We think you have liked this presentation. If you wish to download it, please recommend it to your friends in any social system. Share buttons are a little bit lower. Thank you!
Presentation is loading. Please wait.
Published byIsmael Goodin
Modified about 1 year ago
Irish National Acute Medicine Programme Patient Flow Model O’Reilly O, Courtney G, Casey A* Problem Patients requiring urgent care experienced long delays. The National Acute Medicine Programme established a new model of care streaming acutely unwell medical patients away from ED into Acute Medical Assessment Units in all 33 Irish hospitals. Aims Quality and Safety – patients to be seen by a Nurse within 20 minutes and Senior Doctor within 1 hour of arrival. Access – the patient journey through the urgent care pathway not to exceed 6 hours and eliminate trolleys waits for medical patients. Cost and Value – change processes; increase ambulatory care, reduce overnight admissions and shorten length of stay, resulting in bed day savings. Flow Model Patients are now referred directly for admission from GPs to the Acute Medical Assessment Unit, self referring patients present to ED and have rapid nurse triage. Medical patients in triage category 2 and 3 are referred promptly to the AMAU, shortening the patient experience time. This has decongested ED and radically reduced medical trolley waits. Demand Capacity Modelling The Planning number (PN) is calculated at 84 th centile of daily weekday demand. The number of assessment beds calculated at PN/3, number of short stay beds and ward beds calculated by applying target demand benchmarks and lengths of stay. KPIs Mirror Pathway – 4 Areas of Intervention 1. Assess and Avoid Admission - target 25% Interventions; adequate assessment area, senior decision makers, access to rapid diagnostics. All patients have Early Warning Score within 20 minutes. Close liaison with discharge planner, clear pathways to frail elderly service, stroke unit, CCU, community supports. 2. Short Stay – target 31% to have a length of stay less than 48 hours. Interventions include; adequately sized short stay unit, all patients to be seen by Consultant within 12 hours of transfer from assessment, twice daily Consultant ward rounds, priority for diagnostics, white boards with visible data, regular team “huddle” to determine progress. 3. processing of ordinary patients – target less than 44% of patients to have a length of stay greater than 48 hours. Interventions include; daily ward rounds, weekend nurse enabled discharges, active discharge planning, liaison with carers and community supports, transport. 4. Appropriate Care and Discharge of Complex Patients – target less than 11% of patients to have an LOS greater than 14 days. Interventions; early assessment and identification of complex patients, streaming to geriatric service. Proactive discharge planning, liaison with funding agencies for community placements and supports. The acute medicine pathway has helped the health service manage this demand, despite 21% overall increase in medical discharges, the pathway resulted in 15% increase in avoided medical admissions and only a 6% increase in overnight admissions. The overnight length of stay decreased by 6% and hence no additional beds were required. Key Messages National and local clinical and managerial leadership coalition. Explicit flow model, with quantified demand and capacity calculations for each hospital National monthly monitoring of standard KPIs mirroring pathway performance and feedback Demonstration of the power of data to clinicians and managers to change practice Capacity of assessment and short stay wards to be sized for expected demand, short stay unit as a buffer zone, patients to be pulled first from short stay. Buy in from hospital physician groups, identifying win win scenarios 33% decrease in 30 day rolling average for trolley waits Contact Dr. Orlaith O’Reilly – firstname.lastname@example.org *Acute Medicine Programme Team; Prof G. Courtney, Dr. O O’Reilly, Ms A Casey, Ms. AM Keown, Ms. E Croke.email@example.com Data Source: HIPE, ESRI © Acute Medicine Programme Ireland RESULTS There has been an increased demand for unscheduled care services; an 11% increase in emergency admissions to all specialties between 2006 and 2013 and a 4% increase in ED attendances.
ED Capacity Management Admissions Flow through ED Tim Parke ED Consultant through ED.
Refining and Redefining Emergency Flows Dr Veronica Devlin Programme Lead Service Improvement and Clinical Governance Emergency Care.
Emergency Access Information Network - May 2009 ‘Why do people attend’ NHS Forth Valley A&E and what do we need to do to better manage demand’ Kathleen.
Acute Medicine Programme A clinician-led initiative of the Royal College of Physicians of Ireland (RCPI), the Irish Association of Directors of Nursing.
ED Stream Workshop Acute MOC August 2013 ED Stream Workshop John Hunter Hospital Emergency Department 1.
NHS West Kent Clinical Commissioning Group West Kent Urgent Care DRAFT Strategy Delivering a safe and sustainable urgent care system by
Right First Time – Redesigning how we discharge patients 7 days a week D R A NDREW G IBSON, S HEFFIELD T EACHING H OSPITALS AND S TEVEN H AIGH, R IGHT.
0 Prepared by (15pt Arial) [Insert name of presenter 15pt Arial Bold] [Insert title] [Insert Hospital name] Month 200X (12pt Arial Bold) Understanding.
Winter Evaluation for 2013/14 Winter Planning for 2014/15 Dr Paul Kaiser, Clinical Lead IESCCG Richard Cracknell, Winter Planning Manager Mark Cooke, Senior.
Hospital Operational Standards Jennie Hall, Chief Nurse Dr Ros Given-Wilson, Medical Director Martin Wilson, Director of Delivery and Improvement.
NHSScotland Event 2015 LEADING INTEGRATION FOR QUALITY A:2 Unscheduled Care – Can We Fix It?
Peter Ward Senior Physiotherapist Acute Medicine Driving Healthcare Change Through HSCP Research February 28 th, 2014 Carole Murphy Senior Occupational.
Unscheduled Care Learning Event Issues Identified from Winter Planning Review Michael Bloomfield 19 March 2015.
Dr Dan Beckett Consultant Acute Physician NHS Forth Valley.
CHILDREN AND YOUNG PEOPLE’S HEALTH SUPPORT GROUP Unscheduled Care Helen Maitland National Lead.
Baseline Model of care for proposed community wards Appendix 1.
Community Hospital Review – The Clinical Model What did we recommend? Dr. David Carson, Director, The Primary Care Foundation.
15: The ‘Admin’ Question Patient flow Dr Tony Kambourakis.
Using Quality Improvement Methodology To improve Acute Flow at Wrexham Maelor Hospital.
Ideas from UK modernisation: The Improvement Partnership for Hospitals Penny Pereira Ideas from UK modernisation.
Acute Quality Standards Dan Beckett Acute Physician CMO Advisor for Acute & General Medicine.
General Medicine Improving Quality Care Presenter: Jane Lees Health Service: Auckland District Health Board Innovation Poster Session HRT1215 – Innovation.
A whole system challenge -in a challenged system ! South East Essex Health and Social Care.
Getting Emergency Care Right Power training pack.
ED Stream Workshop Acute MOC August 2013 ED Stream Workshop 1.
Safer Start 8am Monday 08 th February – 8am Monday 15 February.
Jason Holland 10/06/2013 Changing face of Unscheduled Care The Implementation of new roles within the Emergency Care Directorate across Pennine Acute Hospitals.
Local Unscheduled Care Action Plan and Winter Planning Health and Social Care Partnership Meeting 24 Oct 2013.
Seven Day Services Improvement Programme Birmingham, Sandwell and Solihull Collaborative Professor Matthew Cooke Deputy Medical Director (Strategy & transformation)
Mel Pickup, Chief Executive Warrington & Halton Hospitals NHS FT Andy Davies, Accountable Officer Warrington Clinical Commissioning Group Achieving the.
1 Integration to avoid hospital admission: ITHAcA Sarah Purdy on behalf of the HIT.
The Health Roundtable Central Network Respiratory Coordinated Care Program Innovation Presenter: Benjamin Kwan Staff specialist respiratory and sleep medicine.
NCEPOD Report Caring to the end? Issues for physicians Prof IT Gilmore PRCP.
The BHRUT Clinical Strategy Presentation for stakeholders, patients and the public.
Frail Older People Programme Greater Nottingham Jeremy Griffiths Clinical Lead / Chair of SIGNS 30th October 2013.
Berkshire West 10 Frail and Older People Pathway Redesign Programme South Reading Patient Voice Group Stuart Rowbotham; Director of Adult Social Care,
Surge Capacity Plan EMERGENCY DEPARTMENT. Surge capacity strategies will be implemented when volume exceeds staffing and/or treatment space POLICY:
‘Navigating the System’ Finding early opportunities to access Community Services- ‘Discharge to assess’ work stream Bie Grobet South Warwickshire Foundation.
National rapid access to best-quality stroke services Prevent 1 stroke every day Avoid death or dependence in 1 patient every day National Stroke Clinical.
Greater Manchester Area Team Joint Health Overview & Scrutiny Committee 7 th April 2014 Performance Report to Operations Executive- 30 May
Stirling Management Centre 11 th September 2014 Unscheduled Care National Event Learning Workshop.
Health Innovation Exchange Dr Tony O’Connell Director-General Queensland Health.
Shaping a service Colin Hughes Consultant Nurse - Older People (Mental Health) Chesterfield Primary Care Trust.
Frail Older People Co Chairs Maura Devlin and Dr April Heaney Engagement through a workshop with a wide range of stakeholders Key priorities areas identified.
Target Performance: Q1 = 80% Q2 = 85% Q3 = 90% Q4 = 95% We are heading in the right direction 14% Improvement since Sept 2011 Quarter 3 (to date) 87.7.
Urgent Care Planning in South Tyneside David Hambleton Urgent Care Everyone’s problem.
Department of Human Services Promoting patient care through effective patient flow System wide implementation January – July 2005.
Redesigning Care in the Paediatric Emergency Department CYWHS, SA Presented by Ms Heather Gray Chief Executive : CYWHS 25 th November 2005.
© 2017 SlidePlayer.com Inc. All rights reserved.