Transforming costing information HFMA 2018 SW Conference Steven Wainwright Jenny Richards

Complex Patient journeys Adult SALT Bone Health District Nursing Occupational Therapy Integrated Community Teams ‘Other’ services Community Physiotherapy Integrated Assessment & Discharge Team (IADT) Community Inpatients IV Therapy Minor Injury & Illness Unit Other Specialist Nursing Parkinson's & Motor Neurone Disease Podiatry Respiratory Services Tissue Services Urgent Care services Patient 1 77 year old with COPD Patient 2 83 year old with MND Patient 3 78 year old with Diabetes Patient 4 65 year old End of Life Patient This data has given us the power as a Trust to see how our patients are using our services, and how our services interact with one another. For very convoluted patient journeys, pathway data has prompted patient audits Particularly interested in patients using our Rapid Response service – indicates a crisis Presented at monthly Trust-wide management meeting Number of Contacts / Bed Days by service over a 12 Month period

Timeline Patient Journey – Patient 3 Patient journeys over a timeline are providing insightful information as to exactly how services are interacting with one another, and through our links with the Acute Trust through our Integrated Assessment team and data from our Single Point of Clinical Access service, we are able to identify in many cases where patients are admitted to the Acute Trust and then are handed back to the Community Trust. All these services being deployed – is this patient being managed across all services?

Patient Pathway Audit for Transformational Change We’re able to highlight patients that should be included within patient pathway audits, highlighting what went well in the patient’s care, what could have been better and what is required for a transformed approach

Variation in Diabetes District Nurse Contacts by Band Diabetes District Nursing Contacts by Band by locality Cheltenham Cotswolds Forest of Dean Gloucester Stroud Not only do we have patient-level information, but we have significant clinician information as well. We have the information to start questioning clinical variation, to identify and start to eliminate unwarranted variation. Not only this, we now have the ability to start to look at the structure of episodes of care, in the case of DN this will be used to understand how the new B4 Nursing Associate role can fit into the episode of care, and indeed to inform workforce planning.

How we got here and where we’re heading Creative, flexible, iterative approach Excellent joint project approach with Informatics team The Next Phase Outcome Measures BAU use of data by Operations Management to highlight and eliminate unwarranted variation, inform CIP, transform patient pathways