Supporting Life After Stroke Collaborative Working group members: Katrina Moles Pamela Baines Amanda Shapleski Francie Birch Deidre Gough Jacqui Hooper Joy Castro Jill Grieve Michele Moore Raewyn Maguire Alison Howitt Stephanie Easthope Penny Wilkings PDSA Learning's

By 1st July 2014 we will:  reduce the average length of stay for patients with mild to moderate stroke transitioning home to Manukau, Papakura, Manurewa, Takanini and Mangere by 4 days  improve patient functional outcomes (different measures are being tested)  attain a patients satisfaction response of more than 90% The Supporting Life After Stroke collaborative aims to provide a new community-based, specialist rehabilitation service for people with stroke in their own homes rather than in hospital. This will enhance patient experience, speed recovery and improve quality of life for our patients. Aim Statement

PDSA Tree – Supporting Life After Stroke – Page 1 Version Control Date: 11/11/2013 Owner: SLAS Working Group Folder: W:\20,000 Days Campaign\Phase 2\Collaborative - Supporting Life after Stroke\3.1 PDSA Tree Key Adopt Adapt Abandon What next? Testing Change IdeasPDSA’s 2.3 Test timing of using WiMs list Kat Discharge to CBRT Identify eligible patients on acute ward 2.1 Use WiMs list to identify pts Kat 2.2 Attend acute ward MDT to identify stroke severity Deirdre Define patient readiness for discharge criteria 1.1 Schedule community rehab appointments at triage Kat In hospital rehabilitation needs assessment 3.1 Conduct assessment on ward 3.2 Conduct assessment on ward with referral 3.3 Conduct assessment on ward with referral for patient with speech therapy needs Joy 4.1 Current use of discharge planning checklist Jacqui Home visit 5.1 Assess difference between ward OT and community OT home visit assesmtAmanda 3.4 Conduct assessment on ward for first test ESD patient Amanda 1.3 Sort patient list in order of most recent GDD Kat 2.4 Analyse frequency of patients coming from outlier wards Steph 3.5 Complete Gen assessment on ward, follow up with red pen at home visit. Jill 3.6 Team Handover before and after general assessment. 3.7 Team Handover Before General Assess Deirdre 2.5 Test standardised process with different people Kat 2.6 Visit Ward 6 MDT twice a week Kat 3.8 Face to Face General Assessment After Handover Jill 3.9 Discipline-specific handover Amanda 4.2 Test ESD Criteria Checklist with ward 23 Amanda 1.4 Early discharge of ESD patient to CBRT Joy 1.5 Care plans to help CBRT discharge planningKat/Jo Resource Scheduling 1.2 Filter patients by GDD Kat Review ESD eligible patients on Ward 23 for acceptance 9.1 Patient Identification Magnets Raewyn/Alison

PDSA Tree – Supporting Life After Stroke – Page 2 Key Adopt Adapt Abandon What next? Testing Transition from ESD to CBRT 7.1 Joint CBRT/ESD patient visit Deidre Change IdeasPDSA’s Design model of care 6.1 First patient same-day follow up phone call Francie 6.2 Medications able to be collected day before discharge Raewyn 6.3 Test ESD model of care (first patients) Pamela 6.4 Take patient to GP before discharge from ESD Francie 6.5 Follow up phone call from other discipline (test under different conditions) Deirdre Functional Measures 8.1 Trial of functional measures Michelle Version Control Date: 11/11/2013 Owner: SLAS Working Group Folder: W:\20,000 Days Campaign\Phase 2\Collaborative - Supporting Life after Stroke\3.1 PDSA Tree 31 PDSAs completed or underway! “Shall we PDSA it?”

Changes we have tested…. Change Idea# PDSAs Outcome 1 Identify eligible patients while still on the acute ward 6 After multiple tests it was found that a combination of the WiMs list and attending the acute ward MDT meetings was enough to identify patients who are eligible for ESD while still on the acute ward 2 Determine in-home rehabilitation needs while still in hospital 9 Co-ordinating a handover between inpatient staff and ESD staff is challenging, with many disciplines involved in each patients care. Current PDSA is testing discipline-specific handovers 3 Improve the patient experience in transitioning between services 4 Successful tests of change have included: 1.Organising collection of patient’s personal medications before they are discharged, and 2.Taking them to visit their GP before leaving the ESD service 3.Follow-up phone call on day of discharge

PDSA Fun! Plan Staying focussed on your objective and/or change idea – side tracked Working with someone else – asking what are we doing? Fill out the paperwork properly so predictions mean something! Do Collect all relevant data – capture thoughts to one side Study Great when your predictions are wrong - learn more Being careful not to generalise before you have tested with others Act Used structured reporting back– enlisting others wisdom

PDSA Fun! Reflections Everyone giving it a go Working together, drawing on the diversity of the group and individual ownership Clearly documenting is vital – so you know what you mean later Initially so foreign; process of documenting – PDSA flow – makes sense Just give it a go – no PDSA is perfect, don’t get hung up ……“all becomes more obvious afterwards “ Chance to be able to try different options – don’t have to adopt it!

PDSA 4.2 Objective – Obtain essential discipline specific information for new clients to the ESD team. PLAN Change Idea – Complete face to face handover meeting with ESD team and the ward clinicians. Questions – How many of the clinicians involved in the patients care were able to attend the meeting? (% of total) How long does the meeting take? How time consuming is it to arrange the meeting? How is the information recorded, by whom and where is it kept? What % of clinicians prefer a face to face handover (rather than a written referral)?

PDSA 4.2 Predictions – 100% of clinicians involved in patient care will attend the meeting. The meeting will take approximately 15 minutes. The handover meeting will be easy to arrange (take < 15 min). Information to be recorded by the ESD team. 100% of clinicians will prefer face to face handover option. Do Meeting was lacking structure, discussion jumped around. Amanda jotted down notes but there was no consistent way to capture the meeting outcomes. An excessive amount of time was spent trying to arrange the handover meeting. Additional information was received from talking directly.

PDSA 4.2 Study 100% of clinicians involved in patient care attended the meeting. Meeting took 15 minutes which was expected. It took 1 hour over a 12 hour work period to arrange the handover meeting. This was due to number of people that needed to attend and differing schedules between in patient and community services. Information was recorded by the ESD team member but there was no formal way to document. All 8 of the clinicians who attended the meeting found the face to face handover helpful (and preferable) but commented on the challenges of all meeting at the same time.

PDSA 4.2 Act Adapt.1 Trial use of template to record information. Trial one to one discipline specific handovers. Adapt.2 (current) Modify template and continue to use. Trial fixed weekly handover meeting. Use one to one discipline specific handovers in addition when notable change in patient has been observed post handover meeting. Reflection Through a ramp of PDSA’s, a change idea can evolve that will achieve the objective of the original PDSA. What seemed simple at the beginning is where difficulties arose and the most learning was gained. Sharing the PDSA has been valuable as others contribute ideas and learning's. Questions needed to be specific