Delivery System Redesign Chilliwack Clinic

1
Delivery System RedesignChilliwack Clinic

• The Team
• Receptionist/MOA
• RN
• Dietician
• Pharmacist
• MD discussion with patient about CDM
• Appointments arranged monthly
• Clinics twice per month

2
Patient flow through office
Patient registers at front desk fills out
questionnaire
MOA ushers patient to exam room and introduces
patient to RN, dietician, or pharmacist
RN spends ¾ hr with patient while MD sees
other patients
MD speaks with RN about patient visit
and reviews chart of next patient with RN
Patient is ushered to an alternate exam room and
fills out 5 min. questionnaire
MD sees patient for last 10 min. of 1 hr appt.
Patient returns to front desk to book follow-up
appointment
3
Readiness to Learn

• How involved do you think you should be?
• Actively
• Totally
• Very Much
• 100
• I should be really involved with CHF
• As much as possible
• My life depends on it
• (3) Dont know

4
Registered Nurse

• PREPARATION
• Written teaching guide
• Prepared Patient Questionnaire Visit with RN
• Written PDSA cycle
• Resources obtained
• RESOURCES USED
• Heart Stroke Foundation Managing CHF booklet
• CHF guideline Patient Reminders/Resources sheet
• Canadian CHF Clinic Network Patient Info sheet

5
Registered Nurse

• SELF MANAGEMENT VISIT
• (individualized, unique, varied, complex)
• Reviewed Readiness to Learn QA
• ? Their experience with CHF
• ? Their interest in discussing CHF
• ? Their ability to recognize SS of CHF
• Talked about AP and Symptom management concept
• Opportunity to address questions/concerns
• Offered resources and follow-up options
• Patient questionnaire

6
Registered Nurse

• CLIENT FOLLOW-UP
• Physician immediately after RN visit
• Dietician
• Pharmacist
• PDSA CYCLE
• Nurse educator self assessment
• Review responses to Patient Questionnaire

7
Dietitian

• PREPARATION
• individual appointments time and process
• RESOURCES USED
• Nutrition Data Form
• Sodium and Fluid Restriction Handouts
• Other Nutrition Handouts

8
Dietician

• WHAT TO EXPECT
• co-morbidity and dietary complications
• family support
• keen interest to improve diet
• restaurant eating issues
• grocery buying and label reading

9
Dietitian

• FOLLOW-UP
• Individual
• Mail outs
• Grocery Store Tour

10
Pharmacist

• PREPARATION
• Letter to community pharmacists
• Initial/follow-up assessment forms
• Medications calendar
• Pharmanet/chart review
• RESOURCES
• Heart Stroke Foundation (patient)
• CHF literature/practice guidelines

11
Pharmacist

• WHAT TO EXPECT
• Patient education (CHF/medications)
• Co-morbid conditions/medications
• Goals/monitoring/outcome of therapy
• Compliance
• Side effect management
• Herbal/OTC therapy

12
Pharmacist

• FOLLOW-UP
• Phone call follow-up
• medication additions/changes
• adverse effects/side effect management
• questions/concerns
• Contact information provided
• Follow-up assessment form sent to clinic

13
Assessment

• Patient assessment
• RN, dietician and pharmacist assessment
• MD assessment

14
Patient AssessmentRN visit
 
 
15
Patient AssessmentDietician
 
16
Patient Assessment -Pharmacist
 
 
17
Team Member Assessment

• Enjoyed the change from daily routine
• Scheduling by Receptionist a bonus
• Direct communication with the Family MD
• Felt appreciated by the patients
• Would do it again
• Would recommend it to other colleagues
• But RNs, dieticians pharmacists are in short
  supply

18
MD Assessment

• Enjoyed working as a team
• High quality team members
• Able to provide a needed service
• Works better with my schedule if there are extra
  exam rooms
• Appreciated by the patients
• Results in better health outcomes
• Would recommend it for other MDs to try

19
Results

• Reduced hospital admissions (N35)
• First 4 months 36 reduction
• Second 4 months 57 reduction
• 2/3 year 46 reduction

20
Sustainability and Spread

• Cost analysis saved hospital admissions
• Will depend on quality team members being
  available
• Only one of many models of delivery system
  redesign one model will not fit all