Let Me Know

Planning and Implementing a patient

and family activated escalation

response

Mandy Sandford

Clinical Service Director

September 22nd 2014

AIM of PRESENTATION

• Describe the planning process for the service

• Engagement of consumers and staff

• Present the pilot model for Alfred Health

• Highlight communication strategies

• Discuss the results of three-month pilot

• Take home messages

No of Met calls per year

ACHSQC National Standard 9

•Communicating with patients and carers : Patients, families and carers are informed of recognition and

response systems and can contribute to the processes of escalating care.

•This criterion will be achieved by:

– 9.7 Ensuring patients, families and carers are informed

about, and are supported so that they can participate

in recognition and response systems and processes

– 9.9 Enabling patients, families and carers to initiate an

escalation of care response

Global initiatives

Many hospitals have now implemented a process to

enable patients and family activated escalation.

– Australia – REACH, PACE, CARE

– United States - Condition H, Partners in Care

– United Kingdom - Call 4 Concern

Overseas experience

This process is used sparingly. • Literature report 2-5 calls/month or less

• Others reports 5-6% of all Rapid Response calls

• No overload of false positives

• Calls have resulted in pain medication intervention

Other medications, IV fluids, diuretics

revision of discharge plan,

support to anxious pt/family,

some cases - returns to theatre or ICU

Planning

– Project Brief – 2 years ago

– Executive Support

– Reps from 3 sites (doctors & nurses)

– Interviewed & selected consumer reps

– Fortnightly meetings

– Briefings for consumer understanding

– Reviewed current models

– Scope of service – ED ICU M/health Opts

Brainstorming

– What would patients/families want to escalate?

– What calls should not come through this service?

– What characteristics of responders?

– Who could respond 24/7 and at three sites?

– Draft models to test with committees/sites

– Regular meetings with sites

Criteria for calls

– Change in behaviour/condition

– Patient not quite right and no-one listening

– Drowsy/confused – a new change, alarming

– Patient looks different, causing concern

– Patient in pain – unresolved

– Physical distress

– Concerns about treatment

– Anxiety (of patient/relative)

Patient / Family

concern

Nurse talks to patient/family

and assesses patient

Appropriate action/response taken and

inform NIC/HMO

Talk to Nurse looking

after patient

Ask to speak with

doctor/NIC Appropriate action/response

taken

Patient / Family call

Response team

1800 no

Patient/family still concerned

Patient/family still concerned

Draft Model

Press ‘1’ for Alfred Press ‘2’ for Caulfield Press ‘3’ for Sandringham

Responder Responder Responder

Project work

– Marketing: a big piece of work

• Engaged Public Affairs

• Name of program – aligned in-house programs

• Tested with consumers and patients

– Communication Strategy

• Who what when where and how

• What is the key message

– Education strategy

• For responders – skills and tools

Key Messages

• Most health care professionals listen and respond to patient and family

concerns when raised. This is about “casting the safety net” a

little further.

• Patients and families know their loved ones better than us.

• It is important that patients and families know we take their

concerns seriously. Some might fear a decline in the quality of

their subsequent care if they activate this process.

• Staff need to reassure patients and families that they are considered

valued members of the care team and activating this

process is not considered a criticism of staff.

Project timelines

– Sign-off: pick a date

– Information sessions

> Leadership committees to endorse

> Everyone – doctors, nurses, allied health, ward

clerks, cleaners (Switch)

> Nurses Forum

> FAQs

– Amazing response from staff and patients

Communication to the team

Let Me Know sticker in MR with call & actions

If serious, unit are involved

Exploring Riskman email

Evaluation audit of calls

Feedback

Implementation

– Launched July 1st

– CEO message to all staff

– Screen savers

– Patient TVs

– Brochures, posters, badges

– Intranet & Email address for feedback

– Consumers help

Pilot & Results

– 3 month pilot on The Alfred Site July-Sept

– Results so far: 10 calls in 8 weeks

– Types of calls

> Deterioration

> Care & Communication

> Complaint

> Other

0

1

2

3

4

5

July August Sept

Number of Calls / Month

0

1

2

3

4

Det/NQR Care issue Complaint Other

Reason for calls

Next Steps

– Review pilot results

– Refine model for Caulfield & Sandringham

– Pick a date

– Information sessions

– Message for staff

– Survey patients & families re awareness of service

Take home messages

– Executive support

– Engage consumers early

– Engage PR department early

– Pick a date and work towards it

– Message for all – communicate

– Follow-up call with patients & families

– Have fun and celebrate

Thank you