Capacity Leveraging, Earlier Access, Redefining Early Discharge is a partnership between Justice Health and Forensic Mental Health Network and Corrective Services New South Wales, to develop a joint access strategy to create effective and efficient patient flow at the Metropolitan Remand and Reception Centre in Silverwater.
Aim
To ensure that all patients entering the Metropolitan Remand and Reception Centre have access to timely health services that are appropriate for their individual needs.
Benefits
- Timely access to care.
- Reduced risk associated with prolonged wait times.
- Improved patient experience.
- Reduced number of patient complaints. Increased collaboration between Justice Health and Forensic Mental Health Network and Corrective Services New South Wales.
Background
The Metropolitan Remand and Reception Centre is the largest remand and reception correctional facility in NSW. The centre receives patients/inmates who are on remand and are awaiting further court hearings. The facility receives over 25% of new male admissions into correctional centres across the state. In 2018 the centre received 10,988 new admissions, which equates to an average of 31 new admissions per day, seven days per week, 365 days of the year.
The health care service delivery is based on a nurse led model of care and is focused on screening and reception (triaging), providing health care and monitoring the health status of patients and providing treatment as required. Health services provided include primary care, mental health, drug and alcohol, population health and dental.
The morbidity statistics for patients/inmates admitted to the Metropolitan Remand and Reception Centre are significantly greater than the general Australian population identified for all health indicators:
- 25% of adults in custody identify as Aboriginal compared with 2.9% in the community.
- 65% have a diagnosis of mental illness.
- 65% identify has having a substance abuse issue.
- 69% reported using alcohol in a quantity and pattern deemed hazardous.
Implementation
Solution 1: Implementing a dedicated interface to manage patient flow across the Darcy unit.
The implementation will align existing resources to better meet service demand. Trial the reallocation of an afternoon nursing unit manager to be the care navigator for the Darcy unit, including being accountable for the visual management board and cell to cell safety huddles. To lead the multidisciplinary team in the Darcy unit and coordinate bed flow with Corrective Services NSW.
Solution 2: Implementing a multidisciplinary team model of care for service delivery
Review the model of care and implement a multidisciplinary 'discharge' process for all patients in the Darcy unit and implement a complex care planning team for patients with a length of stay of more than seven days.
Status
Pre-implementation/implementation:
Due to the Covid-19 pandemic the use of the Darcy unit has changed. Less patients are currently coming into custody through the police cells locations and therefore bed block and patient flow issues are almost non-existent. Patient/inmate numbers were also reduced in the Metropolitan Remand and Reception Centre to enable the centre to be utilised as an isolation/quarantine hub and enable the building as a state of the art field hospital, to house both male and female patients, if required.
Dates
Commenced July 2019 to July 2021.
Implementation Sites
Metropolitan Remand and Reception Centre, Darcy Unit.
Partnerships
Corrective Services New South Wales, NSW Agency for Clinical Innovation, University of Tasmania
Results
The daily visual management board meeting is now part of everyday business, improved with multiple disciplines attending. This enables each team to triage and plan the workload for the day, redistribute staffing resources, if required, and to plan for the following day.
Lessons Learnt
- Good sponsorship is key to driving change in the organisation.
- Be flexible when resistance impacts on any stage of the project.
- Allow the Centre for Healthcare Redesign methodology guide you, to enable root causes in the diagnostics phase to be identified and addressed with appropriate solutions.
- Acknowledge that change doesn’t occur in isolation, a constant challenge is working with another organisation’s priorities and timeframes.
References
All data and information has been collected from Justice Health and Forensic Mental Health Network and Corrective Services NSW databases.
Contact
Lisa Hogan
Regional Nurse Manager Metropolitan West
Justice Health and Forensic Mental Health Network
Phone: Ph (02) 8226 0813
Lisa.hogan1@health.nsw.gov.au
Benjamin Vafo’Ou
Nursing Unit Manager Mental Health
Justice Health and Forensic Mental Health Network
Ph (02) 9289 5636
Benjamin.vafoou@health.nsw.gov.au
