The Lighthouse Hospital Project

Transcription

1 The Lighthouse Hospital Project PHASE 3 Cardiac Care in the NT Annual Workshop 2017 is proudly supported by:

2 We would like to acknowledge the Traditional Custodians of this Land on which we meet today and to pay respect to the Elders both past and present National Heart Foundation of Australia

3 The Lighthouse Hospital Project Background Lighthouse Hospital Project Phase 3 Implementation of Lighthouse Hospital Project Phase 3 in NT Cardiac Care in the NT Annual Workshop - June 2017

4 Aboriginal and Torres Strait Islander peoples Burden of disease Hospital experience for patients admitted with Acute Coronary Syndrome (ACS) three times more likely to have a heart attack and are dying from cardiovascular disease at almost twice the rate of non-indigenous Australians at significant risk of developing CVD due to high risk profiles onset for disease process is earlier and associated with co-morbidities care not equivalent to non Indigenous patients almost twice the in-hospital coronary heart disease death rate 14% lower rate of angiography a 34% lower rate of coronary angioplasty or stent procedures Cardiac Care in the NT Annual Workshop - June 2017

5 The Lighthouse Hospital Project Phase 3 Lighthouse Hospital Project commenced on 1 January 2017 A collaboration between The Heart Foundation; and Australian Hospitals and Healthcare Association (AHHA). Implemented over three phases: Phase Project scoping Phase Toolkit pilot in 8 sites Phase Roll out to 18 sites Funded by the Commonwealth Department of Health Cardiac Care in the NT Annual Workshop - June 2017

6 Phase 3 Lighthouse Hospital Project Phase 3 Project Aim To reduce the incidence and impact of Discharge against Medical Advice (DAMA) for Aboriginal and Torres Strait Islander peoples with ACS. Achieved through the following objectives: To improve the care of Aboriginal and Torres Strait Islander patients with ACS so that it is culturally safe and appropriate. To improve the experience of Aboriginal and Torres Strait Islander patients with ACS To enhance the relationships and coordination of care between hospitals, Aboriginal Controlled Community organisations and health services and Primary Health Networks. Cardiac Care in the NT Annual Workshop - June 2017

7 The Lighthouse Hospital Project A national targeted project seeking systemic change 18 hospitals across Australia Final state distribution: NSW (5), NT (1), QLD (4), SA (1), VIC (2), WA (5). 11 Metropolitan and 9 Regional hospitals. Cardiac Care in the NT Annual Workshop - June 2017 Hospital Broome Health Campus (WA) Fiona Stanley Hospital* Kalgoorlie Health Campus Royal Perth Hospital Sir Charles Gairdner Hospital Flinders Medical Centre Bairnsdale Regional Health Service St Vincent's Hospital Melbourne Coffs Harbour Health Campus John Hunter Hospital Liverpool Hospital Orange Health Service Tamworth Rural and Referral Hospital Cairns Hospital Princess Alexandra Hospital The Prince Charles Hospital The Townsville Hospital Royal Darwin Hospital State WA WA WA WA WA SA VIC VIC NSW NSW NSW NSW NSW QLD QLD QLD QLD NT

8 The Lighthouse Hospital Project Toolkit OBJ: To achieve cultural proficiency across the hospital OBJ: To improve access to and uptake of evidence-based ACS care for Aboriginal and Torres Strait Islander peoples Cultural Competence safety and security Care Pathways patient journey, variance Patient Family Community Workforce capacity, training OBJ: 1. To develop a culturally and clinically competent workforce 2. To effectively utilise the skills and knowledge of Aboriginal and Torres Strait Islander staff across the hospital, especially within multidisciplinary care teams OBJ: 1. To ensure executive leadership and appropriate accountability across all staff for quality improvement activities across the organisation 2. To develop and ensure effective relationships, partnerships and consultation with Aboriginal and Torres Strait Islander organisations and community Governance leadership, accountability

9 Identifying the opportunities for change/ improvement under domains of toolkit. Domain Example Enablers Issues Governance Workforce Care Pathways Cultural Protocols & Behaviours Effective leadership, clinical champions & partnerships; Effective relationships with AMS, other health services, & between clinician and patient Mandatory cultural development training Entire workforce responsible for delivery of culturally appropriate healthcare Role of AHW, ALO identified & agreed Best practice guideline for collection of Aboriginal and Torres Strait Islander status. Screening complete 3 mo prior to surgery Display of Aboriginal and Torres Strait Islander Art work around the hospital AHW integral to patient journey Screening, assessment and care planning reflect cultural needs/ beliefs Patients not presenting for follow-up appt post discharge, Inadequate communication and care coordination between ACCHO and hospital or hospital to hospital Inadequate training/ orientation frontline staff Staff instability, variable use of AHW Extended waiting time for cardiac surgery due to distance, accessibility, understanding of preop issues Local communities do not feel culturally safe or welcome within the hospital environment

10 Aboriginal and Torres Strait Islander Patients with ACS/RHD transferred from Darwin Hospital to Flinders Medical Centre Step 1: What problem are we trying to solve? PHASE 3 LIGHTHOUSE HOSPITAL PROJECT

11 No. of Clients Interstate procedures coordinated by the Cardiac CNCs (July - November 2014) n = PCI CABG Valves Alternate procedures

12 C O N C O R D A N C E Cooperative National Registry of Acute Coronary Care Guideline Adherence and Clinical Events Royal Darwin Hospital Data Feedback May 2012

13 Percentage (%) Discharge Medications on All appropriate agents RDH Study Average Best Hospital All appropriate therapy 1. All appropriate therapy includes patients discharge on all four agents (Aspirin/Clopidogrel and B-Blocker and Statin and ACE/ARB)

14 Percentage (%) Documented referral to cardiac rehabilitation RDH Study Average Best Hospital STEMI NSTEMI UAP Overall 1. Requires documented referral to a cardiac rehabilitation program at discharge from hospital. Denominator excludes patients who have died in hospital

15 Event Free Survival by Guideline therapy 4 or more Guideline therapies 3 or fewer Guideline therapies Adjusted HR*: % C.I , p=0.240 *Propensity score, 15

16 46 year old female From Katherine Region High risk patient Lost to cardiology follow up post redo- mechanical MVR -since 2015 Several hospital presentations ( ~30 presentations over 18 months) Past Medical History 1. Rheumatic Heart disease- Prority 1 1. MV repair monthly f/u till Oct 2007 stable with Mild MR only. 2. Lost to cardiology follow up from Redo MV surgery Mechanical - MVR - 13/04/15 ( Flinders) - on warfarin with target INR Complicated by sternal wound infection managed conservatively at RDH/HITH 2. hypertension 3. Pulmonary hypertension with a PAP of approx. 50mmHg 4.?COPD smoker 5. ETOH abuse/ suboptimal adherence to medications and follow up and at risk of TOL 6. Obesity 7. Paroxysmal AF 8. Likely obstructive sleep apnoea 9. Previous TB

17 Chronology since MVR 13/04/15 Date Episode Summary 24-29/04/15 RDH admission Sternal wound infection 2-3/05/15 KH admission Worsening heart failure, non-compliance, TOL 17/05/15 KH ED Heart failure with pleural effusion 18/05/15 KH ED SOB 01/06/15 KH ED Chest pain,?urti 9-15/6/15 KH admission Infective exacerbation COPD 23/06/15 KH ED SOB 10/08/15 KH admission Worsening CCF in context of LRTI, SOB, bipedal odema 02/12/15 RDH ED Chest pain, TOL before CXR or troponins 16/12/15 RDH admission No details

18 Chronology since MVR 13/04/15 19/12/15 RDH admission TOL 21/12/15 Treating Doctor Letter of support, we support move to darwin to be closer to tertiary services 19-22/12/15 RDH admission SOB on background of heavy alcohol consumption and medication noncompliance. TOL and then re-presented. 01/01/16 RDH ED Left before being seen 08/01/16 RDH ED Intoxicated and diarrhoea, left before being seen 11/01/16 RDH ED Medication re-supply and warfarinisation 18/01/16 RDH ED Lump in breast, referred to OPD 26/01/16 RDH ED Superficial stab wound to foot 29/01/16 HITH RDH Sub-therapeutic INR and infected foot wound for treatment plan 03/02/16 RDH ED Left foot wound, not infected. For daily dressing.

19 Chronology since MVR 13/04/15 16/02/16 HITH RDH IFD admit for bridging clexane, TOL 07/09/16 KH admission Fluid overload secondary to non-compliance 10/09/16 KH ED assault 29/09/16 KH ED BIBA intoxicated, dysuria, abdominal pain. 30/09/16 KH ED Abdominal pain and dysuria, alcohol consumption 05/10/16 KH ED UTI, ETOH 19/10/16 KH admission Abdominal pain, discharge against advice, ETOH 22/10/16 KH admission Non-infective exacerbation CCF, sub therapeutic INR secondary to non-compliance 03/11/16 KH admission Ascitic tap and TTE 29-31/12/16 RDH admission Decompensated heart failure

20 NT Cardiac OPD visit summary Sebina LANSEN, DOB 29/12/1970

21 Post FMC DC care co-ordination April 2015

22 RDH post dc CNC follow up

23 Diagnosis evidence of the problem Series 1 Series 2 Series 3 CATEGORY 1 CATEGORY 2 CATEGORY 3 CATEGORY 4 Cardiac Care in the NT Annual Workshop - June 2017

24 Local Opportunities and Priorities for improvement Hospital related Primary Care related Cardiac Care in the NT Annual Workshop - June 2017

25 For further information contact Dr Kangaharan PRESENTATION AT THE CARDIAC CARE IN THE NT ANNUAL WORKSHOP DARWIN, JUNE 2017