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ESTABLISHI SHING A G A PATIENT AN AND F FAMI AMILY CENTRE RED C D CARE APPROAC PROACH T TO IM IMPROVEM EMEN ENT
Jo a nne Minfo rd Co nsulta nt Pa e dia tric Surg e o n Alde r He y Childre n’ s Ho spita l L ive rpo o l
@joanneminford
ESTABLISHI SHING A G A PATIENT AN AND F FAMI AMILY CENTRE RED - - PowerPoint PPT Presentation
ESTABLISHI SHING A G A PATIENT AN AND F FAMI AMILY CENTRE RED - - PowerPoint PPT Presentation
ESTABLISHI SHING A G A PATIENT AN AND F FAMI AMILY CENTRE RED C D CARE APPROAC PROACH T TO IM IMPROVEM EMEN ENT Jo a nne Minfo rd Co nsulta nt Pa e dia tric Surg e o n Alde r He y Childre n s Ho spita l L ive rpo o l
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PATIENT AN AND F D FAM AMILY C CEN ENTRED C CARE ARE
...c ompassionate... ...pro vide d with
r e spe c t...
...tha t inc lude s pa tie nts a nd fa milie s a s pa rtne rs... ... tre a ts pa tie nts a nd fa milie s with
dignity...
...re vo lve s a ro und the ne e ds a nd de sire s o f pa tie nts a nd fa milie s... ...ra the r tha n a ro und the o rg a niza tio ns a nd syste ms...
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but w ut we’ e’re a a chi hildren’s ho hospi pita tal we e do all tha that… t… d don’t we? e?
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abdom bdominal pa pain
1/3 1/10 >6 hrs 1/6 1/3 1/3 1/20 211 children
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WHAT AT IS IS IT T REALLY LY LIKE IKE?
Patient shadowing Care flow mapping Patient stories Surveys
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GP Advise d to a tte nd DGH Arrive d in DGH E D T ria g e d Se e n b y do c to r Re fe rre d to AHCH L e ft DGH Arrive d a t AHCH E D Surg ic a l te a m info rme d Se e n b y surg ic a l re g istra r L e ft E D
analgesia
Mo rning surg e ry 1113 1145 1158 1315 1335 1428 1700 1750
investigations reviewed
Next day USS
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total journey - 7hrs 20 minutes total time AHCH - 3 hours 20 minutes face to face time - 1 hour 2 minutes
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Re turne d fo r USS We nt to E D fo r re sults Surg ic a l te a m c o nta c te d Se e n b y SHO We nt to wa rd Bo o ke d e me rg e nc y list Ove rnig ht sta y We nt to the a tre Ove rnig ht sta y We nt ho me
1209 1235 1240 1300
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total journey ≈ 3.5 days total time to theatre ≈ 2 days face to face time ≈ 1 ½ hours
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PATIEN ENT A AND FAMI MILY S Y SHADOWI OWING
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BEFOR ORE P E PFCC - PATIEN ENT E EXPER ERIEN ENCE CE
- long waits
- inconsistent care
- unnecessary admissions
- delayed diagnosis
- complaints
Poor
- or
Exper perie ience ce
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BEFOR ORE P E PFCC - STAFF E EXPERI ERIEN ENCE CE
- distressed children
- angry parents
- no consistency of care pathway
- unnecessary admissions
- formal complaints and incidents
Poor
- or
Experie ience ce
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You got it r ight!
- We ll info rme d
- Pa in Co ntro l
- T
ime ly , e ffe c tive a sse ssme nt, d ia g no sis & tre a tme nt
- Po sitive e xpe rie nc e
fo r c hild / fa mily/ sta ff
Ple ase sor t my pain T e ll me what's going
- n?
Ple ase he lp me ge t be tte r Ple ase be nic e to me ! Ple ase don't make me wait too long
Who a re yo u? Wha t info rma tio n do I ne e d to kno w, ho w lo ng will I wa it? Ho w will yo u find o ut a t first wha t’ s wro ng with me ? Wha t ha ppe ns ne xt? Will yo u ke e p c he c king o n me ? Will yo u se e me a nd tria g e me within 15 minute s? Will a do c to r re vie w me o n the b a sis o f my tria g e c a te g o ry? Will a do c to r se e if I ne e d a n o pe ra tio n within 60 minute s? Will yo u b e q uic k to o rg a nise my te sts? Will yo u te ll me a b o ut this pla n a s so o n a s yo u c a n? Will yo u c he c k if I ’ m in pa in whe n I a rrive ? Will yo u g ive me so me thing to he lp the pa in? Will yo u ke e p c he c king o n me ? Will yo u te ll me wha t to do whe n I le a ve he re a b o ut my c a re ? Will yo u lo o k a t me fa irly q uic kly? Will yo u g ive me a ll the rig ht te sts? Will yo u lo o k a t me a nd de c ide wha t’ s wro ng Will so me o ne mo re se nio r to yo u lo o k a t me a nd he lp de c ide wha t’ s wro ng to o ? Will yo u ma ke a pla n b e twe e n yo u a nd the n c o me a nd te ll me a b o ut it? Will yo u b e kind? Will yo u b e ho ne st? Will yo u g ive me thing s to do ? Will yo u e xpla in thing s to me ? Will yo u liste n to me ?
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AI AIMS AN AND M MEAS ASURES
95% of children/families felt that pain in was we well m mana naged 90% of children have action plan withi thin 2 2 ho hours urs 90% of children/families felt that wa wait it was acce cceptable le < 5% of patients cam ame bac back unexpectedly
SLIDE 19 Date: ___ / ___ / ____ Time : _____ : _____ Accompanied by: Mum Dad Other ______________ Parental Responsibility Yes No Unit number: Name: Address: Date of Birth:
Male Female
School: ___________________________ This proforma record replaces ED notes for this attendance. Please record history and examination below. Analgesia given: (see triage sheet) Patient information given Yes No Yes No Dipstick Urinalysis (including glucose and beta HCG): Time of last food: ___________________ Time of last clear fluid : ______________
HISTORY
History of presenting complaint Past medical & surgical history:
EXAMINATION
Name: Unit Number:
ACUTE LOWER ABDOMINAL PAIN
(Presenting to Emergency Department aged ≥4yrs) SLIDE 20
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SHAD ADOWING G - ImERS ERSE
“It can be very dangerous to see things from somebody else's point of view without the proper training.” ― Douglas Adams, The Ultimate Hitchhiker's Guide
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I mE RSE
3rd Ye a r
Da yc a se Outpa tie nts Ac c ide nt a nd E me rg e nc y
4th Ye a r 5th Ye a r
Wa rd Ba se d (Junio r Dr)
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How
- w doe
does i s it wor work?
- Structured patient shadowing collecting
direct observations of hundreds of patient and family experiences per year…
- ….using this in a system of continuous
service evaluation and improvement…
- ….shaping compassionate healthcare
providers now and for the future.
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Qual uality I Improve vemen ent
Positive Findings Negative Findings
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Po sitive I nc o nsiste nc y I ndividua l / T e a m E xc e lle nc e Awa rds a nd Re c o g nitio n NO RI SK Po sitive Co nsiste nc y Sta ff Mo ra le Po sitive a ffirma tio n a nd Pe rc e ptio n Pub lic ity NO RI SK
Ne gative Inc onsiste nc y Rapid Re sponse Imme diate Re ac tion Or ganisational L e ve l Clinic al L e ve l Pr e ve ntative Str ate gie s Mode l
HI GH RI SK
Ne gative Consiste nc y Continuous Impr
- ve me nt
Mode l
L OW RI SK
+VE
- VE
CONSISTENCY LOW HIGH EXPERIENCE
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Qual uality I Improve vemen ent findings
F ind ing s Inte rpre ta tio n a nd sig nific a nc e L e ve l o f Issue Org a nisa tio na l fe e d b a c k a nd sug g e ste d a c tio n pla n Po sitive Co nsiste nc ie s
Re gular update s about pr
- gr
e ss by Nur sing Staff Good e xplanations and time take n fr
- m nur
sing staff, doc tor s and anae sthe tists Dayc ase Dayc ase F e e dbac k at Dayc ase Update as positive staff r e infor c e me nt
Po sitive Inc o nsiste nc ie s
“Individual tailor ing of tr e atme nt to” Ability to adapt a syste m to use r ne e ds de spite high volume of
- the r
wor kloads E vide nc e of be st pr ac tic e
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Qual uality I Improve vemen ent findings
F ind ing s Inte rpre ta tio n a nd sig nific a nc e L e ve l o f Issue Org a nisa tio na l fe e d b a c k a nd sug g e ste d a c tio n pla n Ne g a tive Co nsiste nc ie s
Conse nt – issue s sur r
- unding
pr ivac y, c onse nt on day Waiting time s L imite d r e sour c e s in waiting r
- om for
patie nt and familie s Sur gic al CBU’s Or ganisational Dayc ase Disc uss with Conse nt L e ad E IDO le afle ts. Conse nt in Clinic – c onfir mation signatur e in dayc ase F ur the r tr ial of stagge r e d admission time s Applic ation to Char ity for pr
- vision of
r e sour c e s in par e nts waiting r
- om e .g.
T e le vision, Ne wspape r s, Magazine s.
Ne g a tive Inc o nsiste nc ie s
Re c e nt illne ss (c hic ke npox) – c alle d hospital advise d of no c onc e r n L ac k of c lar ity - Consultant “r andom dr ug” Who did the y c all? Sur gic al CBU’s Poor c ommunic ation L iaise with sc he duling and booking to r e vie w advic e se nt with dayc ase le tte r . T r ust Polic y Pote ntial for dr ug e r r
- r
(ne ve r e ve nts
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