ESTABLISHI SHING A G A PATIENT AN AND F FAMI AMILY CENTRE RED - PowerPoint PPT Presentation

ESTABLISHI SHING A G A PATIENT AN AND F FAMI AMILY CENTRE RED C D CARE APPROAC PROACH T TO IM IMPROVEM EMEN ENT Jo a nne Minfo rd Co nsulta nt Pa e dia tric Surg e o n Alde r He y Childre n’ s Ho spita l L ive rpo o l @joanneminford

PATIENT AN AND F D FAM AMILY C CEN ENTRED C CARE ARE ... c ompassionate ... ...pro vide d with e spe c t ... r ...tha t inc lude s pa tie nts a nd fa milie s a s pa rtne rs... ... tre a ts pa tie nts a nd fa milie s with dignity ... ...re vo lve s a ro und the ne e ds a nd de sire s o f pa tie nts a nd fa milie s... ...ra the r tha n a ro und the o rg a niza tio ns a nd syste ms...

but w ut we’ e’re a a chi hildren’s ho hospi pita tal we e do all tha that… t… d don’t we? e?

abdom bdominal 1/3 1/3 1/3 pa pain 211 children 1/6 1/20 1/10 >6 hrs

WHAT AT IS IS IT T REALLY LY LIKE IKE? Patient shadowing Care flow mapping Patient stories Surveys

investigations reviewed Next day USS Surg ic a l Arrive d in Se e n b y te a m GP DGH E D do c to r L e ft DGH info rme d L e ft E D Advise d T ria g e d Re fe rre d Arrive d a t Se e n b y to a tte nd to AHCH AHCH E D surg ic a l DGH re g istra r analgesia Mo rning 1113 1145 1158 1315 1335 1428 1700 1750 surg e ry

total journey - 7hrs 20 minutes total time AHCH - 3 hours 20 minutes face to face time - 1 hour 2 minutes

Surg ic a l Re turne d te a m We nt to Ove rnig ht Ove rnig ht fo r USS c o nta c te d wa rd sta y sta y We nt to E D Se e n b y Bo o ke d We nt to We nt ho me fo r re sults SHO e me rg e nc y the a tre list 1209 1235 1240 1300

total journey ≈ 3.5 days total time to theatre ≈ 2 days face to face time ≈ 1 ½ hours

PATIEN ENT A AND FAMI MILY S Y SHADOWI OWING

BEFOR ORE P E PFCC - PATIEN ENT E EXPER ERIEN ENCE CE •long waits •inconsistent care Poor oor •unnecessary admissions Exper perie ience ce •delayed diagnosis •complaints

BEFOR ORE P E PFCC - STAFF E EXPERI ERIEN ENCE CE • distressed children • angry parents Poor oor • no consistency of care pathway Experie ience ce • unnecessary admissions • formal complaints and incidents

Who a re yo u? Wha t info rma tio n do I ne e d to kno w, ho w lo ng will I wa it? T e ll me Ho w will yo u find o ut a t first wha t’ s wro ng with me ? what's going Wha t ha ppe ns ne xt? on? Will yo u ke e p c he c king o n me ? Will yo u c he c k if I ’ m in pa in whe n I a rrive ? Will yo u g ive me so me thing to he lp the pa in? Ple ase sor t Will yo u ke e p c he c king o n me ? my pain Will yo u te ll me wha t to do whe n I le a ve he re a b o ut my c a re ? You got Will yo u lo o k a t me fa irly q uic kly? it r ight! Will yo u g ive me a ll the rig ht te sts? Ple ase he lp Will yo u lo o k a t me a nd de c ide wha t’ s me ge t wro ng Will so me o ne mo re se nio r to yo u lo o k a t me be tte r a nd he lp de c ide wha t’ s wro ng to o ? Will yo u ma ke a pla n b e twe e n yo u a nd the n c o me a nd te ll me a b o ut it? - We ll info rme d -Pa in Co ntro l Ple ase be Will yo u b e kind? -T ime ly , e ffe c tive Will yo u b e ho ne st? nic e to me ! a sse ssme nt, d ia g no sis Will yo u g ive me thing s to do ? & tre a tme nt Will yo u e xpla in thing s to me ? -Po sitive e xpe rie nc e Will yo u liste n to me ? fo r c hild / fa mily/ sta ff Ple ase don't Will yo u se e me a nd tria g e me within 15 make me minute s? Will a do c to r re vie w me o n the b a sis o f my wait too tria g e c a te g o ry? long Will a do c to r se e if I ne e d a n o pe ra tio n within 60 minute s? Will yo u b e q uic k to o rg a nise my te sts? Will yo u te ll me a b o ut this pla n a s so o n a s yo u c a n?

AI AIMS AN AND M MEAS ASURES 95% of children/families felt that pain in was we well m mana naged 90% of children have action plan withi thin 2 2 ho hours urs 90% of children/families felt that wa wait it was acce cceptable le < 5% of patients cam ame bac back unexpectedly

ACUTE LOWER ABDOMINAL PAIN (Presenting to Emergency Department aged ≥ 4yrs) Unit number: Date: ___ / ___ / ____ Time : _____ : _____ Name: Accompanied by: Mum  Dad  Other  ______________ Address: Parental Responsibility Yes  No  Date of Birth:  Male  Female This proforma record replaces ED notes for this attendance. School: ___________________________ Please record history and examination below. Analgesia given: Yes  No  Dipstick Urinalysis (including glucose and beta HCG): (see triage sheet) Yes  No  Patient information given Time of last food : ___________________ Time of last clear fluid : ______________ HISTORY History of presenting complaint Past medical & surgical history: EXAMINATION Name: Unit Number:

SHAD ADOWING G - ImERS ERSE “It can be very dangerous to see things from somebody else's point of view without the proper training.” ― Douglas Adams, The Ultimate Hitchhiker's Guide

I mE RSE 4 th 5 th 3 rd Ye a r Ye a r Ye a r Ac c ide nt Wa rd Ba se d a nd Da yc a se Outpa tie nts (Junio r Dr) E me rg e nc y

How ow doe does i s it wor work? • Structured patient shadowing collecting direct observations of hundreds of patient and family experiences per year… • ….using this in a system of continuous service evaluation and improvement… • ….shaping compassionate healthcare providers now and for the future.

Qual uality I Improve vemen ent Positive Findings Negative Findings

Po sitive I nc o nsiste nc y Po sitive Co nsiste nc y I ndividua l / T e a m Sta ff Mo ra le E xc e lle nc e Awa rds a nd Po sitive a ffirma tio n a nd Re c o g nitio n Pe rc e ptio n Pub lic ity +VE NO RI SK NO RI SK EXPERIENCE Ne gative Inc onsiste nc y Ne gative Consiste nc y Rapid Re sponse Continuous Impr ove me nt Mode l Imme diate Re ac tion Or ganisational L e ve l Clinic al L e ve l Pr e ve ntative Str ate gie s Mode l -VE HI GH RI SK L OW RI SK LOW CONSISTENCY HIGH

Qual uality I Improve vemen ent findings F ind ing s Inte rpre ta tio n Org a nisa tio na l fe e d b a c k a nd sug g e ste d a nd sig nific a nc e a c tio n pla n L e ve l o f Issue Po sitive Re gular update s about Dayc ase F e e dbac k at Dayc ase Co nsiste nc ie s pr ogr e ss by Nur sing Staff Update as positive staff r e infor c e me nt Good e xplanations and time Dayc ase take n fr om nur sing staff, doc tor s and anae sthe tists Po sitive Ability to adapt E vide nc e of be st pr ac tic e “Individual tailor ing of a syste m to use r Inc o nsiste nc ie s tr e atme nt to” ne e ds de spite high volume of othe r wor kloads

Qual uality I Improve vemen ent findings F ind ing s Inte rpre ta tio n Org a nisa tio na l fe e d b a c k a nd sug g e ste d a nd sig nific a nc e a c tio n pla n L e ve l o f Issue Ne g a tive Conse nt – issue s sur r ounding Sur gic al CBU’s Disc uss with Conse nt L e ad Co nsiste nc ie s pr ivac y, c onse nt on day E IDO le afle ts. Conse nt in Clinic – c onfir mation signatur e in dayc ase Waiting time s F ur the r tr ial of stagge r e d admission time s Or ganisational L imite d r e sour c e s in waiting Applic ation to Char ity for pr ovision of Dayc ase r oom for patie nt and familie s r e sour c e s in par e nts waiting r oom e .g. T e le vision, Ne wspape r s, Magazine s. Ne g a tive Re c e nt illne ss (c hic ke npox) Who did the y L iaise with sc he duling and booking to r e vie w Inc o nsiste nc ie s – c alle d hospital advise d of c all? advic e se nt with dayc ase le tte r . T r ust Polic y no c onc e r n L ac k of c lar ity - Consultant Sur gic al CBU’s “r andom dr ug” Poor c ommunic ation Pote ntial for dr ug e r r or (ne ve r e ve nts

Digital al Al Alder H er Hey ey – a a cognitive h e hospital al