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Little People, Big Solutions

Improving access to short term hospital care for Paediatric Patients and their Families

Deb Mcghie Janet Murphy Dr Murthy Korada Cassi Gray

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Overview

Background Issue/Problem Intervention Measurement Lessons Learned Questions??

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Speaker Disclosure Statement

Presenters do not have any affiliations (financial or other) to any commercial organizations

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Maple Ridge : 20,417

Catchment areas: 54,752

Total FHA: 407,038 (42%)

Population of Child/Youth 0-17 years in BC (2012)

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FHA Paediatric ED/Ambulatory Profile 2011/12

Paediatric Ambulatory/ED Visits

0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

90,000

100,000

AbbotsfordRegionalHospital

LangleyMemorialHospital

RoyalColumbianHospital

RidgeMeadowsHospital

SurreyMemorialHospital

Fraser HealthTotal

AmbulatoryEmergency DepartmentTotal Visits

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Ridge Meadows Hospital – Context

212 bed Acute care hospital 4 inpatient Paediatric beds on 10

bed Maternity unit 4 year Retroactive Data Analysis Average of 254 Admissions/year Average Unit Occupancy - < 29% Average Length of Stay – 48 hours

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Problem/Issue…

QUALITY ISSUES

TRADITIONAL SERVICE MODEL LOW OCCUPANCY

HIGH COST

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…or is it an opportunity…?

SITE ENGAGEMENT

HIGH

GROWING POPULATION

PAEDIATRIC SERVICE REVIEW

EXISTING RESOURCES

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Tristan’s story…pause for DVD clip

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Intervention

Shift from in-patient model to “hybrid” 24 hour short stay assessment unit

New Paediatrician referral service Change in Paediatrician service model Specialized Nursing team – updated

education Active “pull” of appropriate patients from ER patient flow algorithms

Cost neutral mandate…but investments required

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Intervention – Team engagement

8 months of planning Paediatricians, nurses, educators at RMH Support of FHA Leadership (site/program level)

Emergency Room Physicians/Staff Family practices and walk-in clinics in Maple

Ridge and surrounding areas Laboratory, Radiology, Pharmacy and

Registration teams

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Measurement – Data Analysis

numbers total

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200

400

600

800

1000

1200

1400

1600

1800

2000

Total ER referrals GP/Clinic urgentoff ice

consult

follow -ups BCCHreferrals

IV therapy

6 w eektotal8 w eek tot

13 w eektotal20 w eektotal52 w eektotal

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Measurement – Referral Criteria

Patient Diagnosis Respiratory

GI-gastro,constipation,etc

GU-UTI

Neuro-seizure,concussion,febrileseizure,etcintegumentary-rash,etc

cardiac

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Measurement – Length of Stay

LOS total

0

100

200

300

400

500

600

700

800

900

up to 1 hour 1-4hours 4-12 hours 12-24 hours 24-36 hours >36 hours #transferred

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Measurement – what our families told us…

“We were told in advance what would be done; seen quickly. We will come back!”

“Timely, informative staff; child friendly and attentive

“Excellent support in ER and in follow up on Paediatrics next day…”

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Outcomes

Permanent service July 2013 Exceeded Occupancy targets 4 beds - 125%; 6 beds - 84%

Time patients spent in ED decreased 11% (up to 15% for patients presenting with Fever; Moderate Shortness of Breath)

Patient/family Satisfaction rating – 4.7/5 Improved employee morale Post Secondary Clinical Training

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Tips for building a Successful Paediatric Observation Service

Early engagement of Emergency team Addition of Paediatric Emergency Clinician

Role Targeted Education planning Up to date Equipment inventory Risk Mitigation planning - structures Impact analysis - Registration,

Housekeeping Broad Communication/Dissemination

Strategy

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Challenges…there were a few…

Pt w LOS >24 hrs – Access to FHA Regional Paediatric Centre

Partner engagement Unit autonomy within partnership framework Physician Model of Care Change in hours = some office waits Addition of 4th Paediatrician August 2014

Success…now what??

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THANK YOU!!!!

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Questions???