Predicting the Unpredictable Andrea Rindt Maternity Services Manager
Who we are in 2013? Approximately 2000 births per year 6 bed birth suite 28 post natal beds all single rooms Maternity @ Home Service Breast Feeding clinic Special Care Unit Low Level 2 accepting admissions from 32 weeks Accredited for 10 cots
The Cabrini Strategic Plan The provision of excellent care Effective, efficient and consumer-focused services Skilled and engaged people Sound stewardship of resources
Our Foundation 100% right care right staff, right bed The 3 32 1 100 s 100% patient satisfaction 100% staff engagement
Achieving the strategic plan
45 Maternity Activity October 2011-March 2012 40 35 30 25 20 15 10 5 0 Oct Nov Dec Jan Feb Mar
The Environment What we were doing day to day IOL s at doctors request Performing regular ad hoc elective caesars High sick leave High Agency use Poor staff engagement Poor patient experience
Understanding the problem Demand What is coming in? What is predictable? Is there a component of our activity that is predictable? Capacity What is our ability to take our patients Practices impacting on activity
Admissions to Maternity (Demand) Average of 3 walk ins per day Spont Labour 57% Induction 24% Elect C/S 19% Predictable activity 43%
What is our capacity? Birth suite empty when women accommodated outside maternity Extra beds arranged and not used
Managing our demand M T W T F S S % Walk-ins 3 3 3 3 3 3 3 53% C/S 4 4 4 30% IOL 1 2 1 2 1 2 2 27% Total 5 8 8 5 8 5 5
Managing to our capacity Colour Aim: To facilitate containing maternity services to our dedicated beds Green Patients contained within unit and capacity for walk in s * Amber Capacity for walk in s Red Patients contained within unit and delivered women accommodated in Birth Suite Black No capacity for walk in s Bed Status Birth Suites Available Actions Available 4 or more None required 2 to 3 3 1. Promote evening maternity discharge package 2. Admit elective Caesars through level 2 DOSA 0 to 1 1 to 2 Amber actions + 1. Postpone inductions 2. Alert Co-ordinator re the potential for access to general beds 0 0 Red actions + 1. Discussion with Coordinator re access to general beds 2. Authorisation of extra beds to be made by Patient Flow coordinator in hours and Nurse Director on call out of hours 3. Review of Caesar list re admission point and post c/s destination *Walk in refers to a woman who presents in spontaneous labour 11 months of data has shown an average of 3 per day
Managing the flow in Birth Suite Colour Green Patients contained within unit and capacity for walk in s * Amber Capacity for walk in s Aim: To facilitate flow and ensure capacity in the birth suite Bed Actions Bed status - Status Ward 4 or more None required 4 or more available 3 2 south to use 219 or 220 last where possible Check bed status in maternity Look at next day discharges, admissions and on-air women Consider cancellation of non-essential inductions 2 3 Follow guidelines for managing bed capacity Red Patients contained within unit and delivered women accommodated in Birth Suite Black No capacity for walk in s 1-2 Amber + Liaise with IC 2 south Cancel non essential inductions (night duty - cancel at 0600) Utilise any available beds in maternity for woman in early labour Transfer early labouring or delivered women to assessment room, maternity sitting room or available bed in maternity Look at staffing in birth suite 0 Red + Liaise with IC 2 south re bed management Transfer early labouring or delivered women to assessment room, maternity sitting room or available bed in maternity Cancel all inductions (night duty to cancel at 0600) 0 1 Follow guidelines for managing red bed capacity 0 Follow guidelines for managing black bed capacity to 28 *Walk in refers to a woman who presents in spontaneous labour 11 months of data has shown an average of 3 per day
35 30 How do we look now? Maternity patients accommodated in maternity 25 20 15 Capacity Occupancy 10 5 0 Jun Jul Aug
Outcomes Sick leave reduced by 6% Annual leave planned and when the staff want it BPA 97% staff engagement Medibank Maternity Experience Index Ranked 2 nd Nationally
The patient experience Press Ganey SECTION FROM TO Staff worked together to care for you 79.4 92.3 Likelihood recommending hospital 86.7 94.6 Overall rating of care 84.6 92.8
What have we learned? Understand the problem you are trying to solve Ask why? Communicate and engage staff Influential leadership Visual displays Open conversations with the multidisciplinary team Recruit champions it can t be done alone Celebrate the successes
Celebrate the successes