The Admitted Patient Specialty Ward

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Presentation transcript:

The Admitted Patient Specialty Ward Dr Alistair Dorward Consultant Respiratory Physician Royal Alexandra Hospital Paisley

Surgery Acute Admissions

Patient Flow Acute Admissions Home Home Acute Admission Unit Respiratory Cardiology Diabetes & Endo GI/Haem Stroke & rehab CCU Acute Admissions Home Home

Specialty Wards Chronic/complex patients seen by appropriate specialist Before After Cardiology 34% 58% Respiratory 53% 67% Asthma 44% 93% Hanlon, Beck, Robertson, Henderson, Capewell, Dorward . Coping with the Inexorable Rise in Medical Admissions: Evaluating a Radical Reorganisation of Acute Medical care in a Scottish District Hospital. Health Bulletin 55 (3) 1997

Speciality Ward Flow Patient selection Elective patients Admission Patient selection Elective patients Infection control Geography Bed Management Ward flow Nursing Medical Physiotherapy Pulm physiology Timely investigations Mobility Morbidity Discharge Discharge planning AHPs SWD Home care Pharmacy Respiratory support O2

Barriers to Patient Flow Medical Unwell   Dying   Symptom control   Requiring O2 Poor mobility Medical Administration Waiting ward round Waiting consultant   Waiting specialist   / Geriatrician opinion Waiting Social work   AHP   Transport   Long term care Other waits Radiology   Endoscopy   Bronchoscopy Pulmonary function Transport Other investigations Refusing home Patient   Relatives Patient Boarding

RAH Respiratory Unit 39 beds – 1 empty

RAH Respiratory Unit 19 male 1 day case 1 elective admission

RAH Respiratory Unit

COPD Current discharge procedures in UK hospitals Only 53% of patients were seen by a respiratory physician before discharge;: 69% were seen by a specialist nurse Only 32% of hospitals use a formal discharge check list Only 22% of hospitals have a COPD discharge pack for Patients Only 25% felt ready to leave hospital Only 26% felt able to cope at home Only 37% felt reassured that good support was available at home Only 34% felt informed about their COPD and reasons for admission Only 52% of hospitals refer patients directly to pulmonary rehabilitation Only 63% of hospitals refer patients to their smoking cessation service

Bed occupancy by illness

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