Kaleidoscope Ambulatory Care Program

More than just a clinic

Tuesday 23 October 2012

The Problem• Satisfaction from families was at 60%,

evidenced by the NSW Health Paediatric Statewide report, 2008

• Complaints from General Practitioners were frequent

• Demand for clinic space and appointments were increasing

• Poor cousin to inpatient services

The Paediatric Outpatients Team

Kaleidoscope

Ambulatory Care Program August 2009

Objective: to develop a child andfamily centred service model by:

– Ambulatory Care Strategy

– Improving patient and family satisfaction

– Clinic Scheduling & Functionality

– Referral Management

– Clinic Bookings

John Hunter Childrens Hospital

Clinic overview 2009• 12 clinic rooms for all disciplines

and specialties - 2 of those 12 clinic rooms off site (15 minutes away)

• Over 40 specialists holding clinics

• Shared NUM with inpatient unit

• 5.4 staff (admin/nursing)

• No designated manager/leadership team

Clinic Statistics

Performance Snapshot: 2009 - 2010

Total number of patients booked 18 648

% of appointments attended 82%% of Did Not Attends (DNA) 12.2%% Cancellations 4.0%

% Appointments rescheduled 27%

% of new patients 29% % of follow up patients 71%

Minimum wait for first appointment 2 weeksMaximum wait for first appointment 20 months

Current clinic waiting room/reception

What consultation uncovered:

Opportunities for improvement

Key SolutionsStrategy:

• Leadership & Governance • Operational Guidelines• John Hunter Children’s Hospital

Ambulatory Care Service Framework• Schedule Management

Process:

• Referral Management• Booking Management• Waitlist Management

•

Leadership:

• The allocation of a designated leader / manager

• Clarity of clinical and non-clinical leadership roles, responsibilities, and accountabilities

Governance: review & modification of:

• Current governance structures • membership / terms of reference /

accountabilities of the JHCH Ambulatory Care Management Committee

Strategy (1):

Leadership & Governance

• To provide leaders and clinicians with a guide to assist in making informed & impartial operational decisions on clinic functionality

• As an orientation / information tool for HNEAHS clinicians

Strategy (2):

Operational Guidelines

Strategy (3):

Service FrameworkPurpose: describes and communicates to health professionals:

• Individual specialty service

• Referral requirements / criteria

• The service provider

• Core service business

• Service alternatives

Strategies (4):

Web-based Service Directory

Strategies (5):

Service Descriptions Online

Strategy (4):

Schedule Management

• Review clinic utilisation and specialty demand

• Consider the current models of care

• Investigate the feasibility of changing the clinic opening & closing times.

Processes

Processes (1):

2009 Referral / Booking / WaitlistProcess Map of referral management and bookings process 2009

Processes (2):

Referral / Booking / Waitlist in 2012

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Referrals In

Referral

Triage

Rural / DistrictHospital

General Practitioner

Staff / VMO Specialists

Emergency Department

Assessmentin Clinic

Allocation ofAppointment

TelephoneAdvice

Allied Health

Emergency Care

Paediatric Ambulatory CareJohn Hunter Childrens Hospital

’

• Booking according to triage code.

• Family & GP notified.• SMS reminder 3 days prior.

RIMS = Referral Information Management System:• family notification• Clinic planning• 100% tracking

The clinician views the referral & assigns a triage category code: 7Days/30days/90Days/365Days.

Referring GP / service faxes referral to central Intake

Challenges• Increased workload for administration

staff with RIMS process (RIMS = Referral information Management System)

• Communication to the 40 different clinicians and changes in practice with referral management.

• Waitlist management

• Physical space.

• Schedule management.

Achievements so far• Full time Ambulatory Care Manager

• Ambulatory Care Management Committee

• Professional Users Guide for Ambulatory Care

• Website for GP’s

• Fully electronic referral management system

• Structured bookings and waitlist

• SMS message reminders for appointments

• Identified KPI’s monitored monthly

• Health Pathways

Performance 2012• Improved efficiency: 6.3% pa

• 100% tracking of referrals

• Reduced DNA rates 12.2% (2009) to 10.17% (2012) even with an increase in patients seen, a 20% improvement.

• 7 paediatric healthcare pathways completedand 4 currently under development

• Manager

Identification and monitoring: Paediatric Ambulatory care KPI’s

The Future Environment

Questions?