Transcript Stroke - PDSA Learnings

Supporting Life After Stroke Collaborative
Working group members:
Katrina Moles
PDSA Learning's
Pamela Baines
Amanda Shapleski
Francie Birch
Deidre Gough
Jacqui Hooper
Joy Castro
Jill Grieve
Michele Moore
Raewyn Maguire
Alison Howitt
Stephanie Easthope
Penny Wilkings
Supporting
Life After
Aim Statement
The Supporting Life After Stroke collaborative aims to
provide a new community-based, specialist
rehabilitation service for people with stroke in their
own homes rather than in hospital. This will enhance
patient experience, speed recovery and improve
quality of life for our patients.
Supporting
Life After
By 1st July 2014 we will:
 reduce the average length of stay for patients with mild to moderate
stroke transitioning home to Manukau, Papakura, Manurewa ,
Takanini and Mangere by 4 days
 improve patient functional outcomes (different measures are being
tested)
 attain a patients satisfaction response of more than 90%
PDSA Tree – Supporting Life After Stroke – Page 1
Change Ideas
Discharge to CBRT
Resource Scheduling
PDSA’s
1.1 Schedule community
rehab appointments at
triage Kat
1.4 Early discharge of ESD
patient to CBRT Joy
Supporting
Life After
1.3 Sort patient list in order
of most recent GDD Kat
1.5 Care plans to help
CBRT discharge
planningKat/Jo
Key
1.2 Filter patients by GDD
Kat
Adopt
2.1 Use WiMs list to
identify pts Kat
2.3 Test timing of using
WiMs list Kat
2.4 Analyse frequency of
patients coming from outlier
wards Steph
Identify eligible patients
on acute ward
2.2 Attend acute ward
MDT to identify stroke
severity Deirdre
2.5 Test standardised
process with different people
Kat
Adapt
Abandon
What next?
2.6 Visit Ward 6 MDT twice
a week Kat
Testing
Review ESD eligible
patients on Ward 23 for
acceptance
9.1 Patient Identification
Magnets Raewyn/Alison
3.2 Conduct assessment on
ward with referral
3.1 Conduct assessment
on ward
In hospital rehabilitation
needs assessment
3.6 Team Handover before
and after general
assessment.
Define patient readiness
for discharge criteria
3.3 Conduct assessment
on ward with referral for
patient with speech therapy
needs Joy
3.7 Team Handover Before
General Assess Deirdre
3.4 Conduct assessment on
ward for first test ESD
patient Amanda
3.5 Complete Gen assessment
on ward, follow up with red pen
at home visit. Jill
3.9 Discipline-specific
handover
Amanda
3.8 Face to Face General
Assessment After Handover
Jill
4.1 Current use of
discharge planning
checklist Jacqui
4.2 Test ESD Criteria
Checklist with ward 23
Amanda
Home visit
5.1 Assess difference
between ward OT and
community OT home visit
assesmtAmanda
Version Control
Date: 11/11/2013
Owner: SLAS Working Group
Folder: W:\20,000 Days Campaign\Phase 2\Collaborative - Supporting Life after Stroke\3.1 PDSA Tree
PDSA Tree – Supporting Life After Stroke – Page 2
Change Ideas
PDSA’s
6.1 First patient same-day
follow up phone call
Francie
Supporting
Life After
6.5 Follow up phone call
from other discipline (test
under different conditions)
Deirdre
Design model of care
Key
6.2 Medications able to
be collected day before
discharge Raewyn
Adopt
6.3 Test ESD model of
care (first patients)
Pamela
Adapt
Abandon
6.4 Take patient to GP
before discharge from
ESD Francie
What next?
Testing
Transition from ESD to
CBRT
7.1 Joint CBRT/ESD
patient visit
Deidre
Functional Measures
8.1 Trial of functional
measures
Michelle
“Shall we
PDSA it?”
31
PDSAs completed or
underway!
Version Control
Date: 11/11/2013
Owner: SLAS Working Group
Folder: W:\20,000 Days Campaign\Phase 2\Collaborative - Supporting Life after Stroke\3.1 PDSA Tree
Supporting
Changes we have tested….
Change Idea
1
2
3
#
PDSAs
Identify eligible
patients while still on
the acute ward
Determine in-home
rehabilitation needs
while still in hospital
Life After
Outcome
6
After multiple tests it was found that a combination of
the WiMs list and attending the acute ward MDT
meetings was enough to identify patients who are
eligible for ESD while still on the acute ward
9
Co-ordinating a handover between inpatient staff and
ESD staff is challenging, with many disciplines
involved in each patients care. Current PDSA is
testing discipline-specific handovers
4
Successful tests of change have included:
1.
Organising collection of patient’s personal
medications before they are discharged, and
2.
Taking them to visit their GP before leaving the
ESD service
3.
Follow-up phone call on day of discharge
Improve the patient
experience in
transitioning
between services
Supporting
Life After
PDSA Fun!
Plan
• Staying focussed on your objective and/or change idea – side tracked
• Working with someone else – asking what are we doing?
• Fill out the paperwork properly so predictions mean something!
Do
• Collect all relevant data – capture thoughts to one side
Study
• Great when your predictions are wrong - learn more 
• Being careful not to generalise before you have tested with others
Act
• Used structured reporting back– enlisting others wisdom
Supporting
Life After
PDSA Fun!
Reflections
• Everyone giving it a go
• Working together, drawing on the diversity of the group and individual
ownership
• Clearly documenting is vital – so you know what you mean later
• Initially so foreign; process of documenting – PDSA flow – makes sense
• Just give it a go – no PDSA is perfect, don’t get hung up
• ……“all becomes more obvious afterwards “
• Chance to be able to try different options – don’t have to adopt it!
Supporting
Life After
PDSA 4.2
Objective – Obtain essential discipline specific information for new
clients to the ESD team.
PLAN
Change Idea –
•
Complete face to face handover meeting with ESD team and the
ward clinicians.
Questions –
• How many of the clinicians involved in the patients care were able
to attend the meeting? (% of total)
• How long does the meeting take?
• How time consuming is it to arrange the meeting?
• How is the information recorded, by whom and where is it kept?
• What % of clinicians prefer a face to face handover (rather than a
written referral)?
Supporting
Life After
PDSA 4.2
Predictions –
• 100% of clinicians involved in patient care will attend the meeting.
• The meeting will take approximately 15 minutes.
• The handover meeting will be easy to arrange (take < 15 min).
• Information to be recorded by the ESD team.
• 100% of clinicians will prefer face to face handover option.
Do
•
•
•
•
Meeting was lacking structure, discussion jumped around.
Amanda jotted down notes but there was no consistent way to
capture the meeting outcomes.
An excessive amount of time was spent trying to arrange the
handover meeting.
Additional information was received from talking directly.
Supporting
Life After
PDSA 4.2
Study
•
•
•
•
•
100% of clinicians involved in patient care attended the meeting.
Meeting took 15 minutes which was expected.
It took 1 hour over a 12 hour work period to arrange the handover
meeting. This was due to number of people that needed to attend
and differing schedules between in patient and community services.
Information was recorded by the ESD team member but there was
no formal way to document.
All 8 of the clinicians who attended the meeting found the face to
face handover helpful (and preferable) but commented on the
challenges of all meeting at the same time.
Supporting
Life After
PDSA 4.2
Act
•
•
Adapt .1
• Trial use of template to record information.
• Trial one to one discipline specific handovers.
Adapt .2 (current)
• Modify template and continue to use.
• Trial fixed weekly handover meeting.
• Use one to one discipline specific handovers in addition when
notable change in patient has been observed post handover
meeting.
Reflection
• Through a ramp of PDSA’s, a change idea can evolve that will
achieve the objective of the original PDSA.
• What seemed simple at the beginning is where difficulties arose and
the most learning was gained.
• Sharing the PDSA has been valuable as others contribute ideas and
learning's.
• Questions needed to be specific