Making Numbers Real: The discharge journey

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Making Numbers Real The discharge journey

• Tania Geyer, Di Norris, Liz Prowse
• Noarlunga Health Services
• (now part of Southern Mental Health, SA)

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NUMBERS (blah blah blah)
KPI 9
KPI 12 65
KPI 8 50
KPI 3 27

• KPI 5 N/A

KPI 11 mc2
KPI 2
KPI 7 5
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KPI 12 Follow-up within 7 days of discharge

• Why focus on this indicator?
• An across service indicator (involves inpatient
  and community)
• Clinical relevance
• We didnt seem to be very good at it
• Tapped into a number of processes around
  discharge and transfer of care

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Baseline Rates of Follow-up
Us 48
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Identified Need of Attention from Benchmarking
Results

• Its a clinical problem not just a number!
• High time of risk
• Consumers falling through the gaps
• Missing link between inpatient and community
  follow-up
• Communication issues
• Links with other KPIs length of stay and 28
  day readmission

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What did we do?

• Discussion/communication with Team Leaders and
  clinicians
• Working group with significant buy-in from
  inpatient and community with project support
• Recognition and understanding of the KPI and
  clinical implications
• Focus on the KPI measuring the consumer
  experience of discharge

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Development of procedure

• Developed by working group high level of
  engagement from teams
• Move into line with general health follow-up,
  e.g. phone call day after surgical discharge
• Examples of procedure points
• Inpatient
• Confirm follow-up with consumer
• Document actions on discharge checklist and
  journey board
• Make contact and complete documentation
• Community
• Inpatient admission report become part of morning
  handover
• Confirm nature of discharge contact

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Implementation and Roll-out of procedure

• Paper based collection initially
• Enhancement of computer system to collect
  contacts made by inpatient staff to discharged
  consumers
• Training
• Recommendation to change the KPI to collect any
  contact made within 7 days
• Examining and improving discharge/transfer of
  care practice inpatient Journey Boards

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Journey Board - Goals

• Make the Consumers Journey visible to the whole
  team by using visual management techniques
• Introduce a standardised communication tool in
  all Southern Mental Health units
• Improve communication between inpatient wards and
  the community teams
• Facilitate making barriers to the journey visible
• Collect data regarding real barriers rather than
  perceived barriers to improve treatment and
  discharge plans

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Baseline Rates of Follow-up
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Referral Triangles
3. When the Psychologist, SW or OT has seen the
Consumer

• 1. When SW/Psychologist/OT was needed

2. When referred to SW/Psychologist/OT
21/7
21/7
23/7
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Referral Triangles - System

• Process Only rub out referral triangle if you
  need to re-refer.

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Evaluation Summary
A total of 133 surveys were distributed to both
inpatient andcommunity staff SMH, 81 surveys
were returned for a 61 response rate.
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Evaluation cont..

• SMH staff showed a positive response with 65
  agreeing that they would encourage other areas to
  implement journey boards, 23 were unsure or
  stated the question was not applicable and only
  12 disagreed.)

• (95 of the general hospital staff surveyed were
  enthusiastic about encouraging other areas to
  implement journey boards only 2 disagreed 9
  were unsure)

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Evaluation cont..

• Comments from General and MH Staff
• Easy access to information
• Keeps control of work load
• Gives a snapshot and an overall picture of
  journey
• Identifies the allocation of workload

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3 Year Comparison
Us 48 to 59 to 68
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And

• Monthly monitoring, by each site and as a region
• Adding collection to residential rehab. centre
• Closing the loop/following up
• Further system enhancements, e.g. new discharge
  screen

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Acknowledgements

• Journeyboarders particularly Anna Szynkar and
  Denise Wright (Flow Coordinators)
• Inpatient and community staff of Southern Mental
  Health, in particular those based at Noarlunga
• Information and project staff
• Consumers and carers of our service
• All Adult Benchmarking participants

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