Tipping points / Triggers Who Owns our RED

Feb 2016

SWSLHD Experience

Kim Clark

SWSLHD WoH Program Manager

Tipping points / Triggers Who Owns our RED?

What was the problem?

Falling overall NEAT

Poor admission NEAT (15-20%)

Increase activity

Poor Transfer of Care (TOC) 69%

No of Patients spending >24hrs in our ED’s – High

Average Daily 0800hrs queue = 21 adult pts

Who Owns the RED?

What was the Goal & What did we do? To improve safe and timely access to care

Governance framework ‒ Structure ‒ People ‒ Information

Data ‒ Know the data, communicate the data – transparency & ACT on

the data – trusting it ‒ Predicting capacity and demand ‒ Daily monitoring and correction

Escalation Strategies

What we did - Governance

Weekly WoHP meeting

Weekly WoH Advisory Meeting

Weekly Capacity/Workforce Planning Meeting

Weekly Emergency Department WoH Meeting

Weekly LLOS Committee

Twice daily Executive rounding in the Emergency Dept

Twice daily Access Meeting (Inpatient Wards) 5 days - patient flow and staffing

Executive PJB meetings

Executive/ED Huddles

What we did – Data Predictions/Tipping points

Inpatients with LOS > 9 days

ED Accessible Bed Occupancy

The ED Queue – yesterday’s admissions still in ED

Performance Discharge targets by Specialty/Ward

ED tipping points

20

40

60

800

1-J

an

08

-Jan

15

-Jan

22

-Jan

29

-Jan

05

-Feb

12

-Feb

19

-Feb

26

-Feb

05

-Mar

12

-Mar

19

-Mar

26

-Mar

02

-Ap

r

09

-Ap

r

16

-Ap

r

23

-Ap

r

30

-Ap

r

07

-May

14

-May

21

-May

28

-May

04

-Ju

n

11

-Ju

n

18

-Ju

n

25

-Ju

n

02

-Ju

l

09

-Ju

l

16

-Ju

l

23

-Ju

l

30

-Ju

l

06

-Au

g

13

-Au

g

20

-Au

g

27

-Au

g

03

-Sep

10

-Sep

17

-Sep

24

-Sep

01

-Oct

08

-Oct

15

-Oct

22

-Oct

29

-Oct

05

-No

v

12

-No

v

19

-No

v

26

-No

v

03

-De

c

10

-De

c

17

-De

c

24

-De

c

31

-De

c

Nu

mb

er o

f p

atie

nts

wit

h L

OS

> 9

day

s

Inpatients with LOS > 9 days (calculated daily) 2014 v 2015

2014

2015

Threshold 45 pts.

Forecasting (a storm)

What we did – LHD Wide

Quarterly LHD WOH Meetings

Project Management Templates

Weekly – Fortnightly Facility WOH Meetings

Minimum data set

10am Facility Report

Long Weekend Facility plans

Bimonthly LHD Patient Access to Care Meetings

Bed Demand Status

Outcome - LOS

Stroke and Other Cerebrovascular Disorders W/O Catastrophic or Severe CC - Was 6.5 days, now 4.1 days

Other Hip and Femur Procedures W Catastrophic CC -Was 47 days, now 19.14

Seizure W/O Catastrophic or Severe CC Was 4.1 day, now 1.71 days

Estimated Acute Overnight Bed Days saved since September 2014:

5000 bed days

Outcome - Performance

Challenges

Absolute trust & understanding of our key metrics–

knowing our business at depth where we were able to

‘see’ things tipping over that day and action ‘same day’

and normalising this approach

Executive Engagement

Clinician Engagement

Where to from here

Review Demand Escalation Plan and Triggers

Refine/ Review/Develop ED tipping points & escalation processes

Questions