Northern Health
Specialist Clinics
Access Policy
Implementation Forum
Cherie Hunter
Ambulatory Care Access
Northern Health : Baseline data
Baseline
Northern Health previously utilised informal processes to manage Specialist
Clinic Access, gathering historical data has proven difficult mainly due to
changes in definitions.
% Accepted/Rejected Referrals within 5 days
75%
60%
45%
30%
15%
0%
Jul
Aug
Sep
Oct Nov
Accepted
Dec
Jan
Feb
Rejected
* NH data has counted weekends as part of the 5 day count
Mar
Apr
Northern Health: Baseline data
Baseline 2013-2014 data
% First Appt within 30 Days for Urgent
Patients
60%
50%
40%
30%
20%
10%
0%
50%
51%
53%
56%
Jul
Aug
Sep
Oct
55%
54%
46%
Nov
Dec
Jan
52%
52%
55%
Feb
Mar
Apr
* NH data has counted weekends as part of the 30 day count
Northern Health: Mapping processes
Stage 1 Baseline Mapping Process
• NH had 4 sites processing referrals in varying ways.
• Processing times / EFT / Skill set varied considerably between sites.
• NH did not have a global understanding of the numerous services patients
are being wait listed for or involved in (IT limitations).
• Access and Intake processes not consistently documented.
• Lots of missed opportunity: Vacancy in clinics not identified and in turn filled.
Examples of complexity:•A 4 point model of referral receipt to the OPA was the best flow model NH was achieving.
•Some systems identified a 15 point model in which referrals were delayed by up to one
week and handled by 15 staff during the process to make an OPA.
Evidence. Evidence. Evidence.
•Undertook a comprehensive Literature review of Evidence Based processes to manage
access
Northern Health: Change achievements
Major initiatives using a Lean approach to Access
Development of:•Process to eliminate duplication in triage (Support the decision of peers).
•Processes for redirection rather than rejection of referrals.
•Extended scope of practice for other health professionals.
•Processes to ensure patients arrive to appointment “Care Ready”.
•New roles with specialities to realign work processes: Medical services
donated
% of earnings to support the employment of nurses within the team.
•Schedule to extend hours of ACETS service operation to support patients
to call in after hours and weekends
•New Models of clinical management to reduce waste: e.g. # management
Northern Health: Clinical Prioritisation
7.3 Clinical Prioritisation. Target within 5 days of receipt of referral
1. A central point of Access (HIP / SC) known as Ambulatory Care Entry and Triage
(ACETs).
2. Comprehensive written triage guidelines developed using evidenced based
practice / Medical staff sign off / input of nursing and allied health teams.
3. Transition from 100% for all referrals needing to be triaged by medical /
midwifery staff to selected clinical conditions only.
4. Processes to eliminate duplication in triage (Support the decision of peers).
5. Clearer direction for GP’s on referral content via NH Intranet / Education to
support improved decision making at time of referral receipt.
6. Processes to ensure patients arrive to appointment “Care Ready”.
7. G.P. Helpline staffed by Senior Registered Nurses available to provide referral
support and direction.
8. Front end clinical sort to ensure referrals processed immediately and where
unsuitable for services they are redirected or rejected at time of arrival.
Currently NH is performing real time clinical sorting / triage / appointment
booking for immediate care need.
Northern Health: Referral Outcomes
8.1 Addition of patient to waiting list / offer to book appointment /or scheduling
of urgent appointment Target: 3 days of referral acceptance
1. ACETs standard workflow developed to deliver on KPI – process for
measurement developed and implemented
2. Front end sorting of referrals by clinician allows for patients with immediate
need to be processed
3. Audit process developed and implemented to clarify patient status on W/L
currently
4. Communication process developed for GPs with patients on W/L to ensure
clinical management actively continues (Treatment plan)
5. Alternative pathways explored, developed and being implemented (PT
pathways whilst patients on W/L for services such as Rheum / Ortho)
6. Regional approach to Diabetes developed and implemented with local service
providers / community partners (using triage guidelines referrers are aware
which service structure best meets the needs of the client).
Northern Health: Process methodology
ACETS: Referral Process Methodology (Single approach to all referrals)
Tasks required to process referrals in ACETS
Referral made
Referral arrives at ACETS
Sort by type of referral (Direct Entry or Complex) to
identify Intake actions required
Assess referral for acceptance/
rejection:
Assess referral for acceptance/rejection:
Complex Referral – requires specialist
clinical input to:
·
Assess need to gather additional
information to assist in decision
making re: referral acceptance/
rejection
·
Liaise with program/service re:
waiting times; and
·
Identify issues of risk for patient.
Direct Entry Referral – direct decision re:
referral acceptance/rejection can be made if:
·
Referral urgency is easily identifiable
·
Service most suitable to provide care is
easily identifiable;
·
Appointment can be scheduled in the
referrers requested time period;
·
Sufficient information is available to
make triage decision;
·
Referral is internal and has been triaged
previously;
·
Service has provided triage criteria and
referral can be triaged according to those
criteria.
Can referrals be accepted
post assessment?
No
Referral requires
additional information:
·
Return to referrer for
additional information
and resubmission
Yes
Referral not suitable for
NH service:
·
Redirect referral to
more suitable service
with patient consent
Process Referral:
·
Clerical Data check
·
Medicare validation
·
IT system loading
·
Appointment Scheduling (Make
appointment or waitlist)
Can OPA be made
immediately or is
waitlisting required?
Immediately
Waitlisting required
Send Referral
Acknowledgement
(if unable to schedule OPA
within 3/7)
Appointment
letter sent
Patient waitlisted
until template
horizon open
Northern Health: Improvements
Sound results with the development of a suite of reports and processes that
standardise work flow, processes and measure results .
Some Examples include:Daily capacity summary
Referral Tracker – Monitoring flow of
referrals from arrival to appointment
Northern Health: Further Actions
Achievements to date
NH are on track to meet the Access Policy across the board
Short term areas of focus relevant to 8.1 & 7.3
•Waiting list audits are proving labour intensive + need to improve
methodology
•Real time uploading of referrals into CPF ( ? Is this a duplicate or new
referral data is showing referrals are sent to NH using a scatter gun
approach to NH)
•Capacity to see Cat 1 patients within 30 days (demand greater than
capacity)
•Service based triage (Medical staff triage weekly making achieving KPI
difficult)
•Some clinicians are reluctant to handover triage process and should
they attend to triage weekly achieving KPI is impossible.