REDDSoC Project - Reducing Day of Surgery Cancellations

Presented by: Annie Williams,

Manager of Innovation & Improvement – Goulburn Valley Health

Shepparton, Victoria

REDDSoC: REDucing Day of Surgery Cancellations Project

Goulburn Valley Health - main campus at Shepparton, Northern Victoria -

with additional campuses at Tatura and Rushworth

Innovation & Improvement Unit @ GVH: established

November 2009

Multiple Surgical Services reviews [internal and

external]

Project Scoping commenced Jan 2010

RHCP funding approved – scope confirmed

“Review the journey of Elective and Emergency Patients, from the time of being confirmed for surgery to entering Recovery”

Branded as the REDDSoC Project

Background:

GVH Redesign Methodology

What did the data say?

Raw data was available…

Which we followed up with process mapping, patient tracking, and

extensive stakeholder communications and interviews.

Number of DOS cancellations GVH for period July 09 to Jun 10

ED patients

Reasons for cancellations

Wait list management

Theatre Utilisation

“No Beds”

Staffing

Issues

Anecdotal evidence was provided:

We had a problem to solve…

REDDSoC @ GVH: • Aim 1: Identify unproductive

activity within OT processes –

to improve capacity within

existing resources

• Aim 2: Reduce ED LOS for

pts awaiting emergency

surgical procedures

• Objective 1: Reduce DOS

cancellations, (planned and

unplanned surgery), by 30%

by 31/12/10

What did we ask of our stakeholders?

We have people

arriving everyday

in our ED that will

require surgery...

What plans do we

have in place?

When the patient is

confirmed for

surgery, how long do

they wait?

What are the

impacts on

patients when

their surgery is

cancelled?

What is it like

for our patients

to wait for a

long time for

their surgery?

Understanding the emergency demand…

What did we learn from the data?

Period: 2 months

Jul/Aug 10

Total Time

[mins]

Median mins

[Range:

mins]

Average OT time

Orthopaedic 14228 155

[58 – 370]

26.95 hrs/week

Gen Surgery 14935 100

[15 - 350]

28.28 hrs/week

Obs/Gynae

3512 84

[35 – 84]

6.65 hrs/week

Vascular 1500 80

[21 – 150]

2.84 hrs/week

Various 1273 2.41

hours/week

Historical

Allocation

4 hrs +

1 hr/day

4 hrs +

1 hr/day

nil

nil

nil

Emergency demand

We did know what coming in from the Emergency Department!

What did our patients tell us?

-3

-2

-1

0

1

2

3

4

5

6

Access to Care Respect for

patients values,

preferences

and expressed

needs

Coordination

and integration

of care

Information

and education

Transition and

continuity

Physical

comfort

Emotional

support and

alleviation of

fear and

anxiety

Involvement of,

and support for

families and

carers

Positive

Sometimes/MixedNegative

01/09/2010

“the staff have been good and

the Doctors are great – No

Problems”

“About 10pm, they looked at the

X ray and said I wouldn’t get to theatre

tonight. It would probably be late

tomorrow”

He was very good with his

communication, but I felt he

was interrupted by the

senior medical officer

“She was very uncomfortable and feeling a bit faint,

so I went up and asked if there was somewhere

Isabelle could lie down. She said there are 3 seats

there together, so lie down there. We didn’t mind

waiting, but She just couldn’t sit”

“Didn’t see a soul until I

managed to get a

nurse…..

Not a good way to spend

the night in this bed”

“It was a long night in the

ED”

“The staff that

looked after

me were

brilliant”

“They kept me informed about

what was going on”

“A doctor

came and

saw me

straight away.

He was

awesome

considerate

and nice”

Impacts of Emergency Demand…

Emergency Surgical Patients

Emergency

Department

Elective Surgical Patients

ED Time to OT - Jul Aug 2010 [by specialty]

0

10

20

30

40

50

60

70

80

90

General Surgery O /& G Orthopaedic

Specialty

Pa

tie

nts

ED < 8 hrs

ED > 8 hrs

Emergency Demand July Aug 2010

0

10

20

30

40

50

60

Mon

day

Tue

sday

Wedn

esda

y

Thu

rsday

Frid

ay

Saturda

y

Sun

day

Day of the week

pati

en

ts

Emergency Admissions

Emergency Procedures

Linear (Emergency

Admissions)

Project Diagnostics:

Capacity did not meet current, or

would not meet future demand!

Limited existing physical and staff

resources

Emergency activity 1/3 of all GVH OT

procedures

Emergency demand was predictable

Limited existing capacity or planning

for emergency demand

Current allocations process did not

maximise existing limited resources

Variation in data entry and

documentation

Elective surgical management

meeting KPIs

REDDSoC Diagnostic Summary

1. Capacity based on demand, both emergency and elective 2. Allocations made to Surgical Specialities 3. Capacity for General Surgery and Orthopaedic Surgery daily [M-F] 4. Capacity created for recruitment for additional surgical specialties – including those to address areas of high elective demand e.g. ENT 5. Approved set of Business Rules for OT allocations, including regular reviews But not all changes were in response to the ‘Hard data’! Public Dental List: many patients are paediatric or have special needs – previous allocations on Friday afternoon had led to long waits and even longer fasting times; and often created challenges in patient management But Now dental sessions Monday morning Children and special needs patients are first on the list, and reports are that there is significant improvement in the processes and positive impacts on patient experience

Some Features of the REDDSoC Model:

4 week planner

2010 Monday Tuesday Wednesday Thursday Friday

am am am am am

0830 start 0830 start 0830 start 0830 start 0900 start

Theatre 1 Mr Heinz Mr Kamenjarin Mr Hunt Mr Dalton General

rotating

Theatre 2 Mr Abdullah Orthopaedics Dr Teale Dr Stegeman Orthopaedics

rotating rotating

Mr Kennedy mthly Clarnette mthly

Theatre 3 Dr Ilic - Jeftic LUSCS Mr Safdar mthly Mr Uren mthly LUSCS

Higher risk pts (Lithotripsy mthly) Mr Forbes mthly Low risk

Mr Mortensen mthly vacant


Treatment Flexible Cystoscopy Dr Nana Mr Abdullah Mr Kamenjarin Mr Dalton or

Room TRUS Mr Heinz mthly Dr Sawhney

pm pm pm pm pm


Emergency

Theatre 1 Mr Heinz Mr Kamenjarin Mr Hunt 3 wks Mr Dalton General

scopes in 4th w k rotating

Mr Safdar mthly

Emergency

Theatre 2 Mr Horton Orthopaedic Mr Critchley Mr Chew Orthopaedic

rotating rotating

Mr Kennedy mthly Mr Uren mthly

Theatre 3 Dr Barmare Dental

Mr Mortensen Mr Mortensen Gynae Registrar

3 w eeks 3 w eeks


Treatment Mr Eastman Mr Dalton Dr Harris M. Kamenjarin 1w k Dr Sandhu 2/52

Room A. Testro 2 w k Mr Dalton 2/52

1430 mthly HUNT Mr Heinz 1 w k

Reviewed for 5th September

REDDSoC Version A.1.3.3 - Proposed OT Schedule Model

THR 1 THR 2 THR 3 T/ROOM THR 1 THR 2 THR 3 T/ROOM THR 1 THR 2 THR 3 T/ROOM THR 1 THR 2 THR 3 T/ROOM

7.30 ECT ECT ECT ECT

8.00 G/S OBS/GYN DENTAL G/S ORT OBS/GYN G/S OBS/GYN DENTAL G/S ORT OBS/GYN

8.30 [HEINZ] [ILIC] URO [HEINZ] [BARMARE] [ILIC] URO [HEINZ] [ILIC] URO [HEINZ] [BARMARE] [ILIC] URO

9.00 [MORT] [MORT] [MORT] [MORT]

9.30

10.00

10.30

11.00 C/O TIME C/O TIME

11.30 ORT ORT

12.00 C/O TIME C/O TIME [BARMARE] C/O TIME C/O TIME C/O TIME C/O TIME C/O TIME C/O TIME [BARMARE] C/O TIME C/O TIME C/O TIME C/O TIME

12.30 **DOS **DOS **DOS C/O TIME **DOS

13.00 G/S C/O TIME G/S G/S G/S

13.30 EASTMAN EASTMAN EASTMAN EASTMAN

14.00 [HUNT 1in8]

14.30

15.00

15.30

16.00

16.30

17.00

17.30

18.00

18.30

19.00

19.30

20.00

20.30

21.00

21.30

22.00

22.30

On-call>

EMERG

AFTER

HOURS

START

TIME

WEEK 1 WEEK 2 WEEK 3

EMERG

AFTER

HOURS

EMERG

AFTER

HOURS

EMERG

AFTER

HOURS

MONDAY

WEEK 4

‘Quarantined’ Emergency Allocations

Ensure capacity every day for orthopaedic and general surgery session

All lists have emergency allocations to meet 80% of predicted demand [

Previous emergency allocations were limited to general surgery

Flexibility within the lists to treat emergency cases based on clinical need

Review of emergency cases booked after 1800hrs to see if clinically they could

be moved to the next elective list

Electronic data report to capture pending OT patients

Validation of predictability of Emergency demand…

Some Key Project Outcomes:

We have seen…

Reduction in DOS Cancellations [app.

50%]

Decreased LOS for Emergency Surgical

patients within the ED [improved

communication, management and transition]

Electronic documentation of pending OT

patients

Less after hours emergency cases =

decreased overtime [$]

Greater predictability for OT medical and

nursing staff

Greater planning for emergency demand

allows more effective management of

resources [e.g.: anaesthetic rostering, CSSD,

cleaning]

0

10

20

30

40

50

60

70

80

90

GS ORT GYN

Num

ber o

f Pat

ient

s

Surgical Specialty

ED SURGICAL PATIENTS[ED ADMISSION TO PROCEDURE]

July 2010 TO Aug 2010

ED < 8 hrs

ED > 8 hrs

0

10

20

30

40

50

60

70

80

90

GS ORT GYN

Nu

mb

er o

f P

atie

nts

Surgical Specialty


July 2010 TO Aug 2010

ED < 8 hrs

ED > 8 hrs

0

20

40

60

80

100

120

140

GS ORT GYN

Nu

mb

er o

f P

atie

nts

Surgical Specialty


Sept 2011 to Oct 2011

ED < 8 hrs

ED > 8 hrs

The impact upon ED surgical patients:

Secrets of our success:

1. Great Executive Sponsorship

2. Clinical leadership

3. Extensive stakeholder

engagement

4. Extensive consultation and

planning – utilising AIM

implementation approach

5. Great project support

6. Communication & branding

Next steps:

Patient Flow Collaborative

Redesign Project

Thank you…

Contacts:

Anne Williams,

Manager of Innovation, GV Health, Shepparton

[email protected]

Jenny Lia - Redesign Project Facilitator

Cheryl Lancaster- Redesign Support

GVH Executive, Operational management, medical officers

and staff of GVH

Victorian Dept of Health – RHCP

NSW Health Centre for Healthcare Redesign

REDDSoC Project - Reducing Day of Surgery Cancellations

Health & Medicine

Transcript of REDDSoC Project - Reducing Day of Surgery Cancellations