Transcript ADHB Process Improvement

Patient Handovers via Ward Hotline Phones
OUR GOAL: All Patients are transferred to our Wards
in less than 30min once a bed request is made
Valuing Our Patients’ Time
- Adult ED Bed Request to Ward Admission
- Children’s ED
PROCESS
REQUIREMENTS
HOTLINE RINGS
ALL calls must be answered on 1st attempt
Less than 30min
Answered by
designated RN
holding Hotline
Phone
- Charge Nurse or Team Coordinator
Bed availability
confirmed with Bed
Manager
-ALL calls must be answered on 1st attempt
- Designated holder of hotline must have knowledge of ward bed
status
RN prepares for new
patient
- Ensure Hotline holder is available to take call
- If RN has patient load – he/she to explain to her patient’s that the
phone may ring for a new patient handover
26th March 2012
Jane Lees
Joyce Forsyth
Tim Denison
Dr. Richard Aickin
HOTLINE RINGS
Handover received
ALL calls must be answered on 1st attempt
Patient arrives
- Nurse is aware of patient arrival time
- Can prioritise workload to enable new patient to be met at
reception
CHIPS updated
- Ward Clerk may update within normal hours
- RN must complete PSAG update for new patient after hours.
- All new patients must have an up to date EDD
1
Where We Began…
Auckland Q1 2009
70% < 6 Hours
(Starship @ 84% < 6 Hrs)
(Adult @ 62% < 6 Hrs)
Source: Working Group for Achieving Quality in Emergency Departments. 2008. Recommendations to Improve Quality and the Measurement of
Quality in New Zealand Emergency Departments. Wellington: Ministry of Health.
3
Adult Performance to 6 hour goal - 2008 to 2012
2008 & 2009 Baseline for Admitted
Patients: 44% < 6 Hours
4
Count of Patients with > 6 Hours in ED by Service
For Inpatient Services, the most opportunity for improvement was in
General Medicine, followed by General Surgery and Orthopaedics
Pareto Chart of Over 6-Hour Patients by Service
2009 - Service Patient Under at ED Discharge
16000
100
14000
60
8000
40
6000
4000
20
2000
Gen Surgery
Orthopaedics
Cardiology
ORL
Respiratory Services
Urology
Neurology
Renal
Other
Count
Percent
Cum %
0
Emergency Medicine
0
CBU
Gen Medicine
Count
10000
Percent
80
12000
5244
34.5
34.5
4547
29.9
64.4
1428
9.4
73.8
1342
8.8
82.7
390
2.6
85.2
387
2.5
87.8
386
2.5
90.3
300
2.0
92.3
242
1.6
93.9
214
1.4
95.3
717
4.7
100.0
5
The Problem: Not just in ED
Project Scope: Hospital-wide initiative involving all parts of the hospital
6 Hour Goal (Key Metric)
2 hours
1 hour
Inpatient
Specialist
Admit to ward
3 hours
Patient
presents to ED
ED Specialist
Assessment
Also In Scope
Bed
Management
ED Performance
is Primary
Influencer
Discharge
Discharge
Ward Performance
is Primary
Influencer
Other Key Performance Influencers
Diagnostic Services
(Labs, Radiology, etc.)
Allied
Health
Elective
Scheduling
Primary Care
Facilities
6
“1-Hour” Project – Bed Request to Ward Admission
Project Scope: Hospital-wide initiative involving all parts of the hospital
6 Hour Goal (Key Metric)
2 hours
1 hour
Inpatient
Specialist
Admit to ward
3 hours
Patient
presents to ED
ED Specialist
Assessment
Also In Scope
Admit to
Ward
Bed
Bed
Management
Management
ED Performance
is Primary
Influencer
Discharge
Discharge
Ward Performance
is Primary
Influencer
Other Key Performance Influencers
Diagnostic Services
(Labs, Radiology, etc.)
Request Bed
Assess Bed
Availability
Allied
Health
Assign Bed
Elective
Scheduling
Primary Care
Facilities
“Handover”
Patient
Move Patient to
Ward
7
Baseline – Bed Request to Ward Admission
Average wait to be transferred to an Inpatient Ward = 8 Hours
Baseline - Adult ED Bed Request to Ward Admission
12
1
1
1
1
_
_
X=8.00
8 Hours
8
6
1
1
1
1
1
4
7% < 1 Hour
2
1 Hour Goal
Nov-09
Sep-09
Jul-09
May-09
Mar-09
Jan-09
Sep-08
Jul-08
May-08
Mar-08
0
Nov-08
Low is Good
Jan-08
Hours
10
1
Month
8
Primary Root Causes
1. Delays to LOS  Bed Block
– Patients wait for decisions,
referrals, reviews, diagnostics,
documentation, equipment,
treatment, etc… prolonging their
stay
– Weekend care – sometimes
treatment not progressed and
patients not discharged
2. Bed Request to Admit Process
– Even when a bed is available it
could take hours to admit a
patient to a ward
– Up to 14 individuals involved and
over 50 steps in the process
Many Causes for Delays to LOS
22
15
Awaiting OPH Bed
12
Staff / Culture
Diagnostics &
Other Services
58
Awaiting Bed in Rehab +
9
Wait for Gastro Investigation
Procedure ERCP (2x wkly)
Waiting for blood results
Vac dressing in Situ
Lack of direct communication btw Surgeon & Allied Health
Charge Nurse not aware
Of OT / PT / SW hold ups
Lack of communication on daily basis
with Drs, Allied Health, Nurses etc.
Estimated Discharge Date & Plan
Not agreed / communicated
13
Discharge expectations
Not communicated with patient/family
Fellow not communicating
LOS plan with H/O
Late referrals to Allied Health
Patient not on home ward
OPH / Other Referrals
Lost (e.g. Fax Machine Error)
51
Lack of coordination with
specialties
Team unaware of
Patient handover
NASC – waiting for
Review / assessment
Taikura Trust – waiting for
Review / assessment
No consistent policy on
Returning patients to other DHBs
Wait for family to agree
on family meeting time
Patient Length of Stay
Is longer than strictly
necessary for care
Waiting for Acute
Theatre Space
11
Cancelled lists
Transplants block OR
No hospice bed avail
Wait for transport
To be coordinated
Weight Bearing Status
Not documented
Electives don the ‘sick’
role & heal more Slowly
Out of area elective
Patients admitted earlier
Day before
Prisoners stay longer
Due to less care available
PT has not got right
Coloured Dr dot
Family unhappy with
d/c destination decision
Easier to keep patient
In hospital than discharge
No incentive to
Expedite recovery
Waiting for reviews
From other services
Slow to coordinate home
Help support on Discharge
Fellows / Registrar decision
Making conservative – keep patient
“Keep everyone” tertiary
Trauma centre
Waiting for test E.g. CTs
Social Situation
More older patients
Consultants do not
Round daily
Patient “waiting to be seen
by consultant”
Not discharging on
A Friday or W/E
Wait for PT/OT/SW Assessment
17
Stoma Education
Wait on Electronic
Discharge Summary
Wait for OPIVA Service
19
Patient &
Family
41
Nursing
shortages
Nursing,staff
Allied
Health,
House Surgeon staff shortages
House Surgeon –
Too much paperwork
Theatre
Pre-op
15
Private Hospital blocks bed
Referring hospital not keen
To take patient back
Allied Health Equipment
Shortages
20
Communication
External Factors
Key
Original votes from team meeting
Add’l Votes by Drs, Nurses, Allied Health
# Total votes in category
Bed Request to Admit Process
57 Steps (++ Variation)
14 Roles
9
Solutions Implemented
10
Daily Rapid Rounds (1 of 2)
Issue: Patients stay longer in hospital as a result of inadequate communication between
doctors, nurses, Allied Health and other multidisciplinary team members
Solution: Daily Rapid Rounds - A short daily ward meeting with nurses, doctors, and
Allied Health to coordinate their patients’ plan for hospital stay and make that plan
visible on a patient-status-at-a-glance board
Benefits: Great team communication, quick referrals, and quick problem solving means
patients wait less and are ready to go home earlier
Ward 68 Daily Rapid Round Team
System
Updated
Live
Charge
Nurse
Social
Worker
Staff
Nurses
Doctors
Occupational
Therapist
Physiotherapist
11
Daily Rapid Rounds (2 of 2)
Wards 65, 66, 67, 68 - Gen Med Average Total Length of Stay
7.5
0.4 day
reduction in
Average LOS
7.0
Lenght of Stay (Days)
2011 & 2012
6.5
Equivalent to
2,100 bed
days per year
6.0
5.5
5.0
2008
2009
2010
2011
Jan
6.14
5.90
6.10
5.95
Feb
6.29
5.75
5.25
5.77
Mar
6.24
5.96
5.83
5.91
Apr
6.37
5.83
5.90
5.72
May
6.71
6.71
5.44
5.80
Jun
6.35
6.30
5.80
5.57
Jul
6.90
6.20
6.51
6.06
Aug
7.03
6.59
5.89
6.02
Sep
7.26
6.88
6.36
6.70
Oct
6.69
7.34
6.10
5.71
Nov Dec
6.27 6.91
6.75 6.30
6.06 5.42
5.94
Orthopaedics
also observed
a 2,000 bed
day per year
benefit after
Rapid Rounds
12
Nurse Facilitated Discharging (General Medicine)
Issue: Patients may be ready for discharge but have to wait for next medical ward round
Solution: Senior nurses can discharge patients if patient meets criteria set by medical
teams – Nurse Facilitated Discharging is initiated by doctors
Benefits: Reduced LOS, increased weekend discharging, earlier in day and after hours
EXAMPLE
discharging
Doctor to
Dr. X
12/2/2010
934199
Successful Weekly Nurse Facilitated Discharges
I Chart Control: A verage number of NFD's per week in General Medicine
12
Before
Baseline After
After
e / paste
label
X
10:00
Sat 13/02/10 or
Sun 14/02/10
1
complet
11:00 a.m.
L)LL Pneumonia
8
Afebrile 24 hours off IV antibiotics
O2 sats > 90% off oxygen
Mobilising independently
6
_
4
Note: if criteria not met on Saturday, please review on
Sunday
3X=3.44
/ wk
X
X
X
GP 6 weeks (after CXR) or earlier if concerns
(Flu CXR)
2
Complete if Criteria Met
X
X
X
Week Beginning Monday
20-Jun-11
25-Apr-11
28-Feb-11
03-Jan-11
08-Nov-10
13-Sep-10
19-Jul-10
24-May-10
29-Mar-10
0
08-Feb-10
Number of NFDs
per Week
NFD
10
CNA or Charge Nurse
13/02/2010
X
11:15 a.m.
Complete if Criteria NOT Met
Example:
Spiked temp > 38°C on IV Antibiotics
13
Patient Status at a Glance
Issue: System not up to date with Estimated Discharge Dates, plan for patients stay not
visible to ward staff, patient information duplicated on white boards
Solution: 42” monitors, redesigned and colour coded patient status – able to eliminate
most physical whiteboards
Benefits: Patient Status at a Glance – saves staff time, easy to see patient’s plan for stay,
estimated discharge dates kept up-to-date
Drop down colour coded
allied health referral status
Tab to view the AED whiteboard
helps create an awareness /
transparency of number of patients
waiting for beds etc.
The patients
discharge
destination i.e.
home,resthome,
OPH etc
Used to indicate
where the patient
is scheduled for i.e.
another ward,
transition lounge,
Patient Information
Access to all patient
information including a
link for Concerto
14
Rapid Improvement Event
 Rapid improvement event (RIE) - part of
the Lean methodology and provides a
mechanism for making radical changes to
current processes and activities within
very short timescales.
 Week long 5 day event at Auckland City
Hospital
 Goal – Patient transfer to the ward in
nine minutes of Bed allocation
 Core Group – ED Charge Nurses, Ward
Charge Nurses, Clerical staff, Orderlies,
Nurse Advisors, Bed Managers.
 Advisory Group – Service Managers
 Sponsors – Director of Performance,
Nurse Director, Clinical Director
Emergency Department
15
Transfer of Care
Issue: Patient handovers were a source
of frustration for both AED and ward
staff. AED staff: “Handover takes too
long as the ward staff ask too many
questions”. Ward staff: “Handover
information is often inaccurate”
Solution: Standardise process for
handover using ISOBAR across wards
and AED. Review transfer of care form
inline with ISOBAR format. Bedside
handover using ISOBAR for AED-APU
transfers. Education package.
Benefits: Improved quality of handover,
reduced time, improved staff
satisfaction
16
Communication
Issue: Phone tag for patient handovers,
long wait for a nurse to come to the
phone for handover (when asked by
ward clerk), AED can’t get through to
ward due to engaged phones.
Patient Handovers via Ward Hotline Phones
OUR GOAL: All Patients are transferred to our Wards
in less than 30min once a bed request is made
Solution: Handover hotline.
REQUIREMENTS
HOTLINE RINGS
ALL calls must be answered on 1st attempt
Answered by
designated RN
holding Hotline
Phone
Less than 30min
Benefits: Dedicated phone for handover
and after hours bed management
handover. Reduces ‘waiting’ for calls
to be answered. Ward RN carries the
phone - eliminates the need for ward
clerks to search for RN to take
handover.
PROCESS
- Charge Nurse or Team Coordinator
Bed availability
confirmed with Bed
Manager
-ALL calls must be answered on 1st attempt
- Designated holder of hotline must have knowledge of ward bed
status
RN prepares for new
patient
- Ensure Hotline holder is available to take call
- If RN has patient load – he/she to explain to her patient’s that the
phone may ring for a new patient handover
HOTLINE RINGS
Handover received
ALL calls must be answered on 1st attempt
Patient arrives
- Nurse is aware of patient arrival time
- Can prioritise workload to enable new patient to be met at
reception
CHIPS updated
- Ward Clerk may update within normal hours
- RN must complete PSAG update for new patient after hours.
- All new patients must have an up to date EDD
17
Bed Request Confusion
Issue: No standard process for a Doctor to communicate a bed request
Solution: All bed requests to “Flow Coordinator”, Flow Coordinator clearly identifiable
with new Green scrub top, and
Benefits: Easily identifiable in Green top, 1 point of contact. Reduced frustration with not
being able to clearly identify who is performing the ‘flow’ role.
18
Documentation
Bed Request Checklist
Issue: Doctor would request bed and leave
without completing documentation (A/D Plan,
6-Hour Plan, or communicate patient special
needs e.g. sideroom)
Date: ………………
Patient
PPDetails
Time: …………..…..
PREFERRED LOCATION
WARD
APU
YES
NO
N/A
YES
NO
N/A
Ward or APU
DOCUMENTATION
A to D Planner / 6 Hour Plan
IV Fluids
Solution: Flow Coordinator reviews 10-second
checklist with doctor at time of bed request
Medications
BED MANAGEMENT REQUIREMENTS
Side Room
Isolation
Benefits: Patient is ready for handover at time of
bed request. No phone-tag and delay to find
out special needs or complete docs
Watch / Security Required
Flexi Monitor
Parameters Set
Flexi Form Complete and Sent
ADDITIONAL INFORMATION
19
Global Transparency
Issue: Poor visibility of available beds at a glance.
Solution: Developed intranet web page that displays “flight deck” view of bed status
Benefits: Anyone, anywhere in hospital has a view of available beds. Saves time. At a
glance view of occupancy and expected discharges within 4hrs
Capacity of each
ward can be
quickly seen
Available Beds
easy to spot
20
Orderly Requests
Designated space
within ED for orderlies
to wait for jobs
Issue: Orderlies were requested by placing a file in
“toast rack”. No ability to prioritise requests or
whether the orderly were aware of a request. No
visibility when request was completed. Orderlies did
not have a designated place to wait “on the floor”
between jobs.
Solution: Requests placed in box with motion detector
and light trigger. This can be seen in a new orderly bay
and nursing staff can see at a glance if an orderly is
requested and when request has been actioned (light
goes off).
Place clinical notes in
box for orderly
request
Benefits: Quicker response time, able to escalate if no
orderly is visible in bay, can see around department if
orderly is requested, fewer calls for orderly over
intercom = less interruptions for staff
Light goes on when
notes are in box
22
Visual Tools
Issue: Patients and families interrupt
flow coordinator and other staff with
queries – no way for patients &
families to establish where to go to
ask questions!
Solution: Improved visual management
on the AED floor. Red feet at
reception area to indicate a place to
wait for inquiry.
Benefits: Reduced staff interruptions,
reduced patient frustration
23
Capacity Triggers
Issue: Unclear escalation response
when hospital resourced beds are
near capacity
Occupancy
Overall
ED
APU
92%
43%
77%
Acute Theatre Hours
Daily (Weekday) Surgical Acutes
Vascular
2
Cardiology
6
General Surgery
11
Solution: Monday-Friday daily capacity
meeting with service managers and
48 hour bed capacity forecasting
Gastro
2
Orthopaedics
7
Renal
Urology
ORL
4
5
4
Neurosurgery
Total Upper Q
1
Acute Bed Requests
Medical
6
Surgical
2
Regular Flex
31W - 2
31E - 10 yes
41 - 4
42 - 2
81 - 3
7
Ward
41
42
76
78
61
75
77
71
73
74
81
83
-37
TCI
5
10
3
0
6
5
1
5
6
6
1
3
51
TODAY
EDD
Available
3
4
4
6
5
3
2
0
10
8
3
2
2
0
3
0
5
9
6
5
6
0
0
1
49
38
Extra Flex
83 - 4
OPH - 4
SHDU - 2
Super Flex
38W - 15
Wha - 14
42 - 4
97 - 4
D
2
0
5
2
12
0
1
-2
8
5
5
-2
TCI
3
2
5
0
1
5
0
6
4
7
0
2
TOMORROW
EDD
2
4
2
2
7
3
3
4
4
4
0
1
D
-1
2
-3
2
6
-2
3
-2
0
-3
0
-1
36
35
36
1
D
2
3
9
0
0
5
3
7
9
5
6
0
TCI
0
4
1
0
2
0
0
0
0
0
0
2
TOMORROW
EDD
0
4
2
0
0
1
2
6
7
5
4
7
D
0
0
1
0
-2
1
2
6
7
5
4
5
49
9
38
29
Surgical Summary
Beds to be freed in next 24 hours
Benefits: Improved utilisation of
resourced beds across services
including use of ‘flexed beds’,
advanced notice of impact to elective
patients (last resort)
Daily (Weekday) Medical Acutes
Cardiology
Cardiology
Cardiology
Haem / Onc
Haem / Onc
Neuro / Med Specs
Gen Med
Gen Med
Gen Med
Gen Med
Respiratory
Total Upper Q
5
4
4
24
4
-38
Ward
31MED
31W
CCU34
38APU
62
64
63
65
66
67
68
72
36
Less current Acute Bed Requests
-2
Less expected Surgical Acutes
-37
Net Surgical Beds in 24 Hours
TODAY
TCI
EDD
Available
0
2
0
8
4
7
1
1
9
0
0
0
0
1
-1
0
5
0
1
2
2
0
5
2
0
6
3
1
5
1
0
6
0
3
3
0
-3
14
40
23
Medical Summary
Beds to be freed in next 24 hours
Less current Acute Bed Requests
Less expected Medical Acutes
49
-6
-38
Net Medical Beds in 24 Hours
5
TOTAL Surgical & Medical Beds in 24hr
2
24
Daily Reporting & Review of Breaches
Issue: Daily 6-Hr performance not visible. Difficult to have timely problem solving.
Solution: Automated report of previous day’s patients who spent over 6 hours in ED
emailed to staff. Key information for each patient visible to support root-cause analysis.
Benefits: Improved visibility of performance, increased urgency with staff, easy to identify
corrective actions in a timely manner, reviewed & coded at daily meeting
Overall
Performance
Inpatient
Services
Time Stamps: ED Start, Sign-on, Referral, Inpatient Sign-on,
Bed Request, BR Complete, ED End
Patient Referral
Reason
25
Results Sustained: Sub-measure – When Bed is Ready
AED to Ward - Patient Transfer Times
90
80
70
1
11
1
1
11
1
Our Goal = 30 Min
1
11
1
1 1 111
1
1
1
1
1
11
1
1
1
1
1
1
1
1 1
1
1
1
60
30-Jan-12
26-Dec-11
21-Nov-11
17-Oct-11
12-Sep-11
08-Aug-11
04-Jul-11
1
1
11
1
1
1
1
1
1
1
11
1
1
1
1
1 1 11 11
11 1 1
1 1111 1 1 1
1 1
1
1
1
1
1
1
30-May-11
14-Feb-11
10-Jan-11
06-Dec-10
01-Nov-10
27-Sep-10
23-Aug-10
14-Jun-10
10-May-10
05-Apr-10
01-Mar-10
30
19-Jul-10
Low Is Good
1
25-Apr-11
40
21-Mar-11
50
28-Dec-09
25-Jan-10
Minutes (Weekly Average)
From Ward Bed Ready to ED Discharge
Admit Week Beginning Monday
26
Results Sustained – ED Bed Request to Ward Admission
80% Reduction in the Time Patients Wait
9
8
7
6
5
4
3
2
1
0
2009
1
2010
1
2011
2012
1
1
2009 =
7.2% < 1hr
1
1
1
2010 =
14% < 1hr
1
1
Low Is Good
1
1
1
1
1 1 1 1
1 1 1
_
_
X=1.222
1hr Goal
Jan-09
Mar-09
May-09
Jul-09
Sep-09
Nov-09
Jan-10
Mar-10
May-10
Jul-10
Sep-10
Nov-10
Jan-11
Mar-11
May-11
Jul-11
Sep-11
Nov-11
Jan-12
Hours
Avg Hours AED Bed Request to Ward Admission
Month
27
Sustaining Change – Business as Usual
 Standard work
 Daily reporting and
analysis of variance
 Breach meeting
 Weekly target tracking
 Audit of standard
operating procedures
 Visual communication
for staff
Count of Code
All
5
10
15
20
602_Clerical Error
3-Hr Phase
320_ED Diagnostics Incomplete - Wait for ED Assessment Sign On to Referral
310_Multiple Presentations in Short Time Frame - Wait for ED Sign On
321_ED Assessment Incomplete - Wait for ED Assessment Sign On to Referral
311_Staff Shortage - Wait for ED Sign On
210_IP Unavailable - Wait for Inpatient Specialist Sign On
2-Hr Phase
Reason
0
220_IP Diagnostics Incomplete - Wait for In-Patient Specialist Decision to Admit /
Discharge
221_IP Assessment Incomplete - Wait for In-Patient Specialist Decision to Admit /
Discharge
223_IP Multiple Referrals Made - Wait for In-Patient Specialist Decision to Admit /
Discharge
113_Bed Currently Unavailable (Any) - Awaiting patient discharge/move
129_Patient - not clinically stable enough to transfer
1-Hr Phase
Code Category
AED Breach Codes - 9 to 15 March 2012
114_Bed Currently Unavailable (Single Room) - Awaiting patient discharge/move
120_AED - handover not initiated in timely manner - Delay to Patient Transfer
111_Bed Unavailable Indefinitely - Bed Management - Patient requires outlying
126_Ward - handover not available to receive in a timely manner - Delay to Patient
Transfer
29
Next Steps – An Example in General Medicine
Opportunity in Patients Referred from 10 p.m. to 8 a.m.
Gen Med 6-Hr Breaches by Cause
Count by Hr of Referral
9
120
Patients Over 6 Hours
Patients Over 6 Hours
(12-Dec-2011 to 12-Feb-2012)
100
80
60
40
20
(12 Dec 2011 to 12 Feb 2012)
8
7
6
5
4
3
2
1
0
13 14 15 17 18 19 20 21 22 23 0
0
3-ED Delay to 2-Gen Med 1-Bed Request
Refer
Delay to Sign to ED Disch
On, Bed
Request or
Disch
1
2
6
7
Hour of Referral to General Medicine
Most breaches on night shift –
only 1 Registrar on duty
30
Starship Children’s Emergency Department
31
Child Health approach
 Why do seperately/differently within same organisation?
– EDs have different structure and function
• Children’s ED includes
• Functions of the adult admission planning unit
• 12 hr short stay admission for acute cases
• Hospital RMO after hours staffing limited to 1 Paed Medical Registrar
• Admission work up and initiation of treatment is by CED clinicians,
with handover to inpatient Registrar at time that child is ready for
ward
• Less emphasis on the “2hr” phase for medical cases, more on “1hr”
(for transfer to ward when child’s condition is ready for this)
32
Child ED Performance to 6 hour goal - 2010 to 2012
33
Child ED Triage Performance - 2010 to 2012
34
Children’s Hospital challenges
•Smaller total numbers, large daily fluctuations in acute
admissions, limited surge capacity
•165 beds vs 650 beds in adult services
•31,000 CED attendances vs 57,000 AED + 11,000 APU
•Historically:
•Difficulties in predicting acute volumes
•Disconnect with electives planning
•High rates of last minute cancellations on day of planned
admission
•High proportion of child admissions needing isolation
•Nursing complexity with increasing skew toward tertiary
electives over local secondary paediatric admissions
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Child Health Improvements
 Weekly capacity planning meeting
– Modelling of short term acute trends
• Increasing accuracy as we gain experience with this tool
• Usually within +/- 10%
– Joined up with elective admission scheduling
• Fewer last minute cancellations
• Best elective performance during winter months for many years
 Improved communication of over-capacity status to Clinicians
– Review of criteria for alerts
– Text message and email early in the day
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Is this all about bed capacity?
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Bed capacity
 Important but not the whole story
 Both Adult and Children’s Hospitals are being driven hard
 Both have occupancy >90% and not infrequent overcapacity alerts
 Both have shown sustained improvement in 6 hour targets
 There comes a point where further improvements will be in only small
increments and investment in capacity is vital.
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