20,000 Days Campaign Storyboard Learning Session 3 11-12 March 2013
17
20,000 Days Campaign Storyboard Learning Session 3 11-12 March 2013 Healthy Hearts
description
Healthy Hearts. 20,000 Days Campaign Storyboard Learning Session 3 11-12 March 2013. Collaborative Team. Clinical Lead: Key Contacts: Project Manager: Clinical collaborative co-ordinator: Improvement Advisor: Decision Support:. Dr Mayanna Lund Andy McLachlan Dr Andrew Kerr - PowerPoint PPT Presentation
Transcript of 20,000 Days Campaign Storyboard Learning Session 3 11-12 March 2013
20,000 Days Campaign StoryboardLearning Session 3 11-12 March 2013
Healthy Hearts
Clinical Lead:
Key Contacts:
Project Manager: Clinical collaborative co-ordinator:
Improvement Advisor:Decision Support:
Dr Mayanna LundAndy McLachlan Dr Andrew Kerr June PooleKatherine McLeanDr Tim SuttonLeanne ElderSitela VimahiSosefo TeuDevi Ann HallAlison HowittSarah MooneyIan HutchbyTanesha Patel & Eric Cuvea
Collaborative Team
Aim
• To improve cardiovascular health in the CMDHB population, across the continuum of care, by July 2013 by:
– Reducing readmission rates from Congestive Heart Failure by 20%
– And increasing the uptake of cardiac rehabilitation rates by 10%
– And Improve access to inpatient Echo and catheter testing so that 70% appropriate referrals are seen within clinically agreed timeframes
Change Packages – Heart Failure Pathway
Change Packages
2o Drivers(Theory of change)
Change Ideas Tested
Describe Process
Early Diagnosis Using lab test taken in ED
Review BNP results for Early Identification of new Heart Failure Patients
Early Diagnosis Hand Held Echo Use Hand Held Echo to confirm underlying heart disease, enabling treatment plan to be initiated early.
Appropriate & tailored care
Multi-disciplinary wards rounds.
Includes, Cardiologist (with Hand Held Echo) and Nursing team to initiate integrated care package.
Change Packages
2o Drivers(Theory of change)
Change Ideas Tested
Describe Process
Consistency of Care
Heart Failure Care Bundle
• Heart Failure Diagnosis• Patient information and Education
(taking Control)• Medicine management• Self Management Plan
Cultural Support •Patient understanding (language)•Patient information and Education•Reduced barriers to self-management
Post Discharge Follow Up Phone call to support patient and identify problems early
Change Packages
2o Drivers(Theory of change)
Change Ideas Tested
Describe Process
Titration Clinics • Nurse led titration clinics to increase capacity.
Heart Failure Rehabilitation
• Provide Patient Information, Education and Exercise to support patient self management.
Combined HH & BB Rehabilitation
Use community based resources to develop programmes.
Healthy Hearts CNS Dashboard
Version 1 – 10th March 2013
Number of new patients seen by the nurse specialist
0
1
2
3
4
5
6
7
8
24/0
9/20
12
01/1
0/20
12
08/1
0/20
12
15/1
0/20
12
22/1
0/20
12
29/1
0/20
12
05/1
1/20
12
12/1
1/20
12
19/1
1/20
12
26/1
1/20
12
03/1
2/20
12
10/1
2/20
12
17/1
2/20
12
24/1
2/20
12
31/1
2/20
12
07/0
1/20
13
14/0
1/20
13
21/0
1/20
13
28/0
1/20
13
04/0
2/20
13
11/0
2/20
13
18/0
2/20
13
25/0
2/20
13
04/0
3/20
13
Week commencing
Number of BNP tests done (new patients)
0
1
2
3
4
5
24/0
9/20
12
01/1
0/20
12
08/1
0/20
12
15/1
0/20
12
22/1
0/20
12
29/1
0/20
12
05/1
1/20
12
12/1
1/20
12
19/1
1/20
12
26/1
1/20
12
03/1
2/20
12
10/1
2/20
12
17/1
2/20
12
24/1
2/20
12
31/1
2/20
12
07/0
1/20
13
14/0
1/20
13
21/0
1/20
13
28/0
1/20
13
04/0
2/20
13
11/0
2/20
13
18/0
2/20
13
25/0
2/20
13
04/0
3/20
13
Week commencing
Number of new patients identified in the CNS book
0
2
4
6
8
10
12
24/0
9/20
12
01/1
0/20
12
08/1
0/20
12
15/1
0/20
12
22/1
0/20
12
29/1
0/20
12
05/1
1/20
12
12/1
1/20
12
19/1
1/20
12
26/1
1/20
12
03/1
2/20
12
10/1
2/20
12
17/1
2/20
12
24/1
2/20
12
31/1
2/20
12
07/0
1/20
13
14/0
1/20
13
21/0
1/20
13
28/0
1/20
13
04/0
2/20
13
11/0
2/20
13
18/0
2/20
13
25/0
2/20
13
04/0
3/20
13
Week commencing
Number of new patients recevining a hand held echo
0
1
2
3
4
24/0
9/20
12
01/1
0/20
12
08/1
0/20
12
15/1
0/20
12
22/1
0/20
12
29/1
0/20
12
05/1
1/20
12
12/1
1/20
12
19/1
1/20
12
26/1
1/20
12
03/1
2/20
12
10/1
2/20
12
17/1
2/20
12
24/1
2/20
12
31/1
2/20
12
07/0
1/20
13
14/0
1/20
13
21/0
1/20
13
28/0
1/20
13
04/0
2/20
13
11/0
2/20
13
18/0
2/20
13
25/0
2/20
13
04/0
3/20
13
Week Commencing
Patient journey
Patient story: 66 year old female on W2
Patient journey
PDSA tree
PDSA tree
Run charts
Most Successful PDSA Cycles?
Measures Summary
• Dashboard (Re-admissions, Admissions and LoS)
• Interventions– Numbers hand held echo’s and outcomes– Management plans completed– Follow up phone calls completed– Patient completing titration clinic– Specialist clinics – patient numbers– Identification of patients with heart events– Numbers of patients attending/completing Rehab– Wait times for cardiac diagnostics – Non Coronary Care pts with positive biomarker
Version: 1.1Dated: 11/02/2013
20,000 Days Healthy Hearts Dashboard
January 2013
Contacts Improvement Advisor: Ian HutchbyDecision Support Analyst: Tanesha Patel/Eric Cuerva
ALOS for Chronic Heart Failure patients is predominantly showing normal variation
Monthly volumes for Chronic Heart Failure patients are unstable and shows some element of seasonality
Monthly Volume of Patients with CHF as primary diagnosis
UCL
CL
LCL
40.0
60.0
80.0
100.0
120.0Ja
n 20
10
Feb
201
0
Mar
201
0
Apr
201
0
May
201
0
Jun
2010
Jul 2
010
Aug
201
0
Sep
201
0
Oct
201
0
Nov
201
0
Dec
201
0
Jan
2011
Feb
201
1
Mar
201
1
Apr
201
1
May
201
1
Jun
2011
Jul 2
011
Aug
201
1
Sep
201
1
Oct
201
1
Nov
201
1
Dec
201
1
Jan
2012
Feb
201
2
Mar
201
2
Apr
201
2
May
201
2
Jun
2012
Jul 2
012
Aug
201
2
Sep
201
2
Oct
201
2
Nov
201
2
Dec
201
2
Nu
mb
er o
f P
atie
nts
ALOS for patients with primary diagnosis of CHF
UCL
CL
LCL
2
3
4
5
6
7
8
9
Jan
2010
Feb
201
0
Mar
201
0
Apr
201
0
May
201
0
Jun
2010
Jul 2
010
Aug
201
0
Sep
201
0
Oct
201
0
Nov
201
0
Dec
201
0
Jan
2011
Feb
201
1
Mar
201
1
Apr
201
1
May
201
1
Jun
2011
Jul 2
011
Aug
201
1
Sep
201
1
Oct
201
1
Nov
201
1
Dec
201
1
Jan
2012
Feb
201
2
Mar
201
2
Apr
201
2
May
201
2
Jun
2012
Jul 2
012
Aug
201
2
Sep
201
2
Oct
201
2
Nov
201
2
Dec
201
2
Day
s
Number of patients with primary diagnosis of ACS
UCL
CL
LCL
60
70
80
90
100
110
120
130
140
150
Jan
2010
Feb
201
0
Mar
201
0
Apr
201
0
May
201
0
Jun
2010
Jul 2
010
Aug
201
0
Sep
201
0
Oct
201
0
Nov
201
0
Dec
201
0
Jan
2011
Feb
201
1
Mar
201
1
Apr
201
1
May
201
1
Jun
2011
Jul 2
011
Aug
201
1
Sep
201
1
Oct
201
1
Nov
201
1
Dec
201
1
Jan
2012
Feb
201
2
Mar
201
2
Apr
201
2
May
201
2
Jun
2012
Jul 2
012
Aug
201
2
Sep
201
2
Oct
201
2
Nov
201
2
Dec
201
2
Nu
mb
er o
f P
atie
nts
Monthly volumes for ACS patients are stable and exhibit normal variation only
Average Length Of Stay for patients with a primary diagnosis of ACS
UCL
CL
LCL
2.5
3.5
4.5
5.5
6.5
7.5
Jan
2010
Feb
201
0
Mar
201
0
Apr
201
0
May
201
0
Jun
2010
Jul 2
010
Aug
201
0
Sep
201
0
Oct
201
0
Nov
201
0
Dec
201
0
Jan
2011
Feb
201
1
Mar
201
1
Apr
201
1
May
201
1
Jun
2011
Jul 2
011
Aug
201
1
Sep
201
1
Oct
201
1
Nov
201
1
Dec
201
1
Jan
2012
Feb
201
2
Mar
201
2
Apr
201
2
May
201
2
Jun
2012
Jul 2
012
Aug
201
2
Sep
201
2
Oct
201
2
Nov
201
2
Dec
201
2
Day
s
Average Length Of Stay for ACS patients is stable and exhibits normal variation only
ACS Readmission Rate
CL
UCL
0%
2%
4%
6%
8%
10%
12%
Jan
2010
Feb
201
0
Mar
201
0
Apr
201
0
May
201
0
Jun
2010
Jul 2
010
Aug
201
0
Sep
201
0
Oct
201
0
Nov
201
0
Dec
201
0
Jan
2011
Feb
201
1
Mar
201
1
Apr
201
1
May
201
1
Jun
2011
Jul 2
011
Aug
201
1
Sep
201
1
Oct
201
1
Nov
201
1
Dec
201
1
Jan
2012
Feb
201
2
Mar
201
2
Apr
201
2
May
201
2
Jun
2012
Jul 2
012
Aug
201
2
Sep
201
2
Oct
201
2
Nov
201
2
Dec
201
2
% R
ead
mit
s
The Readmission rate for ACS patients is stable and exhibits normal variation only
Readmission rate for patients with a primary diagnosis of CHF
CL
UCL
0%
2%
4%
6%
8%
10%
12%
14%
16%
18%
Jan
2010
Feb
201
0
Mar
201
0
Apr
201
0
May
201
0
Jun
2010
Jul 2
010
Aug
201
0
Sep
201
0
Oct
201
0
Nov
201
0
Dec
201
0
Jan
2011
Feb
201
1
Mar
201
1
Apr
201
1
May
201
1
Jun
2011
Jul 2
011
Aug
201
1
Sep
201
1
Oct
201
1
Nov
201
1
Dec
201
1
Jan
2012
Feb
201
2
Mar
201
2
Apr
201
2
May
201
2
Jun
2012
Jul 2
012
Aug
201
2
Sep
201
2
Oct
201
2
Nov
201
2
Dec
201
2
Rea
dm
issi
on
Rat
e
The Readmission rate for CHF patients is stable and exhibits normal variation only
Number of successful phone calls per week
UCL
CL
0
2
4
6
8
10
12
14
16
18
20
18/0
6/20
12
09/0
7/20
12
16/0
7/20
12
23/0
7/20
12
06/0
8/20
12
13/0
8/20
12
20/0
8/20
12
27/0
8/20
12
10/0
9/20
12
17/0
9/20
12
24/0
9/20
12
01/1
0/20
12
08/1
0/20
12
15/1
0/20
12
29/1
0/20
12
05/1
1/20
12
12/1
1/20
12
19/1
1/20
12
26/1
1/20
12
03/1
2/20
12
10/1
2/20
12
17/1
2/20
12
24/1
2/20
12
31/1
2/20
12
07/0
1/20
13
14/0
1/20
13
21/0
1/20
13
Week commencing
Ph
on
e ca
lls
Since mid-November the number of successful calls per week has increased
Number of new patients recevining a hand held echo
0
1
2
3
4
24/0
9/20
12
01/1
0/20
12
08/1
0/20
12
15/1
0/20
12
22/1
0/20
12
29/1
0/20
12
05/1
1/20
12
12/1
1/20
12
19/1
1/20
12
26/1
1/20
12
03/1
2/20
12
10/1
2/20
12
17/1
2/20
12
24/1
2/20
12
31/1
2/20
12
07/0
1/20
13
14/0
1/20
13
21/0
1/20
13
28/0
1/20
13
04/0
2/20
13
11/0
2/20
13
18/0
2/20
13
25/0
2/20
13
04/0
3/20
13
Week Commencing
Achievements to date
- Team building / shared & and agreed focus on patient journey/outcome
- Evidence collection- Fitting the jigsaw pieces into a coherent and appropriate Heart
Failure Pathway
Patient journey
Efficient, empowering and co-ordinated care
