ANNUAL REPORT - Northern Health

Our achievements
Strategic Goal 1
A healthier northern community through
the delivery of quality health services
Northern Health has a strong and integrated approach to
quality service provision ensuring good patient outcomes
and a reduction in clinical risk. Northern Health continues
to deliver quality health services by continuing to enhance
our programs and services. This activity continues despite the
increasing demand on services.
Clinical Services and Master Planning
Northern Health undertakes strategic clinical services
planning in response to increasing or changing demand for
services. The outcomes from this have been rapidly translated
into strategic master planning with predicted outcomes
being 50% increase in services over the next five years and
100% increase in services over the next 10 years.
In addition to strategic clinical services planning, the
Redesigning Care program was established to deliver service
improvement and build health service capability. Northern
Health’s Redesigning Care team has successfully completed
three projects funded by the Department of Health and
designed to ensure patient and family centred care.
‘Smooth Operations: enhancing the surgical patient journey’
has led to reductions in non-elective patient postponements,
reductions in Length Of Stay and improved systems for
pre-admission, elective admissions and unplanned surgery.
‘Redesigning the Non-admitted emergency patient journey’
supported the establishment of the Rapid Intervention and
Treatment Zone (RITZ) in the Emergency Department which
has improved access and care for non-admitted patients.
Patients treated in the RITZ are now seen in a more timely
fashion reducing wait times for all patients
The ‘Improving the MAPU Experience’ project focused
on improving ward level communication for our Medical
Assessment and Planning Unit. Staff in these roles now
spend more time directly with patients and supporting
staff, and the number of MAPU patients discharged prior
to a 48 hour Length Of Stay has improved.
The Redesigning Care team is currently undertaking a major
project aimed at improving care for General Medicine
patients, this project aims to streamline care for the largest
cohort of admissions to the hospital improving efficiency and
patient outcomes by reducing delays and wait times.
Data driven improvement
Northern Health utilises data from a range of sources to
identify opportunities for improving the quality of care we
deliver. These include external organisations such as the
Health Roundtable, which has identified opportunities for
improvement around two major diagnostic related groups
(DRGs) – respiratory patients and orthopaedic procedures.
Respiratory Care
In late 2009 Northern Health’s average Length Of Stay (LOS)
was 5.6 days, which presented an opportunity to save up to
600 bed days by achieving the Length Of Stay of the state’s
exemplar hospitals (4.6 days).
Practice changes which led to substantial reduction in Length
Of Stay include:
• improved discharge planning with the revision of the
daily bed management meeting;
• a revised medical model reducing the patient workload
of our medical workforce;
• better access to sub-acute beds has reduced delays for
patient transfer between Northern Health campuses; and
• the establishment of a patient journey board in the
Medical Assessment Planning Unit (MAPU) increasing
referral response times for allied health staff.
Data collected in March 2010 identified an average Length
Of Stay of 4.9 days, an improvement of 14% equating to
a saving of more than 420 bed days (annualised).
Orthopaedic procedures
Three new initiatives were implemented in 2009 to reduce
the length of stay for acute orthopaedic patients:
• implementation of an Orthopaedic Rehabilitation in the
Home (RITH) program where appropriate patients are
discharged at day three or four and with ongoing care
provided in the patient’s home. This service enables
early discharge of patients (hip replacements, knee
replacements, fracture necks of femurs and a few other
orthopaedic conditions), prevents unnecessary inpatient
rehabilitation bed admissions, and supports patients’
recovery at home;
• introduction of the Risk Assessment and Prediction
Tool (RAPT) to pre-admission clinic for elective joint
replacement surgery patients. The patient answers
six simple questions included in the RAPT. A score
determines the likelihood of the patient discharge
destination. A score of 6+ indicates suitability for
RITH; and
• existing orthopaedic clinical pathways for elective joint
replacement patients were modified to monitor and
reduce Length Of Stay. Major changes included a LOS
objective of five days, improved clinician guidelines and
RAPT and RITH integration.
20 09/10 Northern Health Annual Report