Aim
The CACP project was commissioned in 2021 by the Frail Older Persons Collaborative, Clinical Excellence Queensland, to improve processes within Queensland Health facilities related to the NSQHS Comprehensive Care Standard. The project was initially required to perform a scoping review to:
- understand the current state and identify issues related to the standard for adult patients within digital and non-digital QH acute facilities
- identify opportunities for improved workflows
- provide a plan for future QH work to support facilities in the streamlined provision of comprehensive assessment and care planning.
Further funding for Phase 1 of the CACP Project (FY21-22) has been allocated to work towards addressing the highest priority issues identified using a collaborative statewide approach.
Outcomes
Benefits of Phase 1 include:
- an Integrated Risk Screening/Assessment tool to improve clinicians’ ability to efficiently screen for patient risks arising from hospitalisation with reduced duplication and fragmentation of information compared to current screening tools
- establishment of a Comprehensive Care Collaborative to assist in sharing work currently being conducted in silos (at HHS and facility levels) in order to reduce redundant effort, as well as to increase standardisation of processes across QH.
Overall, this program of work aims to:
- improve collaboration and reduce workload related to Comprehensive Care across HHS/facilities
- improve person-centred care through involving consumers and care partners in goals of care and care planning and providing holistic, coordinated care which addresses risks of hospitalisation identified
- reduce time to complete admission assessments and less duplication and repetition between clinical areas which increases time for direct patient care
- reduce burden of risk screening/assessments to both clinicians and patients/care partners
- reduce length of stay, financial penalties and patient harm through prevention of hospital acquired complications
- improve understanding of patient and care partner goals which encourages person-centred care and minimises care which is inconsistent with patients preferences, goals and values.
Background
The second edition of the National Safety and Quality in Healthcare (NSQHS)- Comprehensive Care Standard requires hospitals to provide person-centred, coordinated and comprehensive care that meets their individual needs and reduces the risks of harm associated with healthcare. These harms, known as hospital acquired complications, include delirium, falls, pressure injuries, malnutrition and incontinence. It is well-recognised that these complications impact patients’ significantly, including increased mortality and morbidity, reduced quality of life, reduced function, longer length of stays and distress to patients and care partners. In addition, these complications place significant burden on the healthcare system through increased costs of admission, increased medical complexity and considerable financial penalties.
Comprehensive assessment and care planning (CACP) is crucial to identify and mitigate potential patient complications. Due to inadequate integration of patient assessments and care planning pathways within QH (both at a local and system level), there is often poor compliance with meeting the requirements of the Comprehensive Care Standard. Identified issues include:
- variations in risk screening/assessment tools used across digital and non-digital facilities
- ambiguity in requirements for various clinical areas
- differing workflows across the patient journey and transitions of care resulting in repetition
- lack of patient and care partner engagement and input into their goals of care and care plans
This frequently results in care plans which are poorly aligned to patient priorities, as well as inefficient staff workflows, and risk assessments which are seen as burdensome by patients and staff. This does not support coordinated and person-centred care.
