The St George Hospital Renal Supportive Care (RSC) service in South Eastern Sydney Local Health District (SESLHD) provides renal, palliative, dietetic and social work support for patients and families. The service cares for:
- end-stage kidney disease patients who have chosen a conservative (non-dialysis) treatment pathway
- renal replacement therapy patients who are struggling with an ongoing symptom burden
- those who are approaching end of life, where a palliative approach is needed.
In June 2022, RSC went live on the Health Outcomes and Patient Experience (HOPE) platform. Leveraging the power of the Integrated Palliative Outcome Score (IPOS)-Renal survey and EQ-5D-5L in their daily practice, RSC made a strategic move to embrace patient-reported measures (PRMs) on the HOPE platform.
Clinicians in the RSC service use PRMs to tailor care according to a patient’s responses and care needs, helping them to manage symptom burden. Clinicians discuss care needs at the consultation and refer to other specialists as required. The RSC multidisciplinary team, which includes dietetics and social work, uses PRMs to provide individualised care that meets the patient’s needs.
Patient-reported measures workflow
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Clinician assigns surveys to patients.
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Patient completes surveys on iPad in the waiting room prior to clinic appointment.
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Clinicians send surveys to patients via email for completion prior to their clinic appointment.
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Patient responses are displayed via the HOPE platform.
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Clinician reviews patient responses.
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Patients is provided with a tailored treatment plan following PRMs review and consultation.
Consumer story
Adam*, an 80-year-old male, was a pre-dialysis patient who eventually moved onto dialysis. During treatment, Adam complained of a severe itch, which was flagged when Adam completed the IPOS-Renal survey. Following consultation and treatment, Adam was able to get his itch under good control.
Clinicians have noted that total symptom scores improve between the first and third visits, with some return of symptoms at visit five. This indicates a need for ongoing PRMs collection to identify areas of concern and support ongoing symptom management.
*Name has been changed for patient privacy.
Benefits for the patient
- Patients receive tailored care plans, personalised interventions and enhanced communication with their healthcare providers. The implementation of PRMs has led to improved patient satisfaction and treatment outcomes, and better overall wellbeing.
- PRMs are used by the entire multidisciplinary team to continuously monitor patient progress and identify any emerging issues that may impact on quality of life.
Benefits for the service
- PRMs are instrumental in enhancing SESLHD services. Through systematic collection and analysis of PRMs data, the district gains valuable insights into areas for improvement and innovation. This data-driven approach enables the district to design and implement targeted interventions that address the specific needs and preferences of our patient community.
- The integration of PRMs with the electronic medical record (EMR) system streamlines data analysis, ensuring ease of access for the entire medical team. By consolidating information, it eliminates the need for clinicians to juggle multiple screens simultaneously. This seamless integration enhances efficiency, enabling clinicians to focus on patient care without the inconvenience of logging into separate systems.
Benefits for the organisation
- Within SESLHD, PRMs foster a culture of collaboration and shared responsibility. Results are communicated transparently through channels including regular reports, presentations and interactive forums.
- Promotes a collective understanding of performance by engaging clinicians, administrators and other key stakeholders in meaningful discussions around PRMs.
Helpful tips for other services
Start small with a single location in a specific department or specialty. Gather feedback, refine processes and support clinicians’ confidence with using PRMs before scaling up.
Involve clinicians, managers and support staff collectively from the outset to ensure buy-in, address any areas of concern, and focus the implementation approach.
PRMs implementation is most successful when it is embedded into routine clinical practice and workflows. Seamless integration enhances adoption and minimises disruption.
Clinical engagement approach
The two SESLHD PRMs leads are responsible for the implementation of PRMs and the HOPE platform locally, supporting education, training, workflow mapping and engagement to enable successful local implementation of PRMs and the HOPE platform.
For the RSC service, the leads took a systematic approach to implementation, including the following: supported by ‘just in time’ education and training.
- identifying clinical services for PRM implementation through consultation and awareness building at all levels of the organisation – leveraging existing relationships and forging new ones with clinicians and managers across the LHD.
- focusing on change and adoption strategies including education, training and implementation support for clinicians and support staff.
- education and training through a series of interactive sessions to socialise PRMs concepts, integrate the use of PRMs into existing clinical workflows and emphasise the importance of review and use of PRMs at the point of care to support collaborative and shared care decision making with patients.
- beyond the initial implementation period, engaging in behavioural change strategies, providing ongoing support, education and feedback to ensure sustained uptake.
Organisational structure
SESLHD PRMs infrastructure includes several key roles.
Sponsors: The Deputy Director, Clinical Governance and Medical Services is the Executive Sponsor for the PRMs program at SESLHD and leads the SESLHD Clinical Governance Unit.
This role is vital to supporting the ongoing implementation, scale and spread of PRMs across the district by removing barriers and championing PRMs at an organisational level. Senior leaders, including patient safety managers, department heads and clinical program managers, provide strategic support at a facility and service level.
Champions: These advocates promote PRMs adoption within their teams and services. They are invaluable in leading and advocating for PRMs use within their service or department, convening and encouraging colleagues throughout the implementation process and supporting sustainability in the longer term. They have incorporated PRMs into their model of care.
Agents: The SESLHD PRMs Program Leads sit within the SESLHD Clinical Governance Unit and report directly to the Deputy Director, Clinical Governance and Medical Services. This alignment ensures seamless communication and integration with patient safety and quality activity.
The alignment of the PRM Program with Clinical Governance units at SESLHD is fundamental to healthcare safety and quality. This ensures that clinical teams and services are supported to deliver patient-centred care that is responsive
Governance
Governance for the PRMs program at SESLHD is supported through the district’s Clinical and Quality Council. Regular reports of integrated PRMs implementation, activity and program updates are provided each month to council. The council members include the chief executive, senior executives and clinical managers from across the LHD, as well as representatives from clinical departments, administration and patient advocacy groups. The council reviews progress, identifies challenges and provides advice on strategic adjustment.
To raise awareness, the SELHD PRMs Leads actively engage with clinicians, department, patient safety, and clinical stream managers as well as clinical professional groups. This engagement includes presentations about PRMs and discussion on opportunities and benefits for using PRMs to enhance patient-centred care.
Acknowledgements
We acknowledge and thank the following for their participation in this project:
- Elizabeth Josland, Clinical Nurse Consultant
- Alison Smyth, Clinical Nurse Consultant
- John Shephard, Executive Sponsor, Deputy Director Clinical Governance & Medical Services
- Becky Walsh, Patient Reported Measures Project Lead
- Kath Helling, Patient Reported Measures Project Lead
- Leanna Chow, Patient Reported Measures Project Officer