Leading Better Value Care Friday 25 th August 2017 Kate Lloyd | - - PowerPoint PPT Presentation

Leading Better Value Care

Friday 25th August 2017

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Kate Lloyd | A/Director Acute Care | 0467 603 578 | kate.Lloyd@health.nsw.gov.au

The ACI acknowledges the traditional owners of the land on which we

• meet. We pay our respects to Elders past and present and extend that

respect to other Aboriginal peoples present here today.

Acknowledgement

Leading Better Value Care

• 1. Management of Osteoarthritis (ACI)
• 2. Osteoporotic Refracture Prevention (ACI)
• Musculoskeletal service (ACI)
• 3. (Diabetes) High Risk Foot Services (ACI)
• 4. Inpatient Management of Diabetes Mellitus (ACI)
• 5. Renal Supportive Care (ACI)
• 6. Inpatient management of Chronic Heart Failure (ACI)
• 7. Inpatient management of Chronic Obstructive

Pulmonary Disease (ACI)

• 8. Falls in Hospitals (CEC)

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Leading Better Value Care

• 1. Management of Osteoarthritis (ACI)
• 2. Osteoporotic Refracture Prevention (ACI)
• Musculoskeletal service (ACI)
• 3. (Diabetes) High Risk Foot Services (ACI)
• 4. Inpatient management of Diabetes Mellitus (ACI)
• 5. Renal Supportive Care (ACI)
• 6. Inpatient management of Chronic Heart Failure (ACI)
• 7. Inpatient management of Chronic Obstructive

Pulmonary Disease (ACI)

• 8. Falls in Hospitals (CEC)

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Unwarranted Clinical Variation

'variation that cannot be explained by the condition or the preference of the patient; it is variation that can only be explained by differences in health system performance'

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Unwarranted Clinical Variation

Chronic Heart Failure (CHF)

• Guidelines for the prevention,

detection and management of chronic heart failure in Australia (2011)

• NSW Clinical Service

Framework for CHF (2016)

Chronic Obstructive Airway Disease (COPD)

• COPD-X (2017)

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TSANZ – Oxygen guidelines for acute oxygen use in adults (2015) Quality Use of Medicines Indicators for Australian Hospitals (2014)

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• Service utilisation data

(administrative dataset)

• Bureau of Health

Information (BHI)

• Healthcare in Focus

(mortality and readmission)

• Admitted patient data

survey

• Local data
• Partnership audit (N=40)
• Feedback session
• Improvement plan
• Implementation of

improvement plan

• Benchmarking
• Audit tool
• Clinical guidelines
• Expert Reference

Group

• NSW care bundle

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Support and Tools

• Pre-planning pack / checklist
• Audit tools (COPD, CHF)
• Auditors (partnership audit)
• Patient reported measures
• experience (linked to BHI)
• outcomes (PROMIS-29 + exploring disease

specific)

• Data analysis (triangulation)
• Feedback session
• Tailored implementation support - QuIC

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(Unwarranted) Clinical Variation in ED

Admission routes

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(Unwarranted) Clinical Variation in ED

Time in ED

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(Unwarranted) Clinical Variation in ED

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(Unwarranted) Clinical Variation in ED

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(Unwarranted) Clinical Variation in ED

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(Unwarranted) Clinical Variation in ED

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Lessons Learned So Far

• Sites require tailored support
• Some common themes:
• oxygen use and prescription
• spirometery testing
• timing of CXR’s
• smoking cessation support
• antibiotic use
• key referrals
• discharge practices
• Also provides an opportunity to showcase what

sites are doing well

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Level 4, Sage Building 67 Albert Avenue, Chatswood NSW 2067 PO Box 699 Chatswood NSW 2057 T + 61 2 9464 4666 F + 61 2 9464 4728 info@aci.health.nsw.gov.au www.aci.health.nsw.gov.au

Kate Lloyd

A/Director, Acute Care (02) 9464 4602 | 0467 603 578 Kate.Lloyd@health.nsw.gov.au

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Level 4, Sage Building 67 Albert Avenue, Chatswood NSW 2067 PO Box 699 Chatswood NSW 2057 T + 61 2 9464 4666 F + 61 2 9464 4728 info@aci.health.nsw.gov.au www.aci.health.nsw.gov.au

CH CHF: F: NS NSW W Inpati atient C t Car are B Bundle

INVESTIGATIONS INDICATOR

• Review of history
• ECG
• Chest x-ray
• Blood biochemistry
• Accurate assessment of fluid balance

Investigations performed? In what time frame? Are actions taken in response to test results? SYMPTOM MANAGEMENT INDICATOR

• Identification of cause of exacerbation
• Evidence-based medicines
• Dyspnoea
• Oxygen therapy
• Non-invasive ventilation, where

appropriate Pulmonary congestion and load on the heart: administration of:

• loop diuretics
• vasodilators
• inotropic agents

Evidence in the clinical notes of best practice, including medicines management PATIENT FLOW, DISCHARGE AND CEILING OF CARE INDICATOR

• Access to specialist support and allied health
• Access to advance care planning and palliative care services
• Access to disease management services
• Provision of individualised management plans
• Appropriate medicines management on discharge

Evidence of :

• key referrals
• appropriate transfer and

discharge

• medicines on discharge best

practice

• community support services

arranged in hospital

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Level 4, Sage Building 67 Albert Avenue, Chatswood NSW 2067 PO Box 699 Chatswood NSW 2057 T + 61 2 9464 4666 F + 61 2 9464 4728 info@aci.health.nsw.gov.au www.aci.health.nsw.gov.au

CO COPD: NS NSW W Inpati atient C Car are B Bundle

CONFIRM (DIAGNOSIS), EXACERBATION AND SEVERITY INDICATOR

• Focused review of history and physical examination
• Spirometry unless the patient is confused or comatose
• Arterial blood gas measurements for appropriate patients
• Chest X-ray and ECG

Investigations performed? In what time frame? Are actions taken in response to test results? OPTIMISE TREATMENT INDICATOR Oral corticosteroids – IV corticosteroids show no additional benefit Timing of administration Antibiotics – for patients with clinical signs consistent with bacterial infection Type and timing Controlled oxygen therapy Compliance with TSANZ oxygen prescription guidelines PATIENT FLOW, DISCHARGE AND CEILING OF CARE INDICATOR

• Access to allied and specialist services in hospital including nutritional support

and smoking cessation services.

• Access to pulmonary rehabilitation services

Key referrals Ceiling of care discussions and access to palliative care services Evidence of advanced care directives and acute resuscitation plans

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