Managers are first point of call

✓Knowledge Based Articles published in ServiceNow – avail

to the 24/7 QHealth state-wide support service.

✓24/7 Support by Smart Devices team

✓PFM Support Team – for problem sorting in Business Hrs

✓Minimal recurrent costs

✓Vendor support available 24/7… if indicated.

✓Daily AO checks of all devices.

✓2018 – 4 FTE Extra Senior Registrar and 3.4 CNC for A/Hrs

✓Most importantly…End User uptake and satisfaction.

For all hospitals using Patient Flow Manager – this is now available as a Module.

“Task Manager Module”

AcknowledgementsRBWH Patient Flow Unit - Susan Moller, Sal Tuigamala, Anthony Nesbit.

RBWH Safety & Quality - Mary Fenn

Medical staff & CMORE - Sonia Chanchlani, Julian De Looze

Metro North IT - Donna Pettiford, Julie Mossler, Michael Cadogen, Damian James

Healthcare Improvement Unit

Smart Devices Team – Frank Mazzaferro et al.

Telstra Health staff - Sri Rajan

Our Carpenter

The RMO’s and wards that went first!!