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Champlain Integrated CHEO Discharge Planning and Champlain CCAC Care Coordination Partnering to provide seamless discharges for children and their families
Champlain
Integrated CHEO Discharge Planning and Champlain CCAC Care Coordination
Partnering to provide seamless discharges for children and their families
Champlain
Presentation Outline
1. Impetus for Change
2. Organizational Partnership
3. Team Building and Implementation
4. Phase I Improvements
5. Phase II Improvements
6. Phase I and II Outcomes and Satisfaction Survey
7. Phase III - Next Steps
Champlain
The Winds of Change
In 2009 regulations came into place to expand the role of CCACs to assist clients in accessing complex continuing care and rehabilitation services
In 2010 The Children’s Hospital of Eastern Ontario (CHEO) conducted a review of their discharge planning department to look for opportunities for quality improvement:
• Described current services including CCAC
• Literature review
• Chart audit
• Key informant interviews
Champlain
CHEO Discharge Planning
2.1 FTE including:
• 1 FTE AA (shared with another department)
• 3 Nurses
300-320 cases per year
CCAC Care Coordination
1.5 FTE including:
• 2 Care Coordinators
300 referrals per year
42% of discharge planning cases also had CCAC involvement
CHEO Discharge Planning
Review 2010 Active Roles – Fragmented staffing
Champlain
Other Findings
Chart Audit and Informant Interview Findings:
• Confusion existed between the role of CHEO discharge planners and CCAC Care Coordinators
• Lack of continuity of care provider due to the number of split FTEs
• Duplication of processes resulted in inefficiencies
• Outcomes of discharge planning were not systemically measured and monitored
Literature review supported a strong need for:
•Continuity of Person
•Clearly identified accountability
Champlain
1. To integrate CCAC Care Coordination and Discharge Planning
2. To streamline processes and communication to produce efficiencies and reduce duplication for care providers, physicians and families
3. To measure and monitor safe, efficient and coordinated discharges for children at CHEO
Review Recommendations
Champlain
• In December of 2011 the first agreement was signed between Champlain CCAC and CHEO
• In November of 2011 the Matrix of Responsibilities was developed
• In January of 2012 the Reporting Structure was agreed upon
• Between January and April 2012 the team met to begin the collaborative process of:
• Reviewing the current process flow and identify opportunities for improvement
Coming together is a beginning Henry Ford
PhysicianPhysician
CHEO D/C PlannerCHEO D/C Planner
CCAC CCCCAC CC
CHEO Consult Form to Discharge
Planners
Quebec Paperwork, if applicable
Referral to CCAC for Home Care
Referral to CCAC for IV Therapy
Confirms HC #, opens CHRIS File
and conducts chart review
Patient and Family Obtains Consent and conducts Assessment
Documents in E-Clin Doc Flow Sheets
OR
Documents in Physician Progress
Notes
OR
Documents in CHRIS
Develop Care Plan
HomeHome
Service and supply ordering
Teaching Checklist
Case ConferenceCase Conference
CCAC DCCCCAC DCC
Assigned to D/C Planner and added to Tracking Sheet
Completes Assesssment
Documents in E-Clin Doc –
Interdisciplinary Information
Summary
ADP Paperwork for Long Term
Equipment and Supplies
Medical Presciptions
Ensure Teaching Occurs
Arrange and attend Case Conference
CCAC CCCCAC CC
Attend Case Conference
Champlain
Phase I Objectives (May to August 2012) :
1. Single point of access (referral) to discharges at CHEO
2. Team building
3. Branding and marketing to CHEO staff and external CCAC service providers as one team
Phase II Objectives (November 2012 to May 2013)
1. Stream line documentation tools and processes to improve communication
2. Streamline team communication tools
3. Training and orientation to new roles and organizations
Phase III Objectives (May To Summer 2013)
1. Buddy Shifts to integrate new practices and support knowledge transfer
2. Fading out of buddy shifts to fully integrated roles
3. Development and monitoring of evaluation metrics
Phased-in Approach
Champlain
Dyads made up of 1 CHEO and 1 CCAC rep developed new forms and processes to bring to the whole team for consideration
Larger teams meetings were initially every three weeks and then once per month to review and vet the work of the dyads
Team consensus to name the new integrated team …
Community Discharge Team (CDT)
Created one physical Community Discharge Team space
• Shared resources, access and communication tools
• Informal support and communication between team members
• All phones calls were channelled through the CDT Administrative Assistant
Keeping together is progress Henry Ford
Champlain
Phase I - Single Point of Access
One integrated referral form
• Four forms integrated into one Community Discharge Team referral which provides all required CCAC, Discharge Planning and IV information
• Consulted stakeholders including Physicians, Case Managers, Clinic Leaders for both content and format
• Easy to use check box format – based on MDs already existing order forms
• Check mark, information prompts and free text format for ease of completion
Champlain
Phase I - One Window Portal
• The CCAC developed the Child and Youth Intake Referral Portal (CHYRP)
• CHYRP is an application that allows referrals to be managed electronically
• The CDT Referral Form is faxed to one number and the all referrals are housed in the CHEO folder of the CHYRP
• The CHYRP provides the capability for the CCAC to receive electronic referrals from CHEO in the future
Champlain
Phase I - Branding and Communication
Bulletins were released to inform CHEO staff and external service providers. Created opportunity to reinforce key messages
First Bulletin for CHEO staff went out in June 2012 with the new branding and key messaging re: single point of access:
• Community Discharge Team (CDT) name
• One referral form
• One fax number
• Go live date
Champlain
Phase II - Efficient Triaging
The CHYRP developed in phase I can be accessed virtually by CCAC staff and from dedicated CHEO computers
Each day one member is assigned as the Triage CDT member who can:
• Monitor the referrals on one system
• Quickly determine the status of a referral at any time
• View the amount of outstanding referrals in the system in real time
• Assign the referral to the next available CDT team member
Managers and covering CDT members can quickly check the status and find all the related referral information
Champlain
Phase II – Tools and Documentation
One CDT consent form
One CDT Initial assessment form including the CCAC assessment
One location in hospital EHR for documentation of assessments where all CHEO staff including Physicians can view the notes
Duplication of documentation is minimized as the Initial Assessment can be printed and uploaded to CCAC DMS
Ongoing documentation for CCAC clients is in the CHRIS notes and all other clients are documented in the EHR flow sheets
Champlain
Phase II – Preparing for Integration
Risk Assessment at CCAC revealed three main risks:
• Staff were feeling vulnerable providing services of the other organization without being an employee of that organization
• More open and shared Information systems and data sharing
• Initial training and ongoing knowledge exchange
Mitigation strategies:
• Renewed Partnership Agreement to include liability and indemnification clauses and reinforced support of employee to complete work as assigned
• Renewed and updated the Systems Agreement with CHEO
• Developed intensive orientation, buddy shifts and ongoing access to updates
Champlain
Phase II - Knowledge Transfer
2 weeks of CCAC Orientation:
• Basic CCAC orientation
• Pediatric specific guidelines and practice standards
• CHRIS training
3 days of Discharge Planning and CHEO orientation
• Refresher on CHEO EHR
• Multidisciplinary CHEO orientation
• Discharge Planning policies and procedures
Buddy shifts began in April 3, 2013
• Dyads of discharge planners and care coordinators worked on cases together and shared management of the portal
PhysicianPhysician
CHEO D/C PlannerCHEO D/C Planner
CCAC CCCCAC CC
CHEO Consult Form to Discharge
Planners
Quebec Paperwork, if applicable
Referral to CCAC for Home Care
Referral to CCAC for IV Therapy
Confirms HC #, opens CHRIS File
and conducts chart review
Patient and Family Obtains Consent and conducts Assessment
Documents in E-Clin Doc Flow Sheets
OR
Documents in Physician Progress
Notes
OR
Documents in CHRIS
Develop Care Plan
HomeHome
Service and supply ordering
Teaching Checklist
Case ConferenceCase Conference
CCAC DCCCCAC DCC
Assigned to D/C Planner and added to Tracking Sheet
Completes Assesssment
Documents in E-Clin Doc –
Interdisciplinary Information
Summary
ADP Paperwork for Long Term
Equipment and Supplies
Medical Presciptions
Ensure Teaching Occurs
Arrange and attend Case Conference
CCAC CCCCAC CC
Attend Case Conference
Buddy Shifts
Champlain
Challenges and Positive Outcomes
Challenges:
• Increase work load during orientation and buddy shifts
• Significant change occurred during peak season at CHEO
• Change Management for members
• IT integration (e.g. printing/access)
• Number of part-time staff – prolonged uptake
Positive Outcomes to date:
• Consistency of practice has improved
• Documentation is streamlined
• Clarity in roles with less duplication for families
• More efficient referral and triage process (one form, one fax, CHYRP)
• Identifying one person who will attend meetings /rounds
Champlain
Working together is success Henry Ford
Champlain
Working together is success Henry Ford
Champlain
Fully Integrated Community Discharge Team
1. Single point of Contact
2. Development, measurement and monitoring of performance metrics
3. Satisfaction survey of patients and families
Phase III – Future State
Champlain
Questions ?
Allison Budge, Manager, Pediatrics, Champlain CCAC
Susan Barnes, Acting Manager of Care Transitions, Children’s Hospital of Eastern Ontario (CHEO)
