David Fitzsimons - Building Redundnacies into a Clinical Databse for Monitoring Patient Care

Clinical Database Redundancies: Monitoring Patient Care

Building Redundancies into a
Clinical Database for Monitoring
Patient Care

Mr David Fitzsimons
Clinical Specialist Speech Pathologist
The Cleft Palate Clinic, The Children’s Hospital at Westmead
Sydney, Australia

Slide: 1 Wednesday 24 October 2012 Copyright © Fitzsimons 2012


Cleft Lip and Palate Team

Plastic and Reconstructive Surgeons
Oral-Maxillofacial Surgeons
Ear, Nose and Throat Surgeons
Specialist Orthodontists
Speech Pathologists
Audiologists
Radiologists
Sleep Physicians
Photographers
Clinical Nurse Consultant
….



Cleft Care

Chronic Condition
Prenatal - End of Growth (~ 18-20 years of age)
Stages of Treatment
- Prenatal Management
- Management of Newborn
- Initial Surgery
- Plastics & ENT
- Speech Intervention
- Secondary Surgery (Speech Surgery)
- Plastics
- Alveolar Bone Graft Surgery
- Plastics
- Orthodontics
- Nose Surgery
- Plastics & ENT
- Jaw Surgery
- Plastics

Cleft and Craniofacial Care

Complex
Requires multiple strategies for teams to achieve goals
Involves a large number of
- Disciplines
- Appointments
- Interventions
- Longitudinal
Vulnerable to
breakdown


Quality Improvement

“…The more steps /
components that exist in
a process, the higher
the chance that
something will go
wrong…”


Cleft and Craniofacial Care

Archiving
Ordering
Speech
Report Database Additional
Samples
Writing Entries Tests

Post-
Collecting Speech Operative
Audit Therapy Follow-up
Data
Referral to Surgery
Local
Services

Quality Improvement Programme
Clinical Care


Quality Improvement Programme

Largely people dependent
Usually a single team member that does it all in our own teams

If anyone can do it......
and someone should do it…..
then no one will do it.

Put systems in place to prevent and/or
minimise disruptions to clinical care


Tools to Help Manage and Monitor Care

Clinical Database
- Research Tool
- Quality Improvement Tool

Great Potential
- Failsafe
- Add layers of redundancy


Aim

Brief illustration of the way in which our clinical database helps us manage
and monitor patient care in our institution


Take Home Messages

1. Value in identifying patients, or groups of patients at risk of
„falling through the cracks‟
2. We can learn from „near miss‟ incidents in our Clinic
3. Build systems that look for these near-miss
incidents

4. Improve our level of clinical care


Clinical Database


Crux

Presented (in part):
2003 – ACLAPA Meeting: Sydney
2005 – World Congress: Durban
2009 – ACPA Meeting: Arizona
2011 – ACLAPA Meeting: Perth


Crux


Process


Process

Database Search
Tables Criteria

Data Entry Results


“Live” Reporting


Reports for Monitoring Patient Care

• Children with repaired or unrepaired cleft palate aged over 6 months,
who have not seen a Speech Pathologist in the last 2 months and do
not have an appointment in the next 2 months (4-8 months target for early
speech and language)
• Children aged 15 months of age who had reduced phonetic inventory
and probable glue ear at their 12 month review (? Lower threshold for ENT
intervention)
• Children aged 18 months of age who were demonstrating „backing
patterns‟ at their last Clinic visit
• Children aged under 5 who had documented evidence of compensatory
speech characteristics, and I have not had contact with their local SLP
in the last 6 months

NOTE: These are NOT research reports

Reports for Monitoring Patient Care

• List of patients with upcoming appointments who have confirmed
syndromic conditions


“Live” Reporting


Triggering Reports

Computer code
Design your own triggers:


Take Home Messages

1. Value in identifying patients, or groups of patients at risk of
„falling through the cracks‟
2. We can learn from „near miss‟ incidents in our Clinic
3. Build systems that look for these near-miss
incidents

4. Improve our level of clinical care


Thank You


David Fitzsimons - Building Redundnacies into a Clinical Databse for Monitoring Patient Care

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