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.