Maitland is the fastest growing regional city in NSW. To meet the growing health care needs of Maitland and surrounding communities now and into the future, Maitland Hospital relocated to a new purpose-built facility in January 2022.
On relocation, the facility experienced an immediate increase in emergency department (ED) presentations and admitted inpatient activity, impacting patient access, flow and performance. As a result, there was an increase in adverse publicity at a local level, with low consumer confidence extending to a systematic loss of public support for the health service. In April 2022, Maitland Hospital partnered with the NSW Ministry of Health Systems & Performance Support Branch, undertaking a desktop review. As a result of the partnership, the Whole of Health Program was commissioned with a focus on six key areas requiring reform, with causes verified, primary drivers identified and solution design nominated.
Reducing average length of stay
The facility faced challenges in patient access and flow resulting in reduced patient access from the ED to admitted inpatient beds. The lack of access to inpatient beds was attributed to low back of house discharges with an increased admission length of stay due to complex patient acuity. This has a cumulative impact by also reducing planned patient admissions for elective surgery. The goal of this project is to improve timely patient access for admitted patients to acute inpatient services. Three key objectives were identified to be achieved by June 2024:
- a reduction in monthly average length of stay from 6.5 days to ≤ 5 days
- a reduction in total emergency presentations with extended stays greater than 24 hours from 276 patients/month to ≤ 150 patient per month
- achieve a 10% improvement in the Bureau of Health Information Patient Experience Questionnaire.
Addressing fragmented coordination of care
Solutions were created to address the challenges associated with patient care outcomes and experience of:
- a fragmented coordination of patient centred discharge planning
- a loss in speciality models of care, resulting in a decrease in consolidated patient care coordination
- limited use of the Electronic Patient Journey Board (EPJB) to facilitate care coordination
- patient access and flow is targeted and optimised Monday – Friday business only.
The key solutions will enable the establishment and transition for all disciplines across Maitland Hospital, Acute Inpatient Services to new ways of working and accountability based on the HNELHD Excellence Framework and HNELHD Strategic Plan 2021 - 2026. Implementation commenced in March 2024 with an overarching communication framework, titled IDEAL, to help frame conversations to assist in the implementation of care with intent at the bedside. This solution addresses the missing link with patient-centred discharge planning, focusing on the principle of partnering with consumers with the aim of improving communication and information sharing to mutually meet the patients and carers needs. This framework is currently being implemented via a pilot ward within acute inpatient services using the Accelerating Implementation Methodology (AIM) approach.
‘Care with Intent’ is the second solution, aimed at improving the fragmented coordination of care within acute inpatient units. Care with Intent, aligns the accountability for the coordination of patient care back to the bedside nurse, improves clarity of roles and responsibilities by utilising existing patient care essentials principles and tools of excellence to improve the therapeutic relationship between the nurse and patient. The solution encourages discussion to empower the patient to be an active participant in their care, ensuring a proactive approach to patient centred care and discharge care coordination and works in with the IDEAL roll-out phase. Next steps include creation of a patient allocation matrix, that will help ensure that patients experience care with the right skillset of staff, and the creation of a discharge response team, designed to provide leadership and centralised coordination of patients requiring moderate to complex discharge planning.
View this project's poster from the Centre for Healthcare Redesign graduation May 2024.
