Karitane redesign intake systems project

Summary

Aim

By August 2019, our aim is to streamline the intake process to improve equitable and timely access for referred families. This means that the right families are linked to the right Karitane service, by August 2019.

Objectives

• Decrease in the waiting period for clients from referral received to being contacted from 23 days to 7 days by August 2019.
• Decrease in the waiting period for clients being triaged and allocated to a service from 35 days to 7 days by August 2019.
• Decrease the average waiting times of high-risk families referred to the residential units at Karitane from nine weeks to six weeks by August 2019.

Benefits

Families

• The development of any further health or psychosocial risk factors to our Level 2 and 3 families by reducing the wait times will be prevented or minimised with a focus on person centred care.
• Families and staff will have a greater understanding of the referral pathways and easier navigation through the services.
• Trust and confidence in Karitane services by staff, families, referring agents and broader community.

Staff

• The development of operational guidelines will provide and support staff on processing, triaging and admission duties.
• Reduced time wasting and duplication of information gathering at both intake and point of admission thus improving the efficiency of the processes of the services.
• Processes that will collect accurate data to enable improved evaluation of the effectiveness of the service.

Background

During 2015, all services were phased into the centralised referral system and there were a number of process issues following this inclusion. Procedures had been implemented and reviewed but there were still cumbersome manual process and significant time lag to activate referrals. In the last five years our referrals have increased by 236% and we receive, on average, 300 referrals per month to be referred to nine services within Karitane.

Other issues identified include:

• Multiple contact touchpoints for our clients before they access one of our services.
• Outdated pre-admission interview information from first intake to the client entering our services.
• Limited management support for intake staff.
• No evaluation of the effectiveness and efficiency of the service.
• Booking and scheduling systems vary across the services.

Our baseline data taken from January to July 2018 report the waiting time of all referred families waited an average of nine weeks to access our services. Furthermore, qualitative data from Karitane staff identified service issues that include families being asked to repeat their story at admission, the levels of care not always matching the client information and poor communication between services.

We have also identified our Level 2 and Level 3 clients (high risk families according to the Families NSW Supporting Families Early Package 2010) are not supported in a timely manner.  An efficient intake system will minimise or prevent the development of any further health or psychosocial risk factors, with a focus on person centred care that is aligned with our early intervention and prevention goals.

Implementation

The team identified four key issues that were identified at the diagnostic stage of the project. These were identified through consumer and key stakeholder engagement. To improve consumer access and reach key objectives, the following solutions for the identified issues were determined.

Issue: Multiple data systems

Currently there is multiple data platforms on which information is recorded and this results in process delays which impact on waiting times in contacting clients Currently Karitane does not have access to the electronic medical record (eMR), therefore referral forms have to be reformatted, with extra fields added to include information required for patient administration system (PAS) registrations. This means that 50% of intake staff time is spent on duplication of data.

Solution

• Customer relationship management (CRM) platform for intake service.
  • Intake staff will have one platform (CRM) on which all referral information, preadmission information and data information will be recorded for easy access and increased security for health information.
  • Clients will be processed in a more efficient and timely manner and client safety is maintained.

Issue: Process delays

The current system has duplicating data entries, communication delays, multiple phone tag with clients.

Solution

• One data platform for all information to be recorded.
• Use of the PAS scheduler for booking clients.
• Text message and email sent to clients upon receipt of referral with information on referral process and support services whilst waiting for admission.

Issue: Client safety

Wait times can impact the clients, with an identified lack of support for clients waiting to be admitted to the residential unit.

Solution

• Weekly multidisciplinary team intake meeting to prioritise referrals for client safety and client flow.
• Improve information on intake processes and services for clients on the website.
• Improved communication between intake and referring agents to support appropriate timely access to care.

Issue: Triage and prioritisation

No current processes to effectively prioritise and triage referrals. Information gathered is repeated throughout services.

Solution

• Guidelines and triage tool
  • To formulate a set of guidelines to triage and prioritise clients into the most appropriate service in a timely manner.
  • To support and instruct Intake clinical staff decision-making for triage and prioritisation of referred clients into low, medium or high priority looking at risk factors, vulnerabilities and protective factors.

Status

Implementation – The project is ready for implementation or is currently being implemented, piloted or tested.

Dates

Project planning started in August 2018, for estimated completion in October 2019.

Some key dates include:

• multidisciplinary team service meetings began in March 2019
• patient administration system scheduler for client bookings began in January 2019
• risk assessment triage tool and guidelines completed in July 2019
• the Karitane triage tool was piloted since June 2019
• piloting the CRM platform since July 2019.

Implementation sites

Karitane – Central Intake at the Digital Health Service

Partnerships

• Centre for Healthcare Redesign
• HealthShare NSW
• CRM Platform

Evaluation

Evaluation of solutions and results measured will be done the following ways.

• Repeat surveys to clients, staff and referring agents once solutions  are implemented for monitoring and evaluation.
• Data collection of waiting times to continue on when clients are being contacted and when they are accessing our services. These results will be monitored, reviewed and evaluated.
• Regular audits to ensure that intake staff comply with the triage guidelines
• Time in motion studies repeated on administration duties and performing triage.
• Organisational key performance indicators and bed occupancy will be monitored to ensure they are in accordance with the local health district agreement.

Lessons learnt

• The importance of scheduling and planning days to work on the project so that deadlines can be met and the momentum can continue.
• Expect objectives to change periodically during the investigation and diagnostics phases of the project.
• Stakeholders will respond to different types of communication so be creative in your approach.
• Check timelines for introducing new systems that affect your project as they may influence your objectives and solutions.

Further reading

• Duncombe R. What systems participants know about access and service entry and why managers should listen. Australian Health review. 2017;41:449-454.
• Migeul R, McLean-Carranza A, Prado-Prado J, Domínguez-Caamaño P. Managing Waiting Times to Predict No-shows and Cancelations at a Children’s Hospital. JIEM. 2016;9(5):1107-1118. http://dx.doi.org/10.3926/jiem.2075
• NSW Department of Health. NSW Health/Families NSW Supporting Families Early Package – SAFE START Strategic Policy. North Sydney: NSW Dept of Health; 2009.
• NSW Ministry of Health. The First 2000 Days Framework (PD2019_008). North Sydney: NSW Ministry of Health; 2019.

Contacts