Delay in completing discharge letters in Mental Health Services

Aim of the project Reduce delay in producing discharge letters. SIGN recommends 1 week (2 weeks if complex or waiting for results) Communication with GP & CMHTs Performance was poor in some areas with delays of several weeks. Objective would be to have an average of 7 days with 100% completed within 14 days.

Process – what we did Process map Minimising delays / steps in process Baseline data (secondary outcomes) Time to dictation Time to typing Time to verification

Improvements Clinical Administration Guidance for Medics clear expectations for medical / admin Electronic inpatient records Juniors no longer waiting days for notes to arrive Development of electronic assessment proforma Information available electronically and can be updated during admission and be ready for discharge. Digital dictation and purchase of equipment Juniors can dictate and upload at any site New Hospital - ? impact

Run chart - dimensions Vertical Axis is mean days to complete discharge letter from Jan 2014 – April 2015 Horizontal Axis is months Data line is in black Median line is marked in blue

GEE Overall there has been no significant shift in the median There was an early trend for a reduction which coincides with producing and circulating a clinical administration guidance for medical staff. Identify reasons for later shifts and reason for outlying bad months – ? due to individuals or systems

GEE Overall there has been no significant shift in the median. There was an early trend for a reduction which coincides with development of a clinical administration guidance for medical staff. There was sustained improvement last year and later negative trend may have been an effect of moving to the new Hospital.

Next steps geE Complete PDSA on secondary outcomes PDSA dictation, typing, verification. PDSA Updating admission clerking during time on ward so that it is ready for discharge.