1. Department of Human Services Promoting patient care through effective patient flow System wide implementation January – July 2005

2. Promoting patient care through effective patient flow System wide implementation January – July 2005 This guide is for Health Services to assist with key innovations which will make organisational wide improvements for patient access. It has been designed to highlight the key innovations which will promote and improve patient access. The toolkit has been formatted as a check list, to enable a planned, system-wide implementation of improvements between January and June 2005. Additional resources to support the innovations are available in the Patient Flow Change Package. For further information on the Patient Flow Collaborative, please visit www.health.vic.gov.au/patientflow Introduction

3. Promoting patient care through effective patient flow System wide implementation January – July 2005 Hospital executive and leadership staff working with common vision and purpose to achieve improved patient flow Agree on governance and vision to improve patient flow Systems that focus on the patient and their journey through service facilities Patient flows that are free of unnecessary delays Patient flow that meets or exceeds user expectation in quality, safety and access. Clear responsibility and accountability within hospitals for efficient patient flow management systems Governance and vision

4. Promoting patient care through effective patient flow System wide implementation January – July 2005 Flow management system and demand indicatorsImplemented Plan completed to implement by July 05 Tracking systems will measure demand load and reasons for patient flow delays (eg via the PFC web tracker). Demand load and system delays will be communicated in real time within hospitals to executives, bed management and clinical staff Hospitals will implement policy endorsed action plans for demand overload situations, or for unacceptable delays Emergency department Emergency departments will implement patient streaming strategies to improve all patients’ throughput times and to decrease emergency department congestion and waits ImplementedPlan completed to implement by July 05 Discharged patients will be managed through fast-track and specific care streams Admitted patients will have appropriate and timely decision- to-admit facilitated by Emergency Physician oversight and receiving unit engagement

5. Promoting patient care through effective patient flow System wide implementation January – July 2005 Length of stay management is the key to effective and efficient patient accessImplemented Plan completed to implement by July 05 Simple delay tracking systems on each unit/ ward to allow delay free patient care will be implemented Standard care bundles for admission & discharge planning will promote proactive length of stay management Executive grand rounds will occur as needed and will identify possible constraints to inpatient flow, and emphasise efficient systems and processes for delay reduction Length of stay

6. Promoting patient care through effective patient flow System wide implementation January – July 2005 Effective whole system inpatient managementImplemented Plan completed to implement by July 05 Bed management systems that have an overview of admissions, length of stay and discharge will be promoted Executive support for bed managers will be clearly defined Predicted bed requirements for daily emergency access will be an integral part of daily bed management meetings and access planning Elective patient access will balance known and predictable emergency patient needs Bed management

7. Promoting patient care through effective patient flow System wide implementation January – July 2005 Promoting best use of surgical capacityImplemented Plan completed to implement by July 05 Day case surgery will become the default preference for elective throughput. Hospitals will review same day surgery practices and agree progressively increasing targets with each clinical service. Targets for increased same day surgery will be monitored weekly Day of Surgery admission will become the norm. Variance will be tracked and audited Same day surgery

8. Promoting patient care through effective patient flow System wide implementation January – July 2005 Managing patients elective surgical waitsImplemented Plan completed to implement by July 05 Audit and validation should be completed via telephone every two months to maintain a live elective surgical waiting list and promote care of the patients waiting Systems and policy for waiting list removals due to patient choice should be followed Clinical validation of available surgical procedure should be made. Any patient who is waiting for an unavailable clinical procedure should be identified and an action plan made after advice and discussion with the Hospital Demand Management team, Department of Human Services Waiting list management

9. Promoting patient care through effective patient flow System wide implementation January – July 2005 Acknowledgements Jenny Bartlett Chief Clinical Advisor, Office of the Chief Clinical Advisor Lee Martin Manager, Clinical Innovation Agency Director, Patient Flow Collaborative Marcus Kennedy Clinical Lead, Patient Flow Collaborative Patient Flow Collaborative Team Rochelle Condon, Improvement Lead Ruth Smith, Improvement Lead Fiona Dickson, Improvement Lead John Walker, Communications and Logistics Lead Prue Beams, Data Analyst

10. Promoting patient care through effective patient flow System wide implementation January – July 2005 Contacts Support to implement these system wide initiatives is available via the Patient Flow Collaborative team who can be contact via: Clinical Innovation Agency Email:cia@dhs.vic.gov.au Phone:9616 7022 Patient Flow Collaborative Team Lee Martin9616 7859 Manager, Clinical Innovation Patient Flow Collaborative Director Rochelle Condon 9616 9026Improvement Lead Ruth Smith9616 9025Improvement Lead Fiona Dickson9616 9030Improvement Lead Prue Beams 9616 7742Data Consultant John Walker9616 9037Communications and Logistics Lead