Thanks to a new assessment process, the transition from being a hospital inpatient to a home care client is now smoother and quicker in Prince Albert Parkland Health Region.
The Home First Nurse and Assessor are using a shorter assessment process for new referrals to the the region’s Home Care program.
The Resident Assessment Instrument – Contact Assessment (RAI-CA) is being used as opposed to a longer and more comprehensive assessment called Resident Assessment Instrument – Home Care (RAI-HC). This process change decreases the initial assessment time from one hour and 45 minutes to just 60 minutes, and allows for a follow-up visit within a month.
It’s common sense, quicker access leads to speedier recovery, increased confidence in health care, and most importantly quality of life and independence for the clients.”
(Lorraine Young, patient and family representative on the improvement team)
These changes and others were introduced as part of a Rapid Process Improvement Workshop (RPIW #36). The theme of the RPIW was for “clients to be assessed and receive what they need when they need it.”
Both RAI-Home Care and RAI-Contact Assessment are tools used worldwide, and are proven to be reliable and comprehensive. As the assessment is being done and all the information is gathered, the electronic tool takes the information and alerts the assessor to any unmet client needs. A care plan is then developed from this client information.
In this situation, the RAI-CA is used because the client needs services set up quickly. This assessment is shorter, but still gives the assessor enough information about the urgency of the service and what may be required initially. If necessary, the assessor will then go back within a 30-day window and do the complete RAI-HC to continue services.
In addition to a shorter assessment, the team also created a Work Standard, accompanied by training for nursing staff, to ensure all documents are placed in main charts upon completion. Following this standard has decreased rework and walking while looking for information including the need to check Procura (the electronic medical record for Home Care clients).
Before these improvements, variations in processes between providers caused long waits for clients to receive home care services. Prince Albert Parkland Health Region’s Home Care services have been able to sustain these improvement gains through a robust audit process and incorporating these process changes into their daily work.