A clinical process redesign project to improve outcomes and reduce care variance for people with Parkinson's disease

Abstract

Background: Redesigning clinical processes is an iterative process that seeks to reduce care variance and improve quality, safety and satisfaction for patients. The aim of this project was to optimise multidisciplinary collaboration, management and integration of clinical processes for people with Parkinson's Disease (PD) in one Emergency Department (ED).

Methods: The retrospective evaluation study design explored the outcomes of a clinical process redesign project. The project included: a pre-post medical record audit, a nurse survey and patient and carer telephone interviews.

Results: The pre-post ED medical record audit revealed in favour of the post group a median reduction of 175 minutes (IQR 0:40 - 19:40) in length of stay, a 21% improvement in timely PD medication administration and 13% improvement in correctly prescribed PD medications. Patients and carers (n=47) were satisfied with their ED experience, clinicians' knowledge and management and healthcare decision engagement. Nurses (n=30) reported improved knowledge, confidence and management in caring for PD patients.

Conclusion: This project led to enhanced multidisciplinary engagement and positive patient, clinician and service outcomes. Redesign principles can provide a pragmatic approach to improve the integration of care, change clinician behaviour, and reduce adverse outcomes within any clinical setting.

Keywords: Clinical pathways; Emergency; Healthcare surveys; Interview; Medication adherence; Parkinson disease.