Transcript Slide 1

20,000 Days Campaign Storyboard
Learning Session 3 11-12 March 2013
Healthy Hearts
Collaborative Team
Clinical Lead: Dr Mayanna Lund
Andy McLachlan
Key Contacts: Dr Andrew Kerr
June Poole
Katherine McLean
Dr Tim Sutton
Leanne Elder
Sitela Vimahi
Sosefo Teu
Devi Ann Hall
Project Manager: Alison Howitt
Clinical collaborative co-ordinator: Sarah Mooney
Improvement Advisor: Ian Hutchby
Decision Support: Tanesha Patel & Eric Cuvea
Aim
• To improve cardiovascular health in the
CMDHB population, across the continuum of
care, by July 2013 by:
– Reducing readmission rates from Congestive Heart
Failure by 20%
– And increasing the uptake of cardiac rehabilitation
rates by 10%
– And Improve access to inpatient Echo and catheter
testing so that 70% appropriate referrals are seen
within clinically agreed timeframes
Change Packages – Heart Failure Pathway
Change Packages
2o Drivers
(Theory of change)
Change Ideas
Tested
Describe Process
Early Diagnosis Using lab test taken Review BNP results for Early
in ED
Identification of new Heart Failure
Patients
Early Diagnosis Hand Held Echo
Appropriate &
tailored care
Multi-disciplinary
wards rounds.
Use Hand Held Echo to confirm
underlying heart disease, enabling
treatment plan to be initiated early.
Includes, Cardiologist (with Hand
Held Echo) and Nursing team to
initiate integrated care package.
Change Packages
2o Drivers
(Theory of change)
Change Ideas
Tested
Consistency of Heart Failure Care
Care
Bundle
Describe Process
• Heart Failure Diagnosis
• Patient information and Education
(taking Control)
• Medicine management
• Self Management Plan
Cultural Support
•Patient understanding (language)
•Patient information and Education
•Reduced barriers to selfmanagement
Post Discharge
Follow Up Phone call to support
patient and identify problems early
Change Packages
2o Drivers
(Theory of change)
Change Ideas
Tested
Describe Process
Titration Clinics
• Nurse led titration clinics to
increase capacity.
Heart Failure
Rehabilitation
• Provide Patient Information,
Education and Exercise to support
patient self management.
Combined HH & BB Use community based resources to
Rehabilitation
develop programmes.
Week commencing
Version 1 – 10th March 2013
Week Commencing
04/03/2013
04/03/2013
14/01/2013
07/01/2013
31/12/2012
24/12/2012
17/12/2012
10/12/2012
03/12/2012
26/11/2012
19/11/2012
25/02/2013
0
18/02/2013
1
25/02/2013
1
11/02/2013
2
18/02/2013
2
11/02/2013
3
04/02/2013
3
28/01/2013
4
04/02/2013
Number of new patients recevining a hand held echo
21/01/2013
4
28/01/2013
Week commencing
21/01/2013
14/01/2013
07/01/2013
31/12/2012
24/12/2012
17/12/2012
10/12/2012
Week commencing
03/12/2012
26/11/2012
19/11/2012
Number of BNP tests done (new patients)
12/11/2012
05/11/2012
29/10/2012
22/10/2012
15/10/2012
08/10/2012
Number of new patients identified in the CNS book
12/11/2012
05/11/2012
29/10/2012
22/10/2012
15/10/2012
0
08/10/2012
5
01/10/2012
0
24/09/2012
6
01/10/2012
04/03/2013
25/02/2013
18/02/2013
11/02/2013
04/02/2013
28/01/2013
21/01/2013
14/01/2013
07/01/2013
31/12/2012
24/12/2012
17/12/2012
10/12/2012
03/12/2012
26/11/2012
19/11/2012
12/11/2012
05/11/2012
29/10/2012
22/10/2012
15/10/2012
08/10/2012
01/10/2012
24/09/2012
12
24/09/2012
04/03/2013
25/02/2013
18/02/2013
11/02/2013
04/02/2013
28/01/2013
21/01/2013
14/01/2013
07/01/2013
31/12/2012
24/12/2012
17/12/2012
10/12/2012
03/12/2012
26/11/2012
19/11/2012
12/11/2012
05/11/2012
29/10/2012
22/10/2012
15/10/2012
08/10/2012
01/10/2012
24/09/2012
Healthy Hearts CNS Dashboard
Number of new patients seen by the nurse specialist
8
10
7
8
6
5
4
4
3
2
2
1
0
Patient journey
• EARLY
DIAGNOSIS
BNP / HHE
Education & cultural
support
• INPATIENT
STAY
• OUTPATIENT
SUPPORT
Telephone follow-up
Titration clinics
Shared
exercise/education
programme
• GROUP &
COMMUNITY
SUPPORT
Patient story: 66 year old female on W2
Shared
exercise/education
programme
• EARLY DIAGNOSIS
• BNP 68
• (requested 12.17 /
results
viewed/accepted
13.37)
• Echo undertaken
• Diagnosis confirmed
• Medication
commenced
Education & cultural
support
• INPATIENT STAY
• Education received on
two occasions from
nurse specialist
• Pharmacy review of
medication
• Noted that English
second language or
poor English
comprehension
• OUTPATIENT SUPPORT
• Telephone follow up
• Letter to GP/on Concerto
noted:
• “xx is still feeling breathless at
times during the day and is
waking at night with shortness of
breath”. I have asked xx to see
you tomorrow for review”.
• “xx has limited knowledge of her
medications even though these
were discussed during her
hospital stay. She would benefit
from going over her medications
again”.
• “Referrals made: Heart failure
nurse practitioner on xx. Please
could you encourage her to
attend”.
• Nurse practitioner clinic
BNP / HHE
Telephone follow-up
Titration clinics
• GROUP &
COMMUNITY
SUPPORT
• Opportunity to
attend with family
member:
• Personalised
and supervised
exercise
prescription
• Education
sessions
including on
medication
• Meet and
monitor weekly
with
nurse/physio
Patient journey
PDSA
tree
• EARLY
DIAGNOSIS
Education & cultural
support
• INPATIENT
STAY
• OUTPATIENT
SUPPORT
Telephone follow-up
Titration clinics
BNP / HHE
PDSA
tree
Run
charts
Shared
exercise/education
programme
• GROUP &
COMMUNITY
SUPPORT
Most Successful PDSA Cycles?
Measures Summary
• Dashboard (Re-admissions, Admissions and LoS)
• Interventions
–
–
–
–
–
–
–
–
–
Numbers hand held echo’s and outcomes
Management plans completed
Follow up phone calls completed
Patient completing titration clinic
Specialist clinics – patient numbers
Identification of patients with heart events
Numbers of patients attending/completing Rehab
Wait times for cardiac diagnostics
Non Coronary Care pts with positive biomarker
Version: 1.1
Dated: 11/02/2013
Monthly volumes for ACS patients are stable and exhibit
normal variation only
Apr 2011
Mar 2011
Jul 2011
Jun 2011
Average Length Of Stay for ACS patients is stable and exhibits
normal variation only
Contacts
Jul 2011
Dec 2012
Nov 2012
Oct 2012
Sep 2012
Aug 2012
Jul 2012
Jun 2012
May 2012
Apr 2012
Mar 2012
Feb 2012
Jan 2012
Dec 2011
Nov 2011
Oct 2011
Sep 2011
Aug 2011
2.5
Jun 2011
LCL
May 2011
90
Apr 2011
CL
Jan 2011
100
Mar 2011
Average Length Of Stay for patients with a primary diagnosis of ACS
Feb 2011
5.5
Oct 2010
110
Nov 2010
120
Dec 2010
UCL
Jul 2010
7.5
Sep 2010
21/01/2013
14/01/2013
07/01/2013
31/12/2012
24/12/2012
17/12/2012
10/12/2012
03/12/2012
26/11/2012
19/11/2012
12/11/2012
05/11/2012
29/10/2012
15/10/2012
08/10/2012
01/10/2012
24/09/2012
17/09/2012
10/09/2012
27/08/2012
20/08/2012
13/08/2012
Jan 2010
18
6.5
3.5
2%
LCL
0%
The Readmission rate for ACS patients is stable and exhibits
normal variation only
Improvement Advisor:
Ian Hutchby
Decision Support Analyst: Tanesha Patel/Eric Cuerva
Dec 2012
Nov 2012
Oct 2012
Sep 2012
Aug 2012
Jul 2012
Jun 2012
May 2012
Apr 2012
Mar 2012
Feb 2012
Jan 2012
Dec 2011
Nov 2011
Oct 2011
Sep 2011
Aug 2011
Jul 2011
Jun 2011
May 2011
Apr 2011
Mar 2011
Feb 2011
Jan 2011
Dec 2010
Nov 2010
Oct 2010
Sep 2010
Aug 2010
Jul 2010
Jun 2010
May 2010
Apr 2010
Mar 2010
Feb 2010
Jan 2010
Dec 2012
Nov 2012
Oct 2012
Sep 2012
Aug 2012
Jul 2012
Jun 2012
May 2012
Apr 2012
Mar 2012
Feb 2012
Jan 2012
Dec 2011
Nov 2011
Oct 2011
Sep 2011
Aug 2011
Jul 2011
Jun 2011
May 2011
Apr 2011
Mar 2011
Feb 2011
Jan 2011
Dec 2010
Nov 2010
Oct 2010
Sep 2010
Aug 2010
Jul 2010
Jun 2010
May 2010
Apr 2010
Mar 2010
Feb 2010
Days
Readmission Rate
ALOS for patients with primary diagnosis of CHF
Aug 2010
Number of new patients recevining a hand held echo
06/08/2012
4
23/07/2012
ALOS for Chronic Heart Failure patients is predominantly
showing normal variation
Apr 2010
Oct 2012
Nov 2012
Dec 2012
2
Jun 2010
Jul 2012
Sep 2012
Aug 2012
60.0
May 2010
Apr 2012
Jun 2012
May 2012
5
16/07/2012
Jan 2012
Mar 2012
Feb 2012
UCL
09/07/2012
Oct 2011
Nov 2011
Dec 2011
CL
Jan 2010
Jul 2011
Sep 2011
Aug 2011
UCL
Mar 2010
20,000 Days
Phone calls
Apr 2011
Jun 2011
May 2011
9
Feb 2010
Healthy Hearts Dashboard
January 2013
18/06/2012
Jan 2011
Mar 2011
Feb 2011
6
% Readmits
Oct 2010
Nov 2010
Dec 2010
8
Dec 2012
Nov 2012
Oct 2012
Sep 2012
Aug 2012
Jul 2012
Jun 2012
May 2012
Apr 2012
Mar 2012
Feb 2012
Jan 2012
Dec 2011
Nov 2011
Oct 2011
Sep 2011
Aug 2011
60
May 2011
70
Feb 2011
80
Jan 2011
CL
Dec 2010
Number of patients with primary diagnosis of ACS
Oct 2010
Jul 2010
Sep 2010
Aug 2010
Monthly Volume of Patients with CHF as primary diagnosis
Nov 2010
2
Sep 2010
130
Jul 2010
150
Jun 2010
0
Aug 2010
1
May 2010
Monthly volumes for Chronic Heart Failure patients are
unstable and shows some element of seasonality
Apr 2010
Apr 2010
Jun 2010
May 2010
40.0
Mar 2010
Jan 2010
Mar 2010
Feb 2010
Number of Patients
CL
Days
140
04/03/2013
25/02/2013
18/02/2013
11/02/2013
04/02/2013
28/01/2013
21/01/2013
14/01/2013
07/01/2013
31/12/2012
24/12/2012
17/12/2012
10/12/2012
03/12/2012
26/11/2012
19/11/2012
12/11/2012
05/11/2012
29/10/2012
22/10/2012
15/10/2012
08/10/2012
01/10/2012
24/09/2012
80.0
Feb 2010
Number of Patients
100.0
Jan 2010
Dec 2012
Nov 2012
Oct 2012
Sep 2012
Aug 2012
Jul 2012
Jun 2012
May 2012
Apr 2012
Mar 2012
Feb 2012
Jan 2012
Dec 2011
Nov 2011
Oct 2011
Sep 2011
Aug 2011
Jul 2011
Jun 2011
May 2011
Apr 2011
Mar 2011
Feb 2011
Jan 2011
Dec 2010
Nov 2010
Oct 2010
Sep 2010
Aug 2010
Jul 2010
Jun 2010
May 2010
Apr 2010
Mar 2010
Feb 2010
Jan 2010
120.0
18%
Readmission rate for patients with a primary diagnosis of CHF
16%
7
14%
UCL
12%
10%
8%
4
6%
4%
CL
LCL
3
LCL
2%
0%
The Readmission rate for CHF patients is stable and exhibits
normal variation only
20
Number of successful phone calls per week
16
UCL
3
14
12
10
8
6
4
CL
2
0
Week Commencing
Week commencing
Since mid-November the number of successful calls per week
has increased
12%
ACS Readmission Rate
UCL
10%
8%
UCL
4.5
6%
4%
CL
Achievements to date
-
Team building / shared & and agreed focus on patient
journey/outcome
Evidence collection
Fitting the jigsaw pieces into a coherent and appropriate Heart
Failure Pathway
Efficient, empowering and co-ordinated care
Patient journey