Improving Patient Access and Flow

Transcription

1 Improving Patient Access and Flow Physician Engagement Presentation London November 17,

2 CFPC Disclosure for Mainpro-M1 In relation to all speakers here today: 1. No funding received for the program 2. No potential conflicts of interest resulting from sponsorship funding have been resolved 3. No conflict of interest disclosure 2

3 Agenda 5:00 Registration & Refreshments 6:00 Welcome / Dinner Introductory Comments Michael Barrett, Chief Executive Officer, South West LHIN Frank Rubini, Regional Manager, Ontario Medical Association 6:40 Setting the Context Improving Patient Access and Flow Michael Barrett, Chief Executive Officer, South West LHIN 7:00 Keynote Address Establishing a Culture of Quality Improvement Dr. Jeffrey Turnbull, Chief, Clinical Quality, Health Quality Ontario 7:30 Panel Discussion (Facilitated by Dr. Gordon Schacter) 8:50 Wrap-up & Closing Remarks 9:00 Evaluation / Adjournment 3

4 Setting the Context: Improving Patient Access and Flow Michael Barrett, Chief Executive Officer, South West LHIN 4

5 Ministry Mandate Highlights from the Minister s mandate letter: Ensuring patients receive the most appropriate care at the most appropriate place Continued expansion of home and community care Championing the delivery of quality coordinated care and establishing more efficient and coordinated care plans Establishing a patient ombudsman Accelerating the adoption of new technologies Strengthening end-of-life care 5

6 What is Patient Flow? According to the Institute for Healthcare Improvement (IHI), Patient Flow is defined as an individual s movement through (and around) the health care continuum 6

7 ED overcrowding is a system-wide challenge and its root cause is usually poor client flow. (e.g., unavailability of inpatient beds, inappropriate admissions, delays in the decision to admit, delays in discharge, and lack of timely access to diagnostic services and care in the community). Poor client flow results from a mismatch between capacity and demand The accountability of Senior Leaders (including physicians) is to be demonstrated in a policy and in their roles and responsibilities. Accreditation Canada January

8 Anne s Story 8

9 Patient Access and Flow Living with substance abuse, bipolar disorder, asthma, Type 2 Diabetes, COPD

10 Patient Access and Flow Has a family healthcare provider Has visited the Emergency Department 69 times in the last 12 months

11 How are we measuring progress related to patient flow? 11

12 Some Key Measures we are Monitoring, Related to Patient Flow 1. Living in Community Reduce Time to inpatient bed for patients that need to be admitted 2. Emergency Department 4. Living in Community/ Post-Acute Care Reduce Alternate level of care (ALC) rate 3. Acute Care/ Sub-Acute Care Increase percent of repatriations in 48 hours Reduce avoidable ICU days

13 More Key Measures related to transitions of care Reduce ER visits best managed in family health care Reduce number of revisits to Emergency Department within 7 days Wait time from primary care to Specialist 1. Living in Community 2. Emergency Department Increase percent of patients seeing family health care within 7 days of discharge 4. Living in Community/ Post-Acute Care Increase Discharge Summaries sent from hospital to community & family health care within 48 hours 3. Acute Care/ Sub-Acute Care Reduce readmissions within 30 days for COPD and other similar concerns

14 The Burning Platform for Change? Anne s experience as an example 14

15 Example - Anne s Health Care Experience Anne tries to get an apt with family care provider it s in 2 weeks (only 38 % see family care within 7 days in the South West) And.her doctor has no idea she was in hospital (33% receive a discharge summary in 48 hours) Anne is discharged and readmitted 10 days later with similar complaints. Approximately 22% of the time, patients with COPD are readmitted within 30 days 1. Living in Community 4. Living in Community/ Post-Acute Care 2. Emergency Department Anne is admitted to hospital with exacerbation of COPD. 3. Acute Care/ Sub-Acute Care Anne spends 32 hours in the emergency department She spends 23 hours in the ED waiting for an inpatient bed

16 Some Drill Down 16

17 Additional Drill Down 1. Time to inpatient bed high volume sites across the South West LHIN 2. ICU avoidable days across the South West and London Health Sciences Centre Internal or external bed not available Internal or external transportation delay Internal staff not available Transfer orders not completed Waiting on test/procedure completion

18 Key Indicator Time to Inpatient Bed Timeliness Opportunity - Anne waited 23 hours in the emergency department for a bed Pay for Results Organizations Admitted Patient (length of stay in ED) (hours) Time to Inpatient Bed (hours) /15-YTD Progress /15-YTD Progress University Hospital % % Victoria Hospital % % St Thomas % % Owen Sound % % Knowledge Transfer Organizations Admitted Patient (length of stay in ED)(hours) Time to Inpatient Bed (hours) /15-YTD Progress /15-YTD Progress Stratford % % Tillsonburg % % Strathroy % % Woodstock % % 18 Substantial improvement in some areas across the LHIN

19 Rate Starting to Monitor ICU Avoidable Days Rate 16.0% 14.0% 12.0% 10.0% What is an ICU avoidable day? An avoidable day in the ICU is when a patient no longer medically needs an ICU level of care, however they are not able to be moved to a step down unit of care due to things like bed not available, etc. 8.0% 6.0% 4.0% 2.0% 0.0% SWLHIN(bed not available) SWLHIN Aviodable ICU days LHSC(bed not available) LHSC Aviodable ICU days Efficiency and Value Opportunity this chart shows that 8-10% of the time a bed was not available so a person had to remain in ICU, even though it was not required

20 What are we doing about improving flow within the South West LHIN? 20

21 Improving Patient Access and Flow in the South West LHIN We have numerous initiatives to improve access and flow in the LHIN, including the implementation of Health Links across the South West Here are some key ones you will hear about tonight 1. Emergency Department Mental Health Access 2. econsult 3. Critical Care Access and Flow Initiative 4. Discharge Planning 21

22 Other opportunities to improve Flow Regional Integration Decision Support (RIDS) is a warehouse that links data together o Other systems do not allow data from different databases to be linked o Through RIDS, we can now track a single patient on their journey through various parts of the health care system Roll-out of Clinical Connect ( viewer which allows review of electronic records across different systems) 22

23 A View of Anne s Journey South West RIDS System 23 Accessed from South West RIDs, November 13, 2014

24 How can Primary Care providers help? 24

25 Key Considerations - How can improvements in primary care help to improve flow? 1. Provide timely access to primary care (appropriate hours of service and communication of after hours clinic times) 2. Understanding which patients are frequently using the Emergency Department o Almost 200 physicians in the South are part of LENs. A new feature allows physicians to see who their frequent visitors might be along with their CTAS level to see if the reason the patient went to ER is for a potentially avoidable issue. 3. Work to improve referral process to specialists 4. Ensure patients are seen within 7 days of discharge from hospital o There are interventions underway to support improved communication of discharge summaries post discharge for patients within 48 hours 5. Create awareness of CCAC care coordinators and community services (i.e. diabetes education programs and services) 6. Maximize use of other health care providers such as NPs

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