Working together and good data deliver significant improvements in Bay of Plenty

Staff from all services at Tauranga and Whakatane hospitals have worked together to implement changes that have resulted in improvements to the quality and safety of the patient journey through both hospitals.

For the three months from November 2011 to January 2012, the DHB has maintained a much improved performance against the ‘Shorter stays in emergency departments’ health target.

Over the same period, the hospitals cared for 875 more acute patients while maintaining bed utilisation at 2008 levels. Forty-four beds at Tauranga hospital were able to be kept closed, allowing more staff to take leave over the summer school holiday period.

There have also been improvements in the number of patients discharged by 11am and at the weekend.

As well as the willingness of staff to work together, key to the success of the changes was establishing an integrated operations centre (IOC) that provides oversight of flow in the hospital and helps staff match capacity to demand.

DHB Project Analyst, Philippa Edwards, says the IOC is based on operational management principles of forecasting, planning, demand-capacity matching and system-wide thinking. It is similar to that used by Air New Zealand.

‘The IOC provides visibility of our day-to-day status and allows us to see all parts of both Tauranga and Whakatane Hospitals at the ward, emergency department (ED) radiology and theatre levels. It’s very data driven, allowing staff to see when parts of the hospital are experiencing strain.

‘The focus is on learning from yesterday, managing today and planning for tomorrow, and the forecasting and planning tools, developed in-house, help staff assess where to reallocate resources to alleviate bottlenecks.’

Operations staff from the resident medical officers’ unit, the nursing and administration bureaux, hospital support services, emergency managers and the hospital co-ordinator were also co-located as part of the changes.

‘It’s meant a different type of thinking has come about. There’s far less need for double checking information, and things that used to take us all day to sort out between different areas of the hospital are now resolved in a few minutes,’ says Ms Edwards.

The hospitals’ status-at-a glance, updated every 12 minutes, is displayed on large screens and through the DHB’s intranet.

‘It details the status of every bed in the hospital, including those in the ED, what’s happening in radiology, elective surgery bookings, what’s happening in each operating theatre, and the patients to be discharged that day. And it all unfolds on the screens in real time.

‘This provides us with organisation-wide visibility, and more transparency, understanding and awareness between departments. Scheduled work is visible to everyone so exceptional circumstances are identified early and key groups can have informed conversations when problems need to be sorted.’

A daily operations meeting is held at 11.30am that also includes staff from radiology, support services and allied health.

Hospital-wide standard operating procedures have been developed based on the acute patient journey. ‘These are kept handy in the IOC and referred to often,’ says Ms Edwards.

When there’s a mismatch between capacity and demand, a variance response management (VRM) tool provides a framework and context for care capacity decision-making.

Hospital Co-ordinator, Julie Williams, says the VRM shows up variations on what was expected for the day, and when there are target breaches, live information is used to work out what’s gone wrong and what needs to be done for the rest of the day to minimise it. ‘It also gives us live evidence and monitoring of changes we put in place.

‘An ED barometer tells us both what we expected to happen and what’s actually happening,’ says Ms Williams. ‘The colour changes if there are surges in ED presentations, which gives managers a ‘heads up’ that there will be more bed requests to be managed for patients being admitted from the ED.’

A ‘transit lounge’ was also established in a surgical ward with spare capacity. It’s used by patients due for discharge who don’t need intensive nursing care, freeing up ward beds. ‘This has made an enormous difference in our ability to manage surge capacity and get patients out of wards earlier.’

Other initiatives include a trial of allied health staff – physiotherapists, occupational therapists and social workers – being available on the weekends, and starting phlebotomy (drawing blood) rounds earlier so results are received earlier, which encourages earlier discharges of patients from the ward.

 

Related items on HIIRC:

Bay of Plenty DHB's use of transitional beds in the community to free up hospital capacity

BoP DHB has one of the busiest emergency department's in NZ

Staff from Bay of Plenty DHB presented on this topic at the Shorter Stays in Emergency Departments Forum, held in Wellington on 26th March 2012. Their powerpoint presentation is attached below.