“Improving Cardiology Service Delivery For Patients” PDFs...“Improving Cardiology Service...

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“Improving Cardiology Service Delivery For Patients”

HRT 1520 Innovations Workshops and Awards

19- 20 November 2015, Sydney

Organisation Name: Logan Hospital

Presenter: Dr Prasad Challa

Summary-Approach for Innovation

Problems Solutions Outcomes

Long OP wait lists

Communication-GP

ED presentations

Long LOS

Limited Capacity of

CIU

Limited

Infrastructure

Limited bed platform

Lack of planning for

discharges

Delays in

Discharges

Extra capacity in

clinics

Guidelines for

referral

ED rounds

Protocols for chest

pains

Technician Led EST

Proper discharge

planning

Utilization of HITH

Expanding CSCF

Consultants-ABC

Reduced Wait list

times

Prompt discharges

Increased turn over

of CIU

Decreased Length of

stays

Increased income –

Facilitating

improving the

infrastructure

Introduction of new

services

TOE,CTCA

and MRI

Efficient running of

the unit

Increased service

delivery

Prompt follow up

Meeting national

standards

Increased

readmissions

Staff satisfaction

Patient satisfaction

Save bed days and

money

Results

The Vicious Cycle of problems in Cardiology at Logan hospital 2012

Bed block

Increased wait list

times

Inefficient patient care

and safety issues

Repeated ED

presentations

Hospitalization

Increased LOS

Increased capacity in OPD

Increased capacity in CIU- Stress Tests

Techs led EST

Effective utilization of

SSU/MAPU

Prompt assessment of

chest pains in the OPD/CIU

Early assessment in the

ED with cardiology

input (morning

rounds)and

communication with GP

prompt and early

discharges with

protocols for chest

pains/AF/CHF

ACRE project

Increased

utilization of HITH

Key Problem

• In 2011/12 Executive realised that we needed to get better at managing our Cardiology patients. The triggers were:-

Cardiology Acute Relative Stay Index (RSI) 2011/12 = 121%

(Worst in peer group. 13% above the average for all of our peers)

– Catchment area prone to heart problems (low socio-economic status)

– Volume of Cardiology discharges 2011/12 = 1,637 (mid-range compared to peers) and expected to increase with the rapid population growth

– Poor after hours GP services

– Need to improve service delivery where possible (and in a safe way) with the existing Cardiology Specialist FTE numbers

THE PROPOSED SOLUTION… REVIEW ALL AREAS OF CARDIOLOGY!

© 2015 Confidential Draft Discussion Document 4

Aim of this innovation

• Aims/Improvements sought included:-

– Working with GP’s to improve referral processes for Chest Pain patients

– Timely review of Cardiology patients in the Emergency Department

– Introduction of new services viz TOE,CTCA.MRI

– Reduced acute inpatient LOS for all patients also for waiting transfer for a cardiac cath lab procedure at the larger tertiary hospital

– Proactive ward discharge processes – both on weekdays and weekends

• Introduction of TOE,EST and ECHO on the weekends

– Faster access for Cardiology patients to outpatient services on-site by increasing the number of clinics.

– Timely access for Stress Tests (Clinical Measurements)

– Increased utilization of Hospital in The Home for Cardiology patients in an attempt to prevent formal readmissions


Baseline Data / Current Situation


EXERCISE STRESS TESTS

2011/12 455

Key Changes Implemented


Emergency Department: ED rounds, proactively attending ED,

ACRE project, faster chest pain pathways, protocols for AF/CHF

Use of chest pain nurses for evaluation

presence of senior Cardiologists input round the clock.

Inpatients: Planning early and prompt discharges, increased CIU support in the weekends

Introduction of TOE, CTCA and MRI to assist investigations

Prompt transfer to cath lab for ACS patients

Hospital In The Home: Increased utilisation of the service with heart failure with input from out team

Outpatient Clinics: Creating additional capacity of clinics,

adjusting numbers to the number of referrals

Engagement with GP: walk-ins for stable chest pains, non emergency patients requiring early review

processing mostly in private before OPD referral

Triage guidelines for referrals

Clinical Measurements: improved capacity with tech led EST and additional capacity for ESE/DSE

Processing ED patients on a priority basis for tests

Decreased wait list times

improved revenue generation with opportunity to invest in additional

equipment creating capacity for more work

Out patients planning


Utilisation of chest pain pathways


Facilitating early discharges


Cardiology –SOPD performance report


Total number of EST performed


Figure 1: Total number of Exercise Stress Tests (EST) performed over the past four financial

years along with average waiting list and outpatient did not attend rates.

0

100

200

300

400

500

600

700

2011/12

physician led

2012/13

physician led

2013/14

scientist led

2014/15

scientist led

Year

Nu

mb

er

of

tes

ts

0

5

10

15

20

25

30

35

Da

ys

wa

itin

g o

r %

Total number tests performed Days Waiting (Av.) Total DNA % OP

Total functional tests performed


Total number of exercise stress echocardiograms (ESE) & dobutamine

stress echocardiograms (DSE) performed over the past 4 financial years

0

50

100

150

200

250

300

350

2011/12 2012/13 2013/14 2014/15

Year

Nu

mb

er

of

tes

ts

ESE

DSE

Outcomes so far


Estimated

Cardiology Bed

Day Savings in

2013/14 = 2,093

2014/15 RSI = 73% (ALOS 1.7 days)

EXERCISE STRESS TESTS

2011/12 455

2012/13 550

2013/14 629

2014/15 640

Lessons Learnt

• Look at your data -organise your work and invest in areas which need most

• Importance of excellent communication

• Value in taking time to organize a well planned approach

• Importance of continued focus on the emergency readmissions– Ongoing monitoring showed that our Cardiology readmission rates within 28 days

were creeping up

e.g. 9% in 2011/12 vs 14% in 2013/14 (the 2nd highest in the peer group)

– After careful consideration of this unintended consequence the Cardiologists began fine tuning the discharge process based on what they were learning

– Emergency readmission rate in 2014/15 = 15% (equal to 2nd highest in peers)

– Further investigation has revealed that it is specifically the short stay (<=24hrs) Cardiology inpatient readmissions have been steadily increasing over the last year

– Action plan – monitor short stay readmissions

• We'll continue to work on becoming safer and more efficient all the time… looking out for more unintended consequences


Lessons Learnt (continued)


Logan Hospital Emergency Readmissions in 28 Days

Including short stay (<= 24hrs) readmissions Excluding short stay readmissions

Cardiology Department Emergency Readmissions in 28 Days

Including short stay (<= 24hrs) readmissions Excluding short stay readmissions

9.7% 13.2% 13.7% 14.8%8.6% 12.7% 12.3% 11.6%

ACTION: Logan

Hospital is now

actively focussing

on reducing Short

Stay readmissions

across the hospital

ACTION: Logan

Hospital Cardiology

Department is now

actively focussing

on reducing Short

Stay readmissions

Contact for this Innovation

For more information Contact:

Dr Prasad Challa

Director – Cardiology, Logan Hospital, Logan Bayside Health Network, Metro South Health

Tel: (07) 3299 2166

Email: [email protected]


mailto:[email protected]

“Improving Cardiology Service Delivery For Patients” PDFs...“Improving Cardiology Service...

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