A SAFEGUARD TO PATIENT CHOICE

Transcription

1 Martinez-Cruz MB, Garcia-Baquero Merino MT, Santos Puebla Damián, Molina Cara Carmen, Pinedo Fernando, Monleón Just Manuela. MADRID PC RESEARCH AND INNOVATION REGIONAL NETWORK COORDINACION REGIONAL DE CUIDADOS PALIATIVOS MAKING SPC BEDS AVAILABLE ROUND THE CLOCK: A SAFEGUARD TO PATIENT CHOICE

2 MADRID

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4 THE CITY The third largest in the European Union, after London and Berlin with its metropolitan area the third largest in the EU after London and Paris It spans a total of km2 with some population MADRID Round the clock SPC Beds THE REGION spans over 8000km2 the total regional population of 6.5 m distributed in Metropolitan Urban Semiurban Rural áreas.

5 I trust my team, can I trust anyone else to carry out my wishes?

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7 mar abr may jun jul ago sep oct nov dic ene feb mar abr may jun jul ago sep oct nov dic ene feb mar abr may jun jul Gestión BED ALLOCATION de ingresos en EVOLUTION camas centralizados OVER 12months Pal24 11 HOME SUPPORT PC TEAMS 11 HOSPITAL PC TEAMS 8 PC BEDDED PUBLIC UNITS 6 PC INDEPENDENT BEDDED UNITS INDEPENDENT HCT U. AECC 1 MIXED PAEDIATRIC PALLIATIVE CARE TEAM INTEGRATED UNIT SANTA CRISTINA JUST UNDER 300 SPC BEDS 7

8 Often, patients included in SPC programs end up in crowded A& E services while PC beds remain unoccupied.

9 SPC BED DYNAMICS OVER NINE DAYS AT THE END OF JANUARY 14 Time FRIDAY SATURDAY SUNDAY MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY 09:00h :00h :00h patients waiting for beds Integrated Care"

10 Many opt for early admissions to prevent emergency situations with nowhere to go to!

11 mar abr may jun jul ago sep oct nov dic ene feb mar abr may jun jul ago sep oct nov dic ene feb mar abr may jun jul BED ALLOCATION Gestión de ingresos EVOLUTION en camas centralizados OVER 12months 350 Adult SPCB Management Methodology Teams selected according to their bed use data: 24hour team as it incorporates the regional observatory Hospital support Team and Home care Team which more often requested beds Two bedded units - public and independent- most frequently requested. All were asked to set most relevant issues to each care settings to ensure straightforward bed allocation even when delegated to a different team. This took 5 days to compile as all teams saw it as a priority.

12 19 fields: Minimum Data Set Main Diagnosis. Referring team. Where is the patient? (with drop down list). Reason for referral to bedded unit. Explaing why urgent if so. Current Treatment plan updated in Referral Document. Multidisciplinary Document (MDTD) documenting Palliative Situation and Estimated Prognosis and up to date patient choices. Family awareness of planned admission within 24 h and receiving unit documented acceptance. Family degree of information. Social and family resources available in case of discharge at later stage.

13 ELECTRONIC PROTOCOL COMPLETION RATE for 30 Patients Diagnosis Prognosis Treatment MD EP UtD T PRIORITY ASSESSMENT N U U Family Awareness Referring Team identification and Contact Tf n. A D RT Ph Nº Patient Choice C/D Family own Choice Interdisciplinary Agreed Action Plan C U t D

14 DISCUSSION PAL24 received during that time Beds Managed and Allocated Jan Jan calls Most Callers were supported with expert s advice Work on a SPC Bed Regional Protocol, based on these findings and professionals ideas, started. 20 were diverted to own GP 150 Generalist services were sent out

15 400 MONTHLY BED MANAGEMENT ENE FEB MA ABR MAY JUN JUL AGO SEPT OCT NOV DIC 2014 ENE FEB MAR ABR

16 TIMING BETWEEN BED REQUEST AND ADMISSION 100,00% 90,00% 80,00% 70,00% 60,00% 50,00% 40,00% 30,00% 20,00% 10,00% 0,00% ENE FEB MA ABR MAY JUN JUL AGO SEPT OCT NOV DIC 2014 ENE FEB MAR ABR

17 WHERE IS THE PATIENT HOME 10,57% A&E Department 56,87% Hospital Ward ENE FEB MA ABR MAY JUN JUL AGO SEPT OCT NOV DIC 2014 ENE FEB MAR ABR

18 BED DECLINED WHEN OFFERED? ENE FEB MA ABR MAY JUN JUL AGO SEPT OCT NOV DIC 2014 ENE FEB MAR ABR

19 Between Jan 2013 and April ADULT BED REQUESTS 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 81% Admitted 19% Declined Cancellations due to 1.Death 2.Worsening Clinical Condition 3. Possibilities of being cared for in own home 0%

20 Team Requesting Bed Home Care Team Hospital PC Team Other Hospital (Referent) 17% 8% 75% Integrated Care" Bed at... Any Independent Sector Public Bedded Unit 4% 27% 69%

21 CONCLUSIONS Just in time SPC beds are an important and significant resource to optimize: they can save both lives and unnecessary suffering. All stakeholders need excellent coordination. Patient s choice increases when a central coordinating center Open All Hours Manned by Experts, puts all resources at their disposal, provided some tools are in place: Shared Information, Palliative Care Electronic Records, Centralized SPC Bed Management In Madrid, PPC/D rates increased over 7% in just the first few weeks of infopal going live! Madrid needs to define better the PC patient s routemap through its hospitals.

22 H 11 public St Cristina Central PC Unit at Hospital Universitario Santa Cristina UCCP 6 independent ESAPD EMCPP 8 public H 6 independent UCCP Regional Coordinación Coordination Regional Coordination ESPH 12 Public Hospitals 6 Teams PAL24 Health Centers Health Centers Hospitals ESAPD: Community Support Team ESAPH: Hospital Support Team EMCPP: Pediáaric Palliative Care Mixed Team UCCP: Palliative Care Bedded Unit PAL24: 24 hour Service

23 Centralized Palliative Care Adult Beds Management CHRONOGRAM GESTIONA EQUIPOS UCP ESAPH Unidad Integrada ESAPD Profesional Responsable de Equipo Específico cumple criterios? SI Consenso con Equipo de AP Profesionales REFERENTES NO PAL24 PAL24 Consenso con Equipo de AP DOMICILIO Hospitales Equipo AP Apoyo de ESAPD UCP SUMMA 112 Phase PROCEDIMIENTO Y FLUJO PARA EL ACCESO A RECURSOS DE CUIDADOS PALIATIVOS DESTINO ORIGEN Single Referral Document DUD MANUAL Creation & development 2012 CREATION & DEVELOPMENT Centralized Beds Management Decision 2013 CENTRALIZED BEDS MANAGEMENT DECISION 2014 FORMALIZED PROTOCOL

24 Bed request ADULT SPC BEDS CENTRALLY COORDINATED FLOWCHART Request Assessment Request and Bed Request Management Acceptance Admission Generalist Teams healthcare profesionals Specialist Teams 520 profesionals 24 Hour Pcare 12 profesionals Specialist Team Leader Admitting Unit 289 beds Right Diretion Adult Patients Admitted CRCP CC UCP

25 TAKE HOME MESSAGE

26 I trust my team, can I trust anyone else to carry out my wishes? Continuity of care, key to provide seamless and appropriate Specialist End of Life support, must incorporate access to a wide range of services: from expert phone advice to 24 hour access SPC Beds underpinned PCEMR and central coordination. Next in Madrid: Access to Children SPPCBeds

27 The best thing about Palliative Care are the patients They remind us of our duty not to abandone them and the privilege of being there, while caring for them. (One of Madrid s PC doctors)

28 THE PROFESSIONALS The Regional central body is permanently collecting ideas suggestions and proposals for improvement from professionals in all levels of care. With most sincere thanks to Madrid 517 SPC Professionals for their dedication, professionalism and availability to care for the patients.