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
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• 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?
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