By Dave Piggott
We’re back from the Improving Patient Flow conference in Melbourne and there’s so much we’re keen to share with you. It was a big two days with a stellar line up of inspiring speakers, with more than 100 patient flow enthusiasts gathered in one room to learn about the latest innovations for optimising patient flow.
The Alfred: Whole-of-health-service reform program
In line with the conference theme, ‘Driving whole of hospital reform to Improve Patient Flow’, Martin Keogh’s keynote presentation described Alfred Health’s journey in tackling NEAT through a whole-of-health-service approach.
However, a troubling statistic indicates that patients were far more likely to suffer a negative outcome during this after-hours period than any other time of day. In addition, they recognised that the clinicians who were available during these times weren’t being evenly utilised, with some being severely overwhelmed with tasks, while others were far from it. In short, they lacked visibility of this capacity and as a result, were unable to optimise their resources to meet demand.Martin shared that a particular area of focus for the Alfred has been After Hours. Like many hospitals, the Alfred has a limited number of senior clinicians being available at night, which often results in patient care decisions being deferred until morning when these clinicians returned.
Recognising an opportunity for improvement, Martin shared how the Alfred developed a tool to gain visibility of their After Hours capacity, as well as the corresponding demand (in the form of tasks that required a clinician’s attention) at a hospital-wide level.
Alongside this tool, they also reshaped the roles of existing staff to form a team of three – a Clinical Operations Manager/After-Hours Manager, an After-Hours Patient Flow Manager, and an Advance ICU Trainee – to provide oversight of patient flow and clinical management of patients after hours.
As a result of these changes, the Alfred is now able to:
- Centrally view and manage all After-Hours tasks;
- Ensure these tasks are evenly distributed across available resources; and
- Optimise the allocation of the limited resources for better patient care.
This approach has served to improve the Alfred’s NEAT outcomes as well, by unblocking one-third of the day which was previously impeded by poor patient flow and insufficient visibility to match capacity and demand.
At the same time, the Alfred is far from the only one driving change in the After-Hours space. The Royal Melbourne Hospital (RMH) recently led the innovation around Patient Flow Manager: Nightlife, which has helped the hospital achieve the same functionality and benefits described above with the added benefit of an integrated real-time solution.
By partnering with Health IQ to develop this functionality, RMH has realised an After-Hours-specific solution that also feeds directly into the tracking of a patient’s overall journey in Patient Flow Manager.
Whole of Hospital Program: Characteristics of high performing hospitals within NSW
Hailing from NSW Health, Luke Worth presented on the insights he has gained by working with health services to help them increase their performance.
A key insight that resonated with us was that there are ‘pockets of excellence’ throughout the health system, in the form of innovative clinicians and staff focused on driving continuous improvements in the hospital environment. He highlighted the need for hospital leadership to identify and nurture these ‘superheros’ of excellence, empowering them to continue their innovation, not only to benefit their own hospital, but the Australian healthcare sector as a whole.Discussing the key characteristics high-performing hospitals share, he emphasised the importance of an end-to-end focus on patient flow with overarching governance to support it.
We certainly see evidence of these ‘pockets of excellence’ every day as we partner with innovative hospital staff to help them realise their visions for such continuous improvement by leveraging technology. In fact, we had one such superhero client actually presenting at the conference themselves, sharing their achievements around discharge planning at Bendigo Health (more below).
At the end of his presentation, Luke drove his point home by wearing his tight superhero underwear on the outside.
Ticket Home: Improving discharge processes
Paul Chappell shared with us how Bendigo Health has optimised their discharge planning processes through Patient Flow Manager
Speaking of ‘pockets of excellence’, Paul Chappell of Bendigo Health shared with us the exciting innovations they have been making to optimise their discharge planning processes.
As Paul discussed, when they began looking for a way to improve their discharge planning, they were facing a number of issues that are not uncommon in Australian hospitals:
- High unplanned readmission rates;
- The inability to easily identify, track, and prioritise complex patients;
- High unnecessary bed days with some patients staying beyond the average State LOS;
- Complications resulting from prolonged hospital stays; and
- Reduced patient access.
Realising this was an opportunity to further improve their patient flow, Bendigo Health reached out to us at Health IQ to build on the efficiencies they had gained through the implementation of Patient Flow Manager. As Paul shared, together we embarked on a joint project to help them gain:
- Real-time visibility of a patients’ status towards discharge;
- A single source of truth for all associated information; and
- The ability to track, identify, and prioritise patients based on special circumstances.
The outcome is called Ticket Home, and Paul highlighted a number of outcomes they have achieved as a result:
- Readmission rates have reduced by an incredible 30% from 5.5% to just under 4%.
- Specifically for complex patients, readmission rates have reduced by 50%.
- The multiday LOS has decreased by 0.53 of a day.
We were also told that this approach has not only resulted in reduced risk of long-stay complications, but helps bring the health service’s revenue per patient closer to optimum. In addition, Bendigo Health has found that patient access has improved, as more patients are going home on time, and beds are being used more efficiently.
Learn more about how Bendigo Health has optimised their patient discharge processes here.
Understanding data to better boost process change
A serial patient flow presenter, Kate Burns from RMH presented on the effective use of data collected to inform process change. Kate shared the various dashboard views that RMH has developed to facilitate informed management decision making.
Leveraging QlikView’s technology, Kate demonstrated how these dashboards allow users to gain ‘status at a glance’ visibility, but also enable them to drill down into further detail, eliminating the guesswork.
A key benefit is the cross-platform visibility offered by these dashboards, providing oversight of information from many hospital systems including Patient Flow Manager.
Prediction of hospital emergency admissions and beyond
Dr Rajiv Jayasena from CSIRO concluded the conference with a deep dive into the patient admission prediction technology that is currently being trailed at Austin Health, in collaboration with Health IQ.
He shared details on the initial implementation of the Patient Admission Prediction Tool (PAPT) at the Gold Coast Hospital, where it helped more accurately predict winter demand. This resulted in significant savings in nursing staff overtime and agency costs.
He highlighted that the success of this tool was unprecedented, citing that PAPT:
- Facilitated proactive rather than reactive ED processes;
- Provided a higher forecast accuracy than any other published study; and
- Was expected to enable cost savings of $23 million per annum through increased efficiency and $250 million per annum through avoided mortality.
The trial at Austin Health is still continuing and a number of benefits are expected as a result:
- Ability to accurately forecast admissions as much as a week in advance at a granular level;
- Ability to accurately plan capacity fluctuations as much as an year in advance;
- Reduce elective surgery cancellations and increase patient satisfaction; and
- Reduce agency staffing costs through forward planning.
To learn more about Austin Health’s journey towards accurate patient admission prediction, click here.
If you have any questions about the presentations discussed above, or would like to discuss how you can improve patient flow at your hospital, please give me a call on 03 9425 8012 or send me an email to firstname.lastname@example.org
Dave Piggott is the Executive Director of Health IQ, and is focused on helping Australian health services achieve better visibility and communication within and across their hospitals. Dave has over 20 years’ experience in Health IT. A graduate of the Australian Institute of Company Directors (AICD) and with a Masters in Open Systems (IT), Dave has worked extensively in the Patient Flow area, and helped over 30 Australian hospitals to improve their flow of patients.