AMP Health and Social Care Professional Implementation Group Update

Transcription

1 AMP Health and Social Care Professional Implementation Group Update November 2016 Welcome to another update from the National Acute Medicine Programme s Health and Social Care Professionals Implementation Group (HSCPIG). The aim of these updates is to keep HSCPs on the ground up to date with the plans of the National Acute Medicine Programme and the work being done by the HSCPIG. As we are sure you are aware, the Programme has a clear vision and a number of aims around the delivery of Acute Medicine in Ireland Vision The programme s vision is that timely, safe and high quality clinical care is delivered to all acute medical patients in an appropriate and dignified environment. Programme Aims The main aims of the programme are: o Safe, quality care for acute medical patients in an appropriate environment o Less medical trolley waits o Reduced elective waiting times for admission/day cases, etc. o Improved efficiency e.g. faster access to investigations o Real savings for the health service It is expected that over 100,000 presentations will be seen in Acute Medicine Units in 2016.

2 What we have been working on this year Refreshed and Reinvigorated HSCPIG It is recognised that HSCPs, in therapies, diagnostics and support, play a key role in the delivery of Acute Medicine, often as part of the multi-disciplinary team. This happens not only in the Acute Medicine Units, Short Stay Wards but also in the Emergency Department. The HSCPIG has been refreshed with new blood coming on stream to build on the work carried out by previous incumbents. The full membership of the group, which has a steering group and professional advisors, can be viewed at the end of this update. It comprises 32 professionals 14 different professions 8 different hospitals Model 3 and 4 four face to face meetings this year plus teleconferences Robust HSCP Managers Communication Network Developed We have worked hard to develop the most comprehensive list of addresses for all HSCP Managers and Department Heads in all Model 3 and 4 hospitals. This has provided us with a robust communication network, the aim of which was to ensure that communications from the HSCPIG were delivered directly to those leading the services in those hospitals. If you are a HSCP Manager or a HSCP Lead in the AMU and did not receive this directly, then please paulg.nolan@hse.ie to be added to the list. Current Service Delivery Survey Carried Out Utilising the Communication Network, we circulated a survey to all HSCP Managers aiming to map out how HSCPs currently support service delivery across their acute floors. Over 130 managers responded to the survey and we are currently collating the data from which we will produce a report. The aim of this report will be to outline what services are currently being delivered how those services are being delivered what are the variances what are the opportunities to minimise those variances Common Screening Tool The group has been carrying on the work on the Common Screening Tool. The concept of the CST is that it would be used by the first HSCP to assess the patient. The CST would enable this clinician to collect information that would be common to a number of HSCPs, such as demographics, and also to carry out screening for issues that would warrant other HSCP intervention. A number of pilots were carried out which helped in the development of the tool, the operating procedure and datasets that can be monitored during pilots. We plan that the next pilot will be run in SVUH and following consultation with professional bodies, we would hope to launch the Tool in the first half of 2017.

3 Key Performance Indicators The group has being working on developing KPIs for the various HSCP disciplines. This is a challenge, given the diverse group of professions; however there are a number of aims in developing these simplified KPIs easy to collect and collate aligned to the programme s aims and KPIs The KPIs are being delivered to allow HSCP departments to demonstrate in a quantitative way how they are helping their hospital meet the aims of the Acute Medicine Programme. Again once developed, there will be consultation with the professional bodies. Links with other National Clinical Programmes The HSCPIG has explored linkages with other National Clinical Programmes where we feel there are clear synergies and commonalities to be explored. We feel there are clear common areas between the National Clinical Programme for Care of the Older Person National Emergency Medicine Programme At our last face to face meeting Rosie Quinn, Senior Physiotherapist in Drogheda and HSCP Rep on the EMP, met with us and gave us an overview of the programme. The programme aims, using an Emergency Medicine Network, to have patient experience times of under six hours. Whilst it is obvious that there are many challenges in the EDs, Rosie pointed out that there are a number of key recognised interfaces, including those with Acute Medicine Units and Diagnostics. The National EMP Report sees key roles for therapies in ED, including Physiotherapists, Speech and Language, Dietetics, Occupational Therapy and Medical Social Workers. The report also references initiatives such as Physiotherapy review clinics, Hand Therapy Clinics as well as Musculoskeletal Therapy Services in ED. These services, which potentially could be extended to the full acute floor, have reported discharges of 50-80% with high patient satisfaction. Mobility interventions, such as the FRAIL team model are also shown to reduce AvLOS and again therapy assessment and intervention at the front door is what needs to be provided in the AMU/SSW. Site Visits As part of the programme, the National Team, including the HSCP Lead, Paul Nolan, have carried out a number of site visits to Model 4 hospitals to look at how the National Programme is being implemented in various sites and to find out what has been working well and what some of the challenges are. What has been clear is that where there is a clearly defined embedded MDT within the AMU/SSW that the impact of HSCP and Therapy staff is maximised. These MDT s sometimes concentrate on facilitating discharge and admission avoidance, like the Rapid Assessment Team Model, which is used in the Mater Hospital or the Frail Elderly Teams which are in place on the Acute Floor in a number of hospitals around the country. On our site visits, Acute Medicine Units who have restricted access to therapy staff and services highlight it as a significant issue in patient care and flow.

4 In St James Hospital, their move towards electronic documentation clearly facilitates coordinated care across the acute floor. It has also allowed the creation of integrated therapy notes, allowing easy sharing of not only the acute presentation, but also historical notes across different therapy professions. It is also important to note is that these notes are not only accessed by therapies but also by both the medical and nursing teams enabling holistic care of patients. Another facilitator of patient flow and care within the AMU/SSW is protected access to appropriate diagnostics, not only radiology but also vascular and cardiac diagnostics. On site visits lack of access to diagnostics has been seen as a barrier to effective working of the AMU/SSW and to patient care. Not only same day slots but also high priority out-patient slots allow for efficient throughput of patients and facilitate ambulatory care of acute medical presentations such as Deep Vein Thrombosis. Small investments in diagnostic staffing and equipment can have significant impacts in reducing delays for scans and tests which aid in patient flow and potentially create bed days within the system. Links with the community continue to be a problem and lack of access to Home Care packages can cause significant delays in discharge, and of course some sites have particular challenges in terms of a higher level of social problems, such as homelessness, within the patient population that they serve. For example, in one major Dublin Hospital acute medical presentations amongst homeless people are about 6 times higher than the general population in the same catchment area. One useful initiative in building relationships between hospital based and community based services is the rotation of hospital based therapy staff into the community and visa versa.

5 Spotlight on the Mater Hospital s RAPID Team The Mater Hospital s Rapid Admission Prevention Interdisciplinary (RAPID) Team was developed in 2012 in alignment with the National Acute Medicine and the Emergency Medicine Programmes. The RAPID team consists of a Medical Social Worker, Occupational Therapist and Physiotherapist and works with patients in the emergency department (ED) and acute medical assessment unit (AMAU). We strive to ensure patients receive swift interdisciplinary assessments and interventions, divert patients from unnecessary hospital admissions, engage in active discharge planning and maintain collaborative and effective working relationships with our community colleagues. The team also identifies patients who are not suitable for discharge and require specialty admission, acute rehabilitation or more complex discharge planning. For those patients requiring admission, discharge planning is commenced on initial presentation, potentially reducing length of hospital stay. On-going reviews demonstrate that the RAPID Team assisted in avoiding hospital admission for on average of 60% of patients. Of those successfully discharged patients were either transferred to post-acute care for further rehabilitation or convalescence and or were discharged home with community services activated. Our KPI for response rates is a response time of 60 minutes for the team leader to carry out their initial assessment and once the team leader has identified the inter-disciplinary team members required, they aim to respond to the referral within 30 minutes. The development our common screening tool has also greatly reduced the duplication and time spent on individual assessments, making the service more streamlined and efficient. We also operate a team leader model, whereby we rotate responsibility for co-ordination of assessments and discharges on a daily basis. The team has engaged in extensive improvement work including identifying and reviewing Key Performance Indicators (KPIs), development of a falls pathway, collaboration with Care of the Older Person service to develop a referral pathway and ongoing collaboration with community partners to ensure a seamless transition of care for patients

6 Diagnostics in Acute Medicine Rapid access to diagnostics is one of the cornerstones of the acute medicine programme to facilitate the aimed six hour target around a decision to admit or discharge. Radiology of course is a major diagnostic area supporting acute medicine. In the Mater hospital their bespoke radiology information system (RIS) embedded into the national integrated medical imaging system (NIMIS) has allowed Radiographers and Radiologists to influence content for referrers (prescribers) to a high level. The department has, via the system developed irefer Guidelines (RCR 2012)for medical imaging Local pre-op CXR referral guidelines (Generated in association with radiology and anaesthetics) An instructional video on using the NIMIS system and accessing ALL imaging nationally thus reducing the amount of repeat procedures A list of local patient doses associated with common radiological thus helping to guide and influence the justification process as well as increase local referrer awareness of dose Acute floor imaging algorithms for CT head trauma AND CTPA referrals giving clear guidance on when not to image Pre interventional radiology (IR) procedure check sheets for appropriate patient preparation, thus improving efficiency and overall patient flow Local pregnancy policy information for referrers (A one page summary of relevant patients and procedures as well as referrer information and records necessary) Similar pathways and solutions are implementable to some extent in all facilities, to help maximise the appropriateness of patient referral for imaging and reduce unnecessary scans thus reducing patient radiation burden and improving diagnostic access for acute pathway patients. Cardiac Diagnostics are another important element, considering that 8 of the top 20 acute medicine presentations involve Cardiac investigations, such as echocardiogram, exercise stress testing or holter monitoring as part of their work-up. It was recognised in both St James Hospital and University Hospital Galway that delays in Cardiac Diagnostics were impacting on acute patient flow. In UHG the addition of one extra Cardiac Physiologist, has enabled the department to more rapidly complete inpatient diagnostics, particularly for the acute floor. A recent audit demonstrated that Increased activity of 8% in Echo, 15% in Exercise Stress Testing 100% of Exercise Stress Tests performed same day (77.8%) or next day 77.8% of Echos performed same day or next day (relative increase of 19.8%) 82% of AMU/SSW Echos performed in <24hrs Bed days waiting for echo reduced by 50.6% - potentially creating/saving 311 bed days per month Rapid access to appropriate diagnostics is a vital part of the Acute Medicine Programme and a recognition of that is important amongst department heads and service planners locally.

7 Have you a service which is successfully supporting the Acute Medicine Programme Why not let us know or contact us if you have comments or questions about the programme paulg.nolan@hse.ie

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