Patient
Flow
You’ve heard it all before!
•
Ambulance ramping
•
Bed block
•
Wait lists
•
New hospitals
•
Alternate models of care
Why do we have this problem?
•
Supply Vs demand
•
Ageing population
•
Use of ED for primary care
•
Under utilisation of existing
infrastructure
Solution
•
Maximise capital infrastructure
–
Replace ALOS with patient appropriate
length of stay
•
Hospitals are an acute setting
•
Understand the blockages in the
hospital and where they are occurring
•
Use business intelligence to identify
quantum of blockages
Medworxx
•
streamline patient flow and safeguard the
appropriateness of care and transitions.
•
350+ Hospital Clients
; international client
base
•
Founded in 2004; based in Toronto, ON.
Listed on TSX Venture Exchange in 2007
Medworxx : Customers
34%
Acute-care Beds in Canada . .4
Provincial Agreements . .350+
Patient Flow Hospitals Canada, UK . .
~28,500
Acute-care Beds Canada, UK. .
1,900
Acute-care Beds UK . . Expanding in USAAppropriate
Time
Appropriate
Care
Appropriate
Place
Patient Flow Platform
Medworxx :: Patient Throughput
Solutions
Patient Throughput Software -Operational Use-
• Medworxx sells Patient Throughput software to Hospitals. This software can interface with all key IT
vendors.
• Tool tracks patients throughout the patient’s stay (real-time data).
Patient Throughput Review -Diagnostic Use-
• Medworxx provides Consulting Firms at Hospitals a review tool to collect hospital specific data related to the patient throughput process. • Data can be used by Performance
Improvement Teams to support their work and to monitor improvements over time.
Medworxx offers two patient flow solutions: Patient Throughput software and a Patient Throughput Review (PTR) tool ( used by Medworxx and independent consultants)
Clinical Criteria : Clinical Value
Key Enabler for Change
•
Standardised and Objective assessments
•
Integrate Medworxx data into Clinical & Management
Processes (consultant ward rounds / strategic planning)
•
Improve Coordination with Multidisciplinary Team and
Community partners
•
Measurement supports Management and decision
making
•
Use data to support strategic plan & Patient Flow
•
Use the evidence based clinical assessments to
determine:
–
Whether patients are currently receiving care in the most
appropriate setting for their needs = MET
–
If they are not currently receiving care in the most appropriate
setting for their needs = NOT MET
• Reason for inappropriate care settings, or causes for delays in discharge
are identified
–
Readiness for Discharge/transition Assessment = RFD
Transitions the patient care plan
Clinical Criteria :: Clinical Value
1. Assess
appropriate level of care
Monitor and
match intensity of service with level of care
2. Identify
flow status and bottlenecks
Identify, track primary reason for day of stay and take action on barriers, interruptions and delays 3. Assess discharge/transfer readiness
Assess clinical stability and prepare for safe
discharge/transfer
Standards Based Approach
1 + 2 + 3 =
Enable decision
making based on
facts, not
suspicion
Turn data into information, make it visible to everyone who needs it,
and make decisions based on facts
Outcomes
• Improve patient throughput
• Reduce avoidable days • Achieve timely
discharge
• Reduce preventable readmissions
Hospitals Gain Insights Into Barriers To
Discharge
Physician
• Unclear plan of care. • Physician consultation has
been ordered for
physician/specialist internal to the organisation.
• Diagnostic tests and/or therapeutic assessments are ordered.
• Physician orders indicate a form of therapy not meeting criteria or beyond the time parameter.
• Day of stay is primarily for observation.
Hospital
• Delay accessing services or resources provided by the organisation.
• Completing processing placement arrangements. • Patient requires services
directed towards improving independence; mobility, strength, endurance, and activities of daily living, required for a safe return to home or alternative setting.
Community
• Waiting for acute
services/consult from another facility.
• Waiting for community
assessment or bed placement. • Patient, family, social, financial
or home environment barriers that delay a safe discharge.
Data and Intelligence Across the Whole
Patient Flow Continuum
Front
Door Episode of Care Back Door
Need for Admission:
• Meets criteria
• Rapid assessments
• Admit source
• Reasons for admission
• Admission by Consultant
• By day of week
• Service Gaps
Need for continued stay: • Meets criteria • % beds utilised • Totals by Provider Organisation • Total by unit/provider/DRG etc.
Reasons for Delays:
• Days since ready for discharge/transfer
• Reasons for delay
• Delays by Consultant
• Delays by Service/Dept
• Delays by Provider
• Days beyond ABF
• Service Gaps
Operational /Management Reports and System Dashboards
Safe Discharge / Transfer
• Pull and push patients to correct level
• Avoidable re-admissions
• Integrated and shared information
If patients were clinically appropriate (or not) for the level of care they are receiving.
If patients were clinically ready for discharge or transition to an alternate level of care.
Barriers for each acute care hospital day beyond what is clinically necessary: segmented by hospital, physician, or community.
Reasons and details for each barrier or delay, such as services delays,
observation days, and community placement issues.
Patient Throughput Review (PTR) Quickly Unlocks Critical Barriers to Patient Flow
PTR Insights :: Allows You To…
Effectively visualise, assess, analyse and share information to increase understanding and promote
timely data-driven decisions
Access a snapshots of unique patient flow barriers and delays
Assess opportunities for hospital improvement via clear visibility into performance – and performance gaps
Profile Key Performance Indicators such as patient days, Average Length of Stay (ALOS), discharges, % occupancy,
Medworxx Glossary
Term Meaning
Clinical Criteria Sets Standardised, evidence-based clinical criteria
Met The patient is receiving the appropriate level of care on that day of stay.
Not-Met The patient no longer requires the level of care that they are receiving.
• Not Met criteria identifies the barrier, delay or
interruption to care which is the primary reason for the patient’s day of stay.
Readiness for Discharge Assessment (RFD)
Satisfying this assessment indicates a patient’s clinical readiness to transition or discharge from their current level of care.
Not Ready for Discharge The patient has unmet needs that must be satisfied before transition or discharge, but they do not require their current level of care to address these needs.
Use of Averages Ignores the Opportunity for
Optimising Care to Individual Patient Needs
Ignored
Opportunity Neglected Opportunity
Care Pathways, EDD and ELOS promote a focus only those patients who extend beyond the mean; this ignores:
• The individual variation that creates the average
• The safety of patients who are ready before the average or being declared “medically fit”
• The outlier patients who are the 2week + stays
• The result is average mediocre performance
• Robust validated criteria stretch performance towards global best practice
Patient Encounters Visibility Board Provides
Comprehensive Real Time Tracking
Clinical status of every patient, and associated barriers and delays are visible throughout the
Medworxx Progression of Care - Every
Reasons and Details – Provides
Customisable Barrier & Delay Tracking
Custom Built Attributes to standardise data collection and processes within the hospital or across a health system
If a patient no longer meets criteria for the level of care they were receiving, on the day of stay assessed, specific reasons for the delay are captured.
Readiness for Discharge/Transition
Assessment Provides Shared Currency
• This is a standardised, evidence based assessment,
• It is completed on every patient who no longer meets level of care requirements.
• If they pass this assessment patients are considered clinically stable and ready for discharge or transition to a lower level of care.
Cumulative interactive real-time view of patient
“journey”
Medworxx Reports : Readiness for
Discharge Tree
Provides a tree diagram detailing the RFD days
applicable to each category. Provides data as to
why patients that are clinically stable remain in
hospital.
Possible Insights
• There are conservable days related to either a physician, hospital or community reasons
Opportunities
• Drill down to reasons clinically stable patients remain in
hospital
• Implement strategies to
address/manage conservable days
Potentially Avoidable Days : Readiness for
Discharge by Category
27
Potentially avoidable days are incurred when a patient no longer meets clinical criteria for inpatient status
• For 38% of the days audited, patients were RFD - ready for discharge or transfer to a lower
Potentially Avoidable Days: Physician
Reasons
28
The majority of RFD days for Doctor-related reasons were attributed to pending plans
24 17 16 12 1 0 5 10 15 20 25 30 Discharge order
required Unclear plan of care physicians ordersNo current Other Referrals: Dietician Pending
Avoidable Days: RFD - Physician Details (multiple reasons may be selected per day)
Medworxx Patient Flow
Discharge orders required,
unclear care plans, and no current physician orders contribute to the greatest number of Doctor-related RFD days.
ALOS : By Admission Day
29
Patients who are admitted on Saturdays have an exponentially greater ALOS than patients admitted on all other days and the audit ALOS of 6.2 days.
ALOS :: Actual vs. Potential
The ALOS for patients in this audit was 6.2 days. We evaluated what the potential ALOS could be if patients had no Ready for Discharge (RFD) days.
Alternative Level of Care Days
Community reasons (Processing Placement and Waiting Community) accounted for the largest percentage of reasons for ALC days.
• All activation reasons were attributed to one patient who was clinically stable but had mobility
issues post total knee replacement who could have been managed in an inpatient rehab bed.
31 21 15 11 1 0 5 10 15 20 25
Processing Placement/ALC Activation/ALC Waiting Community/ALC Social Issues/ALC
Alternate Level of Care: Days By Status
Medworxx Patient Flow
Discharges by Days of the Week
32
A very large discrepancy between the beginning of the week – Mon-Weds and end of week/weekend was observed.
17 13 12 5 5 5 4 0 2 4 6 8 10 12 14 16 18
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
Day of Discharge Charge: Count By Day Of Week
Medworxx Patient Flow
Reporting and Analytics – Regional & Provincial
Examples
Alberta Health Services :: Statistical Reports
Edmonton Zone (Acute Mental Health)
Total Bed Days Alternative Level of Care (ALC) categories – i.e. patients occupying an acute bed who should be in an alternative level of care bed.
Alberta Health Services :: Statistical Reports
Edmonton Zone (Acute Mental Health)
There were 38% of patients in acute beds at a not-met, ready for discharge (RFD) status across the region.
Alberta Health Services :: Breakdown of the
reasons for delay by category
Winnipeg Regional Health Authority ::
Regional Patient Flow Report
Examples of benefits achieved by our
clients - Liverpool
Medworxx Case Study
• Activity Based Funding
– Opportunity to increase efficiency
• NEAT targets
– Free up more beds, delivering increased capacity
– Changes culture of organisation to a pull from the units as opposed to a push from ED.
• Capacity and Throughput
– Theatre lists
– Reduced ramping/crisis management
Improvements Yr1 Yr2 Yr3
% Reduction Potentially Avoidable Days Achieved
40% 60% 80%
New ALOS 5.28 4.92 4.56
Number of Hospital Beds Required 264 246 228
% Capacity Increase 9% 15% 21%
CONTACT ASPEN MEDICAL: E: [email protected]
