1. Using Quality Improvement Methodology To improve Acute Flow at Wrexham Maelor Hospital

2. Hello! I am Neil Windsor Service Improvement Manager at Wrexham Maelor Hospital

3. Three phases of Acute Flow PMO Front Door Acute Hospita l Phase See & Treat Rapid Assessment Unit Ambulatory Care Model Admission Avoidance Reduction in attendances Acute Hospital Phase Board Rounds EDD Bed Management Ward Rounds Discharge < 12pm Home for Lunch Discharge

4. 2. ACUTE HOSPITAL PHASE Consistent focus on discharge

5. “ Prioritising discharge activities only when beds are full may have little impact on patient throughput or average length of stay. “ Consistently prioritising discharge activities can significantly reduce length of stay in elective or emergency clinical care pathways. Simulation of patient flows in A&E and elective surgery Discharge Priority: reducing length of stay and bed occupancy Michael Allen, Mathew Cooke & Steve Thornton, Clinical Systems Improvement 2010

6. Use of PDSA Cycles to drive improvement -- Bed Management Meeting -- Expected Date of Discharge -- Board Rounds -- Senior Review Before Mid-day -- Ward Rounds -- Home Before Lunch -- Discharge Flow (pre 9am) -- Rapid Assessment Unit -- < 21 day Length of Stay -- Ambulatory Care -ERAS #NoF -

7. Board Rounds Daily, early morning Board Rounds, led by a senior clinical decision maker ▪Identifying the deteriorating/at risk patients. ▪Identifying patients to be discharged today and tomorrow. ▪Receive the MDT’s progress report for each patient’s case management and discharge plan. ▪Review the EDD of all patients. ▪Discuss new patients and identify requirements from the MDT to support discharge. ▪Determine the level of complexity of the patient (simple/complex).

8. Board Rounds

9. Expected Date of Discharge - Process

10. Expected Date of Discharge - Delays

11. Expected Date of Discharge Data

12. Results

13. A Better barometer of improvement http://i3.dailypost.co.u k/incoming/article8507 352.ece/ALTERNATE S/s615/maelor- hospital.jpg

14. Thanks!! Any questions?