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Improving Patient Access and Flow
November 17, 2014
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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
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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
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Setting the Context:
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Improving Patient Access and Flow
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Ministry Mandate
• 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
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What is Patient Flow?
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According to the Institute for Healthcare Improvement
(IHI), Patient Flow is defined as an individual’s
movement through (and around) the health care
continuum
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ED overcrowding is a system-wide challenge and its root cause is
usually poor client flow.”
(e.g., unavailability of inpatient beds, inappropriateadmissions, 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.
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Patient Access and Flow
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Living with substance abuse, bipolar
disorder, asthma, Type 2 Diabetes,
COPD
Patient Access and Flow
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Has a family healthcare provider
•
Has visited the Emergency
Department 69 times in the last 12
months
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How are we measuring progress
related to patient flow?
1. Living in
Community
Some Key Measures we are Monitoring, Related to Patient Flow
2. Emergency
Department
3. Acute Care/
Sub-Acute Care
4. Living in
Community/
Post-Acute Care
Reduce Time to inpatient bed for patients that need to be admitted Reduce avoidable ICU days Reduce Alternate level of care (ALC) rate Increase percent of repatriations in 48 hoursReduce number of revisits to Emergency Department within 7 days Reduce readmissions within 30 days for COPD and other similar concerns
1. Living in
Community
More Key Measures related to transitions of care
2. Emergency
Department
3. Acute Care/
Sub-Acute Care
4. Living in
Community/
Post-Acute Care
Increase Discharge Summaries sent from hospital to community & family health care within 48 hours
Reduce ER visits best managed in family health care
Increase percent of patients seeing family health care within 7 days of discharge Wait time from primary care to Specialist
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The Burning Platform for Change?
Anne is admitted to hospital with
exacerbation of COPD.
She spends 23 hours in the ED waiting for an inpatient bed
1. Living in
Community
Example - Anne’s Health Care Experience
2. Emergency
Department
3. Acute Care/
Sub-Acute Care
4. Living in
Community/
Post-Acute Care
Anne spends 32 hours in the emergency departmentAnne is discharged and readmitted 10 days later with similar complaints. Approximately 22% of the time, patients with COPD are readmitted within 30 days
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)
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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
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Key Indicator – Time to Inpatient Bed
Pay for Results Organizations
Admitted Patient (length of stay
in ED) (hours) Time to Inpatient Bed (hours) 2012-13 2014/15-YTD Progress 2012-13 2014/15-YTD Progress University Hospital 30.1 32 6.3% 22.4 23.4 4.5% Victoria Hospital 29.5 26.8 -9.2% 21.9 18.5 -15.5% St Thomas 7.7 6.9 -10.4% 1.4 1 -28.6% Owen Sound 9.1 9 -1.1% 4.1 4 -2.4% Knowledge Transfer Organizations
Admitted Patient (length of stay in
ED)(hours) Time to Inpatient Bed (hours) 2012-13 2014/15-YTD Progress 2012-13 2014/15-YTD Progress Stratford 16.4 11.7 -28.7% 7 4.1 -41.4% Tillsonburg 24.6 23.2 -5.7% 18.1 17.6 -2.8% Strathroy 10.3 11.7 13.6% 4.8 5.7 18.8% Woodstock 12 8.4 -30.0% 4.4 1.9 -56.8% Timeliness Opportunity - Anne
waited 23 hours in the emergency department for a bed
Substantial improvement in some areas across the
0.0% 2.0% 4.0% 6.0% 8.0% 10.0% 12.0% 14.0% 16.0% R ate
SWLHIN(bed not available) LHSC(bed not available) SWLHIN Aviodable ICU days LHSC Aviodable ICU days
Starting to Monitor ICU Avoidable Days Rate
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
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
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What are we doing about improving
flow within the South West LHIN?
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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
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Other opportunities to improve Flow
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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
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Roll-out of Clinical Connect (“viewer” which allows review of
electronic records across different systems)
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A View of Anne’s Journey
South West RIDS System
Accessed from South West RIDs, November 13, 2014
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How can Primary Care providers
help?
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)
