Out of the Box- Creating Ambulatory
Rehabilitation Efficiency
Organisation Name: The Prince Charles Hospital
Presenter: Ann Coe
HRT 1520 Innovations Workshops and Awards
19- 20 November 2015, Sydney
Background:
• Six (6) members of the Rehabilitation Day
Therapy Unit (RDTU) multidisciplinary team
participated in a series of workshops developing
skills in project management and clinical
redesign following successful application to the
Queensland Institute of Clinical Redesign
(QuICR) school.
Ann Coe, Clinical Nurse
ann.coe@health.qld.gov.au
Metro North Health & Hospital Service
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Key Problem: An inconsistent referral pathway and
management led to a prolonged patient journey and time
delays in service delivery to an ambulatory rehabilitation
program.
Due To:
• Multiple referral receivers- lack of one central referral
process/point of contact
• Lack of formalised pathway
• Inconsistent decision making across the journey
• Poorly defined service model/profile
• Inconsistent communication internally and externally
• Delays in patient journey due to “the process”
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Aim of this innovation:
• The aim was to use clinical redesign methodologies to improve
efficiencies of the service through evaluation of the current
model of care, diagnostic identification of gaps in service
provision, and establishment of solutions to enhance the patient
experience.
• Sustain efficiencies and progress forward with initiatives that
were identified through the project
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Baseline Data highlighted:
What was analysed and who was consulted:
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Data analysis- 5 years of local rehabilitation data
Patient interviews/videos- consultation with patients and their carers
Process mapping- current vs. ideal pathway
Issues prioritisation- included quick wins
Referrer questionnaires- internal and external
Benchmarking- gaps in availability and consistency of other services data
Stakeholders Forum- inconsistent communication common theme
Literature review- lack of comparators in literature
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The Process Map- highlights the many steps and decisions in
the pathway of a referral before the redesign project
Key Changes Implemented:
• Define service identity- reviewed and published February 2015
• Review and redesign service brochure- published January 2015
• Development of internal electronic referral system in existing IT system
( Refer)- actioned August 2015
• To use an existing referral process within the hospital service for external
referrers – Central Patient Intake (CPI) of Metro North Hospital & Health
Service- already available
• Acknowledgement of referral for patient and referrer- acknowledgement
(previously not done) and triage now within 48 hours
• Previous administration of referral processing was up to 26 steps- reduced to
12-13 steps
• One gatekeeper (Clinical Nurse) for triaging has reduced a time efficiency of 47 days
• Efficiency: previous bookings/meeting time is now used for clinical care – also
created 2 extra therapy sessions available; 5 clinicians have gained an extra
hour of clinical time per week.
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Outcomes so far:
Average number of new referrals per month continue to steadily increase:
2010: 36 vs. 2015: 80 (staffing and resources have not increased)
Trend line of Waiting times from referral to initial assessment has significantly
reduced since Sept 2014. A slight increase in May –July 2015, but returning to
decrease in September & October 2015.
Waiting Times (days)
Referral to Initial Assessment
40.00
35.00
30.00
Day(s)
25.00
20.00
15.00
10.00
5.00
0.00
January
February
March
April
May
June
2013 Referral - Ax
July
August
2014 Referral - Ax
September
October
November
December
2015 Referral - Ax
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Outcomes so far:
Referral pathway now- internal via Refer system
External via MNHHS Central Patient Intake
•Redesigned brochure
•Staff Orientation book
•List of further innovations “car parked ideas” to progress
forward
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Lessons Learnt:
• The value in consulting with patients, their carers and all stakeholders
• The importance of staff engagement when undergoing change
• Being open to “the good, the bad and the ugly” when examining your
processes
• Keeping good quality data and dumping unnecessary process waste
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For more information Contact:
Ann Coe
Tel:07 3139 6831
Email: ann.coe@health.qld.gov.au
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