Clinical Reconfiguration Service Plan

Transcription

1 Clinical Reconfiguration Service Plan Southern Adelaide Local Health Network February 2016

2 Contents 1. Executive Summary Introduction Purpose Length of stay reduction strategies... 5 Long stay patient strategy... 5 Timely Aged Care Assessment Team (ACAT) assessments... 5 Medical Ambulatory Care Service (MACS)... 5 Standardisation of care for planned surgical activity... 5 Enhancing patient care and collocation of services Capital Works Clinical Reconfiguration Timelines Workforce... 8 Nursing RN3 staff... 9 Nursing RN2, RN1 and EN staff... 9 Allied Health staff Patient Services Assistants staff Administrative / Clerical staff Workforce Summary Affected Surgical Division Clinical Reconfiguration affected FMC Medical Division Clinical Reconfiguration FMC Mental Healthl Division Clinical Reconfiguration Noarlunga Hospital General Medicine Whittaker Ward Summary of to be allocated staff 17 Page 2/17

3 1. Executive Summary Since October 2015, several strategies have been implemented across Southern Adelaide Local Health Network (SALHN) in collaboration with clinicians. These strategies are aimed at improving patient care, streamlining service provision and reducing inpatient length of stay (LOS). The successful strategies provide an opportunity to reconfigure services across the network prior to winter this year and in preparation for the transfer of services from the Repatriation General Hospital (RGH) in The LOS reductions have resulted in beds being regularly flexed down' over recent months. The clinical reconfiguration will occur over several stages and will be supported by a minor capital works program until late June The clinical reconfiguration will improve patient flow and discharge processes through the right sizing of wards optimising skill mix and availability of senior staff and enable patients to be located with their specialist teams, reducing the amount of time spent locating patients in other wards. More single rooms will be built through the minor capital works program and there will be an overall increase of physical beds at Flinders Medical Centre (FMC). The Clinical reconfiguration includes the following ward mergers and relocations Relocation of Trainee Medical Officers (TMO) Lounge - February 2016 Establishment of a Medical Ambulatory Care Service (MACS) April 2016 Merger of 4GS (Surgical Short Stay) and 5D (Emergency Short Stay) April 2016 Relocation of 6B (Acute Care of the Elderly-ACE) to 4G April 2016 Relocation of 4GP(Mental Health) to 6B May 2016 Merger of 4A (General Medicine) with Ward 6B (Acute Care of the Elderly) and relocation to 4G May 2016 Relocation of Whittaker Ward (General Medicine) from Noarlunga Hospital (NH) to Ward 4A at FMC June 2016 Establishment of a SALHN Day Procedure Unit on Level 2 clinics area and relocation of some services currently provided in previous Haematology/Oncology Day Unit (HODU) space on Ward 5G - June 2016 Nursing, medical, allied health, patient support assistants (PSA) and administrative staff will be in scope for the changes across and within FMC and NH. Human resource principles will be implemented across salaried and nursing staff in consultation with staff and unions. There will be no TVSPs or forced redundancies. Some staff will be required to relocate across sites (NH to FMC) and within FMC. A merit based Expression of Interest process will be undertaken. Options are presented under the workforce section (pages 9 and 10). A consultative working group will be established with unions and staff. Page 3/17

4 2. Introduction SALHN has introduced new strategies to improve patient care and reduce inpatient Length of Stay (LOS) across the Network. SALHN is constantly evolving to meet the needs of our community. Several new and innovative strategies have been developed in collaboration with clinicians in the delivery of patient care, which has reduced LOS. The recent improvements in patient care combined with LOS reductions has provided opportunities to reconfigure services across the Network, to maximise clinical expertise and inpatient space. The LOS reductions have resulted in beds being regularly flexed down' over recent months. The clinical reconfiguration will occur in several stages and be introduced across FMC and Noarlunga Hospital (NH), supported by a minor capital works program. The clinical reconfiguration, including capital works, is to be completed prior to the expected increase in demand in winter 2016 and will support the preparation for the transfer of services from Repatriation General Hospital (RGH) in It is expected that the clinical reconfiguration will create a number of efficiencies and quality improvements in patient care which will Improve patient care, outcomes and support improved patient flow and discharge processes. Right size wards to optimise skill mix and availability of senior staff. Enable more patients to be located with their specialist team reducing unproductive time spent locating and caring for patients in other wards. Provide more single rooms for improved patient care and more purpose built areas to support specialty areas. Include minor capital works to maximise available inpatient spaces. Support the Royal Adelaide Hospital ramp down Prepare SALHN for the transfer of services from RGH to FMC and NH. Strategies which have supported reduced length of stay in recent months have focussed on long stay patients and reducing the amount of time for assessments of older people and community supports. As part of the reconfiguration, a new Medical Ambulatory Care Service (MACS) will be established at NH and a SALHN Day Procedure Unit will be established at FMC. Some additional inpatient surgical activity will be provided as Day of Surgical Admission (DOSA) cases and the SALHN Day Procedure Unit will further enhance patient care by reducing the need for stays in hospital. There will be no impact on patient care throughout the clinical reconfiguration and all clinical services provided by SALHN will continue. 3. Purpose The purpose of the SALHN Clinical Reconfiguration Plan is to provide an overview of the strategies and service moves across FMC and NH, including consultation, workforce summary, capital works and associated timelines. In consultation with clinicians, several strategies have been developed to support streamlined service provision across SALHN. Page 4/17

5 4. Length of stay reduction strategies SALHN is committed to evolving and developing new and more efficient and patient-centred ways of providing care to manage growing demand. Clinicians have been engaged in developing several strategies which have reduced inpatient LOS which provides opportunities to reconfigure clinical services and spaces. These strategies include: Long stay patient strategy Improving internal processes for access to tests, procedures or aged care assessments and facilitating timely discharge has reduced length of stay for many patients who have had a length of stay greater than 14 days. In November 2015, there were more than 100 patients at FMC with a length of stay greater than 14 days. This has now reduced to around 70 patients. Many of these patients no longer require acute medical care however they remain in hospital awaiting tests and aged care assessments. Timely Aged Care Assessment Team (ACAT) assessments In 2014/15 the average waiting time for ACAT assessment was over 8 days at FMC, 8 days at RGH and 5.5 days at Noarlunga. Additional ACAT assessors have been recruited and changes have been made to the management of ACAT assessment appointments. Length of stay for patients awaiting assessment to return home or to residential facilities has reduced significantly with two thirds of assessments now completed within two days a reduction of up to six days for some patients. Medical Ambulatory Care Service (MACS) MACS is a specialist led model of care and will be located at the GP Plus Super Clinic Noarlunga. It will: provide rapid access to specialist medical ambulatory care services for patients substitute hospital admissions through more timely access to specialist care and follow up in the community substitute Emergency Department presentations for care that is better provided in an ambulatory setting support patients to remain at home while still receiving specialist care in an ambulatory setting. enable early hospital discharge of medical inpatients providing rapid access to follow up appointments Standardisation of care for planned surgical activity The clinical reconfiguration program has identified opportunities to increase the number of patients that can be admitted on the day of surgery and/or admitted for day surgery. The provision of clinically appropriate day surgery will reduce the demand on inpatient beds. Enhancing patient care and collocation of services The collocation of clinical services through the 'right sizing' of wards to optimise skill mix and specialist expertise will improve patient flow, enabling more patients to be located with their home teams. 5. Capital Works During the clinical reconfiguration there will be minor capital works to provide additional in-patient and clinical procedural capacity. The capital works will occur in a staged process until the end of June 2016 and there will be no impact upon patient care or clinical services during this period. Page 5/17

6 The current Trainee Medical Officer (TMO) lounge will be relocated from Ward 4A (Medical Ward) on level 4 to level 2 in the previous Chief Executive Office (CEO) space. Prior to the relocation, refurbishment will occur to the vacated CEO space to ensure adequate facilities are available. It is proposed that these works will be undertaken in February. Ward 6B, currently the Acute Care of the Elderly (ACE) ward will undergo minor capital works to provide a dedicated space for mental health consumers. This will ensure that mental health consumers are no longer required to share a ward with surgical patients. Minor works will also be undertaken in the vacated Ward 4GP (Mental Health space) prior to the relocation of the general medical ward (4A). This will provide the appropriate environment for the collocation of ACE patients and general medical patients. The vacated TMO space in ward 4A will require minor capital works to create an additional eight medical beds. The eight bed configuration will encompass one four bed bay and four single rooms to support specific patient needs and to support flow out of the Emergency Department for patients requiring single room accommodation for clinical needs. The capital works will be completed prior to the expected increase in demand related to winter and ramping down of the Royal Adelaide Hospital. This will result in an increase in bed capacity of Ward 4A from 16 beds to 24 beds. A dedicated SALHN Day Procedure area will be custom built to accommodate services which have historically been provided in inpatient beds, including infusions and procedures. The dedicated space will include a combination of chairs and a procedural room. This will accommodate the relocation of the services from the Haematology/Oncology Day Unit (HODU) on Ward 5G to an area accompanying the level 2 medical outpatient clinics. The capital works is due for completion in June Consultation with affected stakeholders will occur throughout the planning stages of this area. The vacated space on Ward 5G will undergo refurbishment to increase the physical bed space of ward 5G (Haematology/Oncology ward) from 16 beds to 24 beds. The increase in bed capacity will include the configuration of four single rooms and one four bed bay. The refurbishment is due for completion by June The capital works associated with the clinical reconfiguration will provide: additional physical 16 bed capacity at FMC including eight single rooms a dedicated inpatient environment for the mental health service in Ward 6B a SALHN day procedure unit that will support timely access to dedicated space for delivery of day procedures and substitution of some work that has historically been provided in inpatient beds. Page 6/17

7 6. Clinical Reconfiguration Timelines The following table provides an overview of: Current in-scope funded bed configuration as at February 2016 Post clinical reconfiguration in-scope funded bed configuration as at June 2016 Physical bed capacity post capital works as at June 2016 Ward MACS FMC In-scope Bed configuration Funded Funded Physical Feb-16 Jun-16 Capacity GP Plus GP Plus 5D FMC Comment MACS established at GP Plus Super Clinic Noarlunga to support inpatient substitution, prevent emergency department presentations and hospital admissions April: merger of 4GS (elective Surgical Short Stay) and 5D(Emergency Short Stay) and located in Ward5D 5A FMC April: Surgical ward will increase to 26 beds 6B FMC ***4A FMC ***5G FMC 4GS (4G) FMC 4GP (4G) FMC Noarlung a Whittaker Ward B currently 16 bed Acute Care of Elderly (ACE) ward. In April ACE patients will transfer to 4G and in May, 10 mental health consumers in 4G will transfer to 6B to a dedicated mental health space. 4A currently General Medicine 16 beds. In May 4A will move to 4G creating an empty 4A ward space to be refurbished to 24 beds. In June Whittaker Ward (NH) general medical beds (16) will transfer to 4A FMC. 4A FMC will have physical capacity of 24 beds post the capital works completion. This will also provide flex capacity as needed 16 bed Haematology/Oncology ward - no change. Refurbishment to occur to increase physical bed capacity to 24 in June Provides flex capacity as needed Currently 4GS is an elective Surgical Short Stay ward and will merge with 5D. 4GP is a Mental Health inpatient ward. In June 2016, 4G will be a combined General Medical/ACE ward. Currently Noarlunga Whittaker ward is a General Medical ward. Recent occupancy has been in the low 20 beds. MACS will commence in April 2016 at GP Plus Noarlunga. This will support inpatient bed substitution. In June 2016, 16 beds will be relocated to 4A at FMC. 29 physical beds will remain located at Noarlunga to be used for future service provision. Total ***Capital works to occur to provide increase in physical bed capacity Beds will continue to be flexed up and down based upon demand Length of stay reductions have resulted in beds regularly 'flexed down' over recent months. Physical capacity will be increased across SALHN. A purpose built SALHN Day Procedure Area on Level 2 and relocation of services provided in the previous Haematology/Oncology Day Unit (HODU) in Ward5G will be relocated to new area. Page 7/17

8 The Clinical reconfiguration includes the follow ward mergers, relocations and timelines Relocation of TMO Lounge - February 2016 Establish Medical Ambulatory Care Service (MACS) April 2016 Merger of 4GS and 5D April 2016 Relocation of 6B to 4G April 2016 Relocation of 4GP to 6B May 2016 Merger of 4A with Ward 6B and relocation to 4G May 2016 Relocation of Whittaker Ward to Ward 4A at FMC June 2016 Establishment of new Day Procedure Unit to Level 2 clinics area - June Workforce The in-scope staff affected by the clinical reconfiguration include: Nursing Division of Medicine, Cardiac and Critical Care Division of Surgery and Perioperative Medicine Division of Mental Health Noarlunga Whittaker Ward (Medicine) Medical Trainee Medical Officers Division of Medicine, Cardiac and Critical Care FMC Surgical and Perioperative Medicine Division of Mental Health Noarlunga Whittaker Ward Allied Health FMC and Noarlunga Hospital Patient Services Assistants FMC and Noarlunga Hospital Administrative Ward Clerks/Admin Assistants at FMC and Noarlunga Hospital Page 8/17

9 The following staff impacts will result from the clinical reconfiguration Some staff will be required to relocate across sites (NH to FMC) and within FMC Vacancies will be held to give preference to staff in scope. Some reporting lines will change There will be no TVSPs and no forced redundancies Relevant staff in scope will be invited to put in their preference for work location as a result of clinical reconfiguration and ward location changes In the event that the number of staff preference for positions is greater than the number of positions available, a merit based process will be undertaken Human Resource Principles will be developed in consultation with stakeholders. These have been provided to unions for consultation Medical Staff at Noarlunga Hospital There are currently two medical teams based at NH - One team will relocate to MACS (April 2016) - One team will relocate with the transfer of Whittaker Ward (NH) 16 beds to FMC 4A (June 2016) Nursing RN3 staff Options will be discussed with relevant staff as part of the consultation process Current vacancies within the Divisions may allow for agreement between affected staff on temporary placements Alternatively, a merit based process can be undertaken now, or in the future for affected Level 3 staff Nursing RN2, RN1 and EN staff Staff will be invited to submit their preference for relocating or remaining in a divisional or site based (for Noarlunga Hospital) bank roster A merit based Expression of Interest process will be undertaken if the number of staff preference for positions is greater than the number of positions available The bank rosters are virtual wards. Staff working in the bank rosters will be rostered according to their contracted hours across all shifts. Bank roster staff will work according to their rostered shifts but it may be in different areas. Page 9/17

10 Allied Health staff Redistribution of roles across FMC Staff in scope at Noarlunga will be invited to submit their preference to transfer to FMC with Whittaker Ward A merit based Expression of Interest process will be undertaken if the number of staff preference for positions is greater than the number of positions available Unallocated allied health staff will be matched to appropriate work across SALHN and will get first preference for vacancies across SALHN Patient Services Assistants staff Staff at FMC will be reallocated to other areas within FMC Staff at Noarlunga Hospital will be reallocated to other areas within Noarlunga Hospital Administrative / Clerical staff In scope staff will be invited to submit their preference A merit based Expression of Interest process will be undertaken where applicable Unallocated staff will be matched to appropriate work and will get first preference for vacancies across SALHN A consultative working group will be established with unions and staff. Page 10/17

11 8. Workforce Summary Affected Surgical Division Clinical Reconfiguration affected Note: Nursing and midwifery staffing levels to be negotiated in accordance with the SA Nursing/Midwifery Enterprise Agreement staffing model Appendix 2 business rules. Current State Dated Division Ward Current RN Level *RN Level 2 ACSC 5.00 *RN Level 2 Clinical 5.00 Surgery 5D + 4GS RN EN PSA 7.95 Allied Health - AHP Admin 2.20 Total Post Clinical Reconfiguration Division Ward Post merge RN Level *RN Level 2 ACSC 3.00 *RN Level 2 Clinical 7.00 Surgery 5D RN EN PSA 5.58 Physio AHP Admin 1.20 Total Additional Nursing Staff requirements 4 beds in 5A Current RN Level *RN Level 2 ACSC 0.00 *RN Level 2 Clinical 0.00 RN EN 2.11 Total 7.11 *RN Level 2 skill mix to be discussed through the consultation process Page 11/17

12 Surgical Division Clinical Reconfiguration affected Surgical Nursing Bank RN EN 0.21 Total 5.86 To be allocated Surgical Staff **RN RN EN 0.00 ***PSA 2.37 Physio AHP Admin 1.00 Total ****4.42 **RN3 surgical unattached position has the option to be placed in a temporary vacancy within the Surgical Division. ***PSA 2.37 to be reallocated within current vacancies ****Vacancies will be held to give preferences to staff in scope Page 12/17

13 FMC Medical Division Clinical Reconfiguration (Note: Nursing and midwifery staffing levels to be negotiated in accordance with the SA Nursing/Midwifery Enterprise Agreement staffing model Appendix 2 business rules.) Current State Dated Division Ward Current FMC Medicine 6B + 4A RN Level *RN Level 2 ACSC 3.00 *RN Level 2 Clinical 2.00 RN EN PSA 5.78 Allied Health - AHP Allied Health - OPS 0.31 Admin 2.00 Total Post Clinical Reconfiguration Division Ward Post merge FMC Medicine 4G RN Level *RN Level 2 ACSC 3.00 *RN Level 2 Clinical 2.00 RN EN PSA 5.06 Allied Health AHP Allied Health - OPS 0.31 Admin 1.00 Total FMC Medicine Nursing Bank RN EN 2.96 Total 7.50 To be allocated FMC Medicine Staff **RN RN EN 0.00 ***PSA 0.72 Physio AHP Admin 1.00 Total ****3.82 *RN Level 2 skill mix to be discussed through the consultation process **RN3 medicine unattached position has the option to be placed in a temporary vacancy within the Medicine Division. ***PSA 0.72 to be reallocated within current vacancies ****Vacancies will be held to give preferences to staff in scope Page 13/17

14 FMC Mental Healthl Division Clinical Reconfiguration Note: Nursing and midwifery staffing levels to be negotiated in accordance with the SA Nursing/Midwifery Enterprise Agreement staffing model Appendix 2 business rules. Current State Dated Division Ward Current FMC Mental Health 4GP RN Level RN Level 2 ACSC 2.00 RN EN 4.02 PSA 1.31 Allied Health - AHP Allied Health - OPS 0.00 Admin 1.00 Total Post Clinical Reconfiguration Division Ward Post merge FMC Mental Health 6B RN Level RN Level 2 ACSC 2.00 RN EN 4.02 PSA 1.31 Allied Health AHP Allied Health - OPS 0.00 Admin 1.00 Total FMC Mental Health Nursing Bank RN EN 0.00 Total 0.00 To be allocated FMC Mental Health Staff RN RN EN 0.00 PSA 0.00 Allied Health AHP Admin 0.00 Total 0.00 The Mental Health ward is a direct transfer of. Page 14/17

15 Noarlunga Hospital General Medicine Whittaker Ward Current State Dated Division / Ward Current Noarlunga General Medicine Whittaker Ward RN Level RN Level 2 ACSC 2.00 RN Level 2 Clinical 0.00 RN EN PSA 2.64 Dietetics AHP Dietetics AHP Dietetics AHP OT AHP Physio AHP Physio OPS Social Work AHP Social Work AHP Social Work AHP Social Work OPS Speech Path AHP Speech Path AHP Admin 2.00 Total Post Clinical Reconfiguration (4A 16 Beds) Ward savings FMC 4A 16 beds (NH relocation) RN Level RN Level 2 ACSC 2.00 RN Level 2 Clinical 0.00 RN EN 7.29 PSA 2.31 Dietetics AHP1 Dietetics AHP Dietetics AHP3 OT AHP Physio AHP105 Physio OPS Social Work AHP1 Social Work AHP2 Social Work AHP Social Work OPS3 Speech Path AHP2 Speech Path AHP Admin 1.00 Total Note: Nursing and midwifery staffing levels to be negotiated in accordance with the SA Nursing/Midwifery Enterprise Agreement staffing model Appendix 2 business rules. Without prejudice Page 15/17

16 Noarlunga Hospital Whittaker Ward Note: Nursing and midwifery staffing levels to be negotiated in accordance with the SA Nursing/Midwifery Enterprise Agreement staffing model Appendix 2 business rules. Medicine Nursing Bank FMC RN Level 2 ACSC 0.00 RN Level 2 Clinical 0.00 RN EN 3.07 Total Nursing Bank Noarlunga RN Level 2 ACSC 0.00 RN Level 2 Clinical 0.00 RN EN 2.04 Total 7.07 To be allocated RN Level **PSA 0.33 Dietetics 0.37 Occupation Therapy 0.63 Physio 0.72 Social Work 1.12 Speech Path 0.37 Admin 1.00 Total *5.54 *Vacancies will be held to give preferences to staff in scope **Noarlunga PSA staff will remain at Noarlunga Page 16/17

17 Summary of to be allocated staff Total to be allocated RN RN RN EN 0.00 Allied Health 4.36 Admin 3.00 Total PSA (ongoing funded positions available within current vacancies) 3.42 Staff vacancies will be held to give preference to staff in scope. Without prejudice Page 17/17