Improving care for obese patients through data driven health service redesign. (#170)
In July 2011 an Obesity Service Redesign Project was established for Canberra Hospital and Health Services (CHHS). The aim was to use a coordinated approach to improve the health of people with severe obesity. Quantitative and qualitative data sets were identified and analysed. This included quantitative data on hospital separations, Diabetes Service referrals, elective surgery alerts to wardsmen, alerts to physiotherapy for patients referred from ED and staff injuries. Qualitative data was also collected through interviews with six morbidly obese patients and two carers, as well as extensive consultations with CHHS staff. Results included major issues with stigmatisation of obese patients, serious under recording of obesity in coding separations including a 45% decline from 2008 -9 to 2011-12, patients coded for obesity had an average length of stay of 12.1 days, increasing staff injuries due to managing obese patients, a lack of appropriate bariatric equipment and a pattern of patient management based on late identification obesity related problems and an adhoc poorly coordinated response. The interventions arising from this service redesign project include; processes to increase the coding of obesity with ICD10 AMV8, recording of obesity related interventions in clinical notes, a shift towards active, non-judgemental management of obese patients through revision of clinical policies and procedures, staff education and acquisition and centralised management of bariatric equipment. In summary this project combined available quantitative data with the voice of patients about the experience of being an obese person receiving health care services, as well as staff concerns, frustrations and suggestions. This has driven a wide variety of measures implemented across our services and sets the scene for the introduction of a public obesity management service in 2014.