Enhanced Multidisciplinary Care project

1
Enhanced Multidisciplinary Care project

• Sue Laracy
• Internal Medicine Services and
• Allied Health Professionals
• Royal Brisbane and Womens Hospital

2
Access / Bed Management issues

• MAPU
• Summer/ Winter Bed Management Model
• Process mapping
• Utilisation review Barriers to discharge
• 30 internal to the Division
• 30 external to the Division
• 30 external to RBWH

3
(No Transcript)
4
(No Transcript)
5
(No Transcript)
6
Frailty criteria2 or more of

• ADL dependence
• Difficulty walking
• History of falls
• Stroke within 3/12
• Unplanned admission within 3/12

• Dementia
• Depression
• Incontinence
• Malnutrition
• Prolonged bed rest

Cohen HJ, Feussner JR, Weinberger M et al. NEJM
2002346905-12
7
Care complexity
PHYSIOTHERAPIST
MEDICAL TEAM
OCCUPATIONAL THERAPIST
NURSES
DISCHARGE FACILITATOR
DIETITIAN
SOCIAL WORKER
SPEECH THERAPIST
8

• Multidisciplinary teams

• Discharge planning

Reduced LOS Improved functional status Less
discharge to residential care Improved provider
satisfaction
Reduced LOS ?Reduced readmissions Improved
patient satisfaction
Curley C et al. Medical Care 1998 Landefeld S et
al. NEJM 1998
ParkesJ, Shepperd S. Cochrane Library 2002
9
RBWH 2001/2002

• Multidisciplinary teams

• Discharge planning

Ward vs unit basis MAPU vs ward
staffing Fragmented allied health staffing Poor
communication
Delayed premorbid assessment Delayed
referrals Poor communication
10
The Problem
Complex care needs Hospitalist approach Attendance
at MDT meetings inconsistent Organisation of
services inconsistent Staffing of allied health
inadequate
11
The Hypothesis
Re-engineering of the processes of care could
lead to reduced length of stay without
increased readmissions ? reduced hospital use
over 6 months cost-effective strategy
12
The Model

• Improve team processes
• Early assessment of patient needs
• Mandated daily MDT meetings
• Consistent, coordinated team

13
The EMC model

• Team organisation changes
• consistent membership
• unit-based care
• increased resourcing
• Work practice changes
• early patient assessment
• regular meetings
• specified discharge date

14
PHYSIO
OT
SOCIAL WORK
NUTRITION
SPEECH
15
Performance indicators

• acute LOS, patient days
• readmissions 30 day and 6 month
• functional status
• discharge destination
• death and nursing home (6 months)
• allied health use patterns
• staff feedback
• medical officer overtime

16
Results bed day savings
1927 BED DAYS IN 9 MONTHS (7 BEDS PER DAY)
EMC
17
Results acute LOS reduction
AVERAGE ACUTE LOS REDUCED FROM 7.35 DAYS TO 6.7
DAYS
EMC
18
Cumulative readmission numbers
EMC start
19
Functional status at discharge
20
Discharge destination
21
Allied health utilisation
22
Staff feedback-positives

• Increased meeting time balanced by increased
  efficiencies eg not paging staff
• Prompter, more appropriate referrals
• Improved workload sharing between disciplines
• Improved understanding of other disciplines
• Sense of shared goals in care

23
Acute LOS effects
24
Costs and savings

• COSTS
• AH staff 120,248
• Project nurse 50,000
• 184 per patient

• SAVINGS
• Medical bed day 231
• Mean saving 1.4 days over 6 months
• 324 per patient

Potential savings of 560,000 /year
25
Patient and staff outcomes

• Patients
• Better access to allied health services
• Reduced functional decline in hospital
• Improved health perceptions
• Reduced time in hospital
• Staff
• High satisfaction
• Improved workload management

26
Internal Medicine Model of Care

• EMC model implemented across 4 Units
• BETTER Model rather than Best Model
• Enhanced AHP resourcing 10.4 FTE
• Multi Disciplinary Quality programme