Pursuit of excellence at Alfred Health

I had a chance in advance of some presentations I'll be making this week at Alfred Health to view a number of the clinical process improvements at The Alfred, the system's tertiary referral teaching hospital, based in Melbourne.  The organization has spent years in adopting a culture of continuous process improvement, relying in great measure on the ideas and engagement of front-line staff.

First stop was the Emergency Department with my guides Rebecca (Bec) Atkins, the Nurse Manager, and ED Deputy Director, Dr. Jeremy Stevens.  As many of my readers know, EDs often suffer from patient flow problems.  The arrival patterns and condition of incoming patients are unpredictable, and many hospitals suffer from extended lengths of stay in the ED for patients who have been admitted to wards on the hospital.  Unfortunately, such patients end up boarding in the ED awaiting available rooms, creating backlogs that work backwards all the way to emergent patient arrivals.

I don't have pictures that can demonstrate the approaches used, but the folks at The Alfred have worked through this problem and have configured the various divisions of the ED for a more uniform and predictable throughput to the rest of the hospital--notwithstanding unpredictable arrival patterns and levels of patient acuity.  Among other things, they use a multi-bed short-stay section very thoughtfully, allowing it to be a resting place for patients who need a bit of extended care and/or observation but are unlikely to need to be admitted.  While the state of Victoria sets a standard that up to 25% of short-stay patients can ultimately be admitted, The Alfred's figure is more in the range of 15%.  This indicates that the triage function and the follow-up care in the ED are well enough carried out to be more precise about which patients are likley to be admitted.

From the ED, we were off to the intensive care units, with guides Dr. Owen Roodenburg, Deputy Director of the ICU, and Sharon Hade, the Nurse Manager.  You see them here in the natural light-enhanced unit, with switchable glass windows that automatically adjust to change their light transmission properties as the sunlight changes on the building.  In addition, the smart glass is used as a divider between the patient bays, where it can be manually switched from translucent to transparent to provide privacy or to allow a sense of openness.

There's lots to report about the ICUs, but one aspect that grabbed my attention was the availability in the family waiting rooms of iPads with useful information for waiting patients.  Developed by one of the staff members and put in place this last July, this application was thoughtful, clear, and very user-friendly.  (It was designated as a finalist in the Australian Mobile and Application Design Awards for 2014.)  What follows are some of the screen shots showing the capabilities of the program.  Their purpose is self evident, so no explanation is needed:

Here's the video tour:

But wait, it gets better!  Look at these scenes presenting--with utter transparency--important metrics of clinical performance: line related infections, hand hygene, and overall mortality.

And, just in case a staff member forgets to employ proper hand hygiene, here's a friendly reminder that patients and families have been encouraged to question them on the issue!

All in all, an impressive showing.  I'm looking forward to the rest of this week's activities.  Stay tuned.