The Health Roundtable 20,000 Days Campaign Presenter: Diana Dowdle Middlemore Hospital Innovation Poster Session HRT1215 – Innovation Awards Sydney 11 th and 12 th Oct a_HRT1215-Session_DOWDLE_CMDHB_NZ

The Health Roundtable Key Problem  The increasing demand on resources across Counties Manukau is driving the need for continuing improvements in the way that we keep our community healthy.  Identified we cannot continue to rely on hospital based healthcare.  Between the demand for Middlemore Hospital beds was growing 2% faster per year than expected from demographic growth.  Given the predicted 5.5% increase in bed days annually (demographic and non-demographic growth), we need to save 20,000 hospital bed days. 2

The Health Roundtable By 9am on 1 July 2013 the Campaign aims to give back to our community 20,000 healthy & well days, so reducing hospital bed days by 20,000. To achieve the aim, the Collaborative Improvement programme works across the whole of the health sector and supports the implementation of best practices through five key work streams: Living well in community Keeping people at risk well in the community Rapid response in the community to acute events Co-ordinated and rapid care in emergency care Safe and timely care for those who need hospital care 20,000 Days Campaign Aim 3

The Health Roundtable Collaborative Structure Select Topic Expert Meetings Identify Change Concepts Pre work LS 1 S P A D LS 2 Holding the Gains Spread LS 3 Collaborative Teams Supports : s/ visits/ reports/ sponsors / meetings/ assessments / conference calls P A D S 4

The Health Roundtable Campaign Driver Diagram 5

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Bed day Saving Unplanned Re admission Operational Definition Bed Days: Actual patient time on bed Savings: Cumulative savings is the difference between the forecasted bed required and the actual bed used since June 2011.Savings can be a positive or negative figure. Average Length of Stay (ALOS) This graph shows the cumulative bed saving on a monthly basis. Criteria Middlemore, Age >-15 years, Surgical/Medical specialty (incl Gynae), Acute and Elective This graph shows the readmission rate over a period of time. Operational Definition Re-admission: An unplanned acute readmission to same speciality as discharged within 7 days Criteria Middlemore, Age >-15 years, Surgical/Medical specialty (incl Gynae), Data extracted based on Inpatient discharged location Operational Definition LOS: Days between admission to discharge Criteria Middlemore, Age >-15 years, Surgical/Medical specialty (incl Gynae) Criteria Middlemore, Age >-15 years, Surgical/Medical specialty (incl Gynae) This graph reflects the ALOS over a period of time. Trigger /Dot Days Admission Occupancy EC Presentation Bed day Predicted Vs Actual 20,000 Days Campaign Dashboard Definitions Operational Definition Dot Days: A day is referred as “Dot Day” when Middlemore central send an when the Hospital is full. Date of Dot Days: The actual date when the was sent. Operational Definition Admission: Patient admitted to MMH wards for more than 3 hours from the 1st seen by time This graph shows the admission of acute adult patient admitted to Middlemore over a period of time. This Graph chart shows the days on which date the hospital was full and also the days between two Dot days. Hospital full days are also termed as Dot days. One of the aim is to minimise the Dot days and increase the time between Dot days. One of the contributing factor to achieve this is bed day saving Criteria All s sent by Middlemore central with a subject “Hospital full” This graph represents the Average daily presentation to MMH emergency care. Criteria All presentation to MMH Emergency department This figures include adult and Paediatrics Operational Definition This graph reflects the total monthly occupancy of Surgical, Medical and Gyne specialty combined on a monthly basis Criteria Middlemore, Age >-15 years, Surgical/Medical specialty (incl Gynae). Occupancy includes: MSSU and Observation Operational Definition Occupancy: Actual patient time on bed C.L in the graph represents Median This graph shows the Actual bed day usage compared to the predicted usage. If the actual is less than predicated then we will have bed day gain. Operational Definition Bed Days: Actual patient time on bed Predicted bed day: Cumulative bed required calculated based on bed modelling Cumulative: Previous 12 months of data from the current month Criteria Middlemore, Age >-15 years, Surgical/Medical specialty (incl Gynae), Acute and Elective UCL: Upper control Limit is automatically calculated by the software it selves. CL: Centre Line can also be called as Average. LCL: Upper control Limit is automatically calculated by the software it selves. Note: The graphs will help us to detect Shifts, Trends and variations. The lines within control limits indicate that the data is stable and in Statistical control. 7

The Health Roundtable Key Changes Implemented 13 Collaborative teams established for intervention areas that will make an impact on reducing bed days  Better Breathing : - set up Community based Pulmonary rehabilitation - early diagnosis bundle in GP practices with screening smokers /ex smokers 40 years and over  Cellulitis & Skin Infections : - simple abscess cases managed via TADU with no admission  St John Ambulance services : - increased numbers of status 3 & 4 people transported to community Accident & Medical Centres.  Hip Fracture Management : - 7 day rehabilitation with Physiotherapy available at the weekends 8

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Outcomes So Far  13 Collaborative teams established with Aims / Charters / Measurement dashboards / designing and testing for change through PDSA cycles  Ability to report on high level measures for whole system  8,194 days saved since June 2011  Active engagement across the health sector  Strengthening of networks  Successful Learning Sessions: 4-5 May & 6-7 September 2012  Building capability for sustaining model of improvement 10

The Health Roundtable Lessons Learnt  Involvement of all key clinician leaders, managers, frontline staff, community, primary care at the beginning buiolds the will and maintains engagement.  Having multidisciplinary health professionals involved in each Collaborative team provides co-ordinated care  Telling patient experiences of their journey through the health system told either by video/ interviews or photos is very powerful reminder of the need to make improvements.  Strong support from the CEO for the Campaign provides a mandate for the work and links with Counties Manukau Health strategic direction  Baseline measurements are important to demonstrate improvements. 11