Dynamic Discharging in Medicine Ward 9 – St John’s Hospital

Meet the Team

Drivers People Data Strategy

Discharge

Nursing Treatment Plan Medical Treatment Plan OT Plan PT Plan Discharge Nursing Treatment Plan Medical Treatment Plan OT Plan PT Plan Other AHP Plan Social Care Pharmacy Community Care Patient Preferences Family Preferences

The Aim The patient: Work in collaboration to ensure that patients are discharged in a timely and safe manner. The individuals and team: Improve communication to clarify expectations and timescales to work within. Support each other to manage workload. The hospital: Support patient flow. Beds available at the right time. The patient: A bed is available in the right place for them when required.

The Concept Action the plan Create the plan

Follow through of these actions in a timely manner. In Action Follow through of these actions in a timely manner. Two daily huddles: Protected time to collectively discuss, agree and prioritise discharge plans

Huddles Patients of Concern Request Early Review Ward Safety Issues 9.10am 2.30pm Patients of Concern Request Early Review Ward Safety Issues Staffing Falls Risks/ Infection Control Today’s Discharges Are the following in place? IDL Transport POC Care Home expecting patient Other specialists/services PT/OT review (any equipment required?) If required request early review Appropriate for lounge? Future Discharges As above Delayed Discharges What is the delay? Have all relevant referrals been made? Update from discharge hub team

Dynamic Discharge Huddle on Ward Huddles Site Safety Huddle 8.30 Dynamic Discharge Huddle on Ward 9.10am Ward Rounds AM Site Bed Meeting 13.00 2.30pm

Measurements to date

Number of Discharges

Number of Discharges

Number of Discharges – Winter Comparison

Number of Discharges – Winter Comparison

Length of Stay

Length of Stay

Time of Discharge

Average number of days from admission to OT referral Occupational Therapy Number of referrals Average number of days from admission to OT referral 12 weeks before DDD 15 10 days

Average number of days from admission to OT referral Occupational Therapy Number of referrals Average number of days from admission to OT referral 12 weeks before DDD 15 10 days 12 weeks with DDD 24 4.4 days Daily point of contact Advice ‘Green Trouser Effect’ – visibility prompts people to think about OT

Pharmacy

Pharmacy The role of pharmacy in discharge is recognised earlier Average Number of scripts received by pharmacy a month Before DDD 57 After DDD 80 The role of pharmacy in discharge is recognised earlier Setting expectations for scripts earlier

Pharmacy

Pharmacy

Discharge Hub Monitoring delayed discharges. Picking up potential delays. Progressing referrals. Supporting the ward to understand when a patient becomes a delay. Demystifying Packages of Care and Care Home placements.

Team Reflections ‘Really value having the protected time to discuss as a team’ ‘I like how it does not eat into clinical time’ ‘I like how it is prompt and sets the day off’ ‘It helps medics prioritise the writing of scripts’ ‘We are thinking about Monday discharges on a Thursday!’ ‘Help reduce the Monday madness’ getting tasks done in advance ‘Helpful getting updates on delayed discharge patients’ ‘Good to get updates on OT/PT input and outcomes to help decisions’ ‘empowering staff to initiate discharge planning’ ‘I feel we have a better team dynamic. Better communication.’ ‘Aware of staffing issues and consider the impact that will have on our day.’

To reap the benefits Willingness and perseverance Depends on punctual attendance and participation Requires leadership Cannot be person dependant Requires up to date information Conversation is essential – question one another Raise concerns Explore alternatives Requires team members to follow through with actions Forward thinking

Moving Forward Celebrate the achievement so far! Sustainability Review how we can discharge appropriately earlier in the day How can we become more proactive rather than reactive Share the lessons

Q&A