Making Numbers Real: The discharge journey

Tania Geyer, Di Norris, Liz ProwseNoarlunga Health Services(now part of Southern Mental Health, SA)

NUMBERS… (blah blah blah)

KPI #5 = N/A

KPI #9 = KPI #12 = 65%

KPI #3 = 27%

KPI #7 = 5%

KPI #2 =

KPI #8 = 50%

KPI #11 = mc2

KPI # 12: Follow-up within 7 days of discharge

Why focus on this indicator?

• An across service indicator (involves inpatient and community)

• Clinical relevance

• We didn’t seem to be very good at it

• Tapped into a number of processes around discharge and transfer of care

Baseline Rates of Follow-up

Us: 48%

Identified Need of Attention from Benchmarking Results

• It’s a clinical problem not just a number!

• High time of risk

• Consumers falling through the gaps

• Missing link between inpatient and community follow-up

• Communication issues

• Links with other KPI’s – length of stay and 28 day readmission

What did we do?

• Discussion/communication with Team Leaders and clinicians

• Working group with significant buy-in from inpatient and community with project support– Recognition and understanding of the

KPI and clinical implications– Focus on the KPI measuring the

consumer experience of discharge

Development of procedure• Developed by working group – high level of

engagement from teams• Move into line with general health follow-up,

e.g. phone call day after surgical discharge • Examples of procedure points:

Inpatient– Confirm follow-up with consumer– Document actions on discharge checklist and

journey board– Make contact and complete documentation

Community– Inpatient admission report become part of

morning handover– Confirm nature of discharge contact

Implementation and Roll-out of procedure

• Paper based collection initially

• Enhancement of computer system to collect contacts made by inpatient staff to discharged consumers

• Training

• Recommendation to change the KPI to collect any contact made within 7 days

• Examining and improving discharge/transfer of care practice – inpatient Journey Boards

Journey Board - Goals

• Make the Consumers Journey visible to the whole team by using visual management techniques

• Introduce a standardised communication tool in all Southern Mental Health units

• Improve communication between inpatient wards and the community teams

• Facilitate making barriers to the journey visible

• Collect data regarding real barriers rather than perceived barriers to improve treatment and discharge plans

Baseline Rates of Follow-up

Referral Triangles

1. When SW/Psychologist/OT was needed2. When referred to SW/Psychologist/OT3. When the Psychologist, SW or OT has seen the Consumer

21/7 21/7

23/7

Process: Only rub out referral triangle if you need to re-refer.

Green – good to go

Yellow – more to do

Red – not good to go

Referral Triangles - System

Q2 The introduction of the Consumer Journey Boards has improved the visibility of the Consumers Journey

0

10

20

30

40

50

60

StronglyAgree

Agree Disagree StronglyDisagree

Unsure N/A

Q7 Has the Consumer Journey Board made your job easier?

0

5

10

15

20

25

30

35

StronglyAgree

Agree Disagree StronglyDisagree

Unsure N/A

A total of 133 surveys were distributed to both inpatient andcommunity staff SMH, 81 surveys were returned for a 61%

response rate.

Evaluation Summary

(95% of the general hospital staff surveyed were enthusiastic about encouraging other areas to implement journey boards only 2% disagreed 9% were unsure)

Q10 Would you encourage other areas to implement Consumer Journey Boards to enhance patient f low and communication?

05

10152025

303540

4550

StronglyAgree

Agree Disagree StronglyDisagree

Unsure N/A

Evaluation cont..

• SMH staff showed a positive response with 65% agreeing that they would encourage other areas to implement journey boards, 23% were unsure or stated the question was not applicable and only 12% disagreed.)

Comments from General and MH Staff

• Easy access to information• Keeps control of work load• Gives a snapshot and an overall

picture of journey • Identifies the allocation of workload

Evaluation cont..

3 Year Comparison

Us: 48% to 59% to 68%

And…

• Monthly monitoring, by each site and as a region

• Adding collection to residential rehab. centre

• Closing the loop/following up

• Further system enhancements, e.g. new discharge screen

• Journeyboarders – particularly Anna Szynkar and Denise Wright (Flow Coordinators)

• Inpatient and community staff of Southern Mental Health, in particular those based at Noarlunga

• Information and project staff

• Consumers and carers of our service

• All Adult Benchmarking participants

Acknowledgements