1. Title of the Change Project
Student ID.
MSc in Healthcare Management,
Institute of Leadership, Royal College of Surgeons in Ireland
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No Time To Lose
Implementation of Integrated Discharge Planning in an Acute Hospital.
Katherine Kenny:
MSc in Healthcare Management
Abstract
This organisational development project involved the implementation of a multidisciplinary approach to Integrated Discharge Planning (IDP) at the Midland Regional Hospital Mullingar.
IDP is high on the agenda in hospitals due to the relentless pressure in Emergency Departments. The Clinical Care Programmes promote a proactive approach to IDP to ensure smooth patient flow. The Special Delivery Unit and the National Task Force for Emergency Departments have fully endorsed the principles that are at the core of national policy and the hospital’s admission and discharge policy in relation to IDP. The rationale for the development is to improve patient flow and to ensure a safe discharge from hospital to the preferred identified discharge destination.
The project was conducted over a four-month period from November 2014 to February The HSE organisational development model was used as the guiding framework for the project. The evaluation process utilised audit to measure compliance with the hospital’s admission and discharge policy at the pre and post implementation stages involving 70 medical records on both occasions.
At the end of the project there was an improvement in the overall compliance rate with the hospital’s admission and discharge policy from 42% in November 2014 to 76.8% in February A risk issue was identified in November 2014 with only 20% compliance in relation to the issuing of discharge summaries for patients, this improved to 82% in February 2015 following specific intervention.
This project has demonstrated an improvement in IDP at the hospital and has stimulated further improvement initiatives to enhance this aspect of patient flow.

2. Introduction & Background Organisational Impact
No Time To Lose
Implementation of Integrated Discharge Planning in an Acute Hospital.
Katherine Kenny:
MSc in Healthcare Management
Introduction & Background
Methodology
Evaluation
The publication of the HSE Integrated Care Guidance1 highlighted the requirement for hospitals to implement robust processes for IDP to improve patient flow from hospital to the preferred identified discharge destination. The hospital’s admission and discharge policy2 reflects this. There is a sense of urgency nationally to improve compliance in this area of clinical practice in an effort to alleviate pressure being experienced with high numbers of patients waiting for admission on trolleys in Emergency Departments.
The HSE organisational development model3 was used to guide this project with specific actions in each of the four phases identified.
Initiation: Creating solid foundation for the change.
Support from senior management.
Use of stakeholder analysis.
Planning: Development of a shared vision, working group for IDP.
Implementation: Communication - formal and informal.
Education sessions – 38 sessions, 220 staff attended.
In pre implementation audit, a risk was identified with immediate action to rectify poor compliance with issuing of discharge summary.
Resistance – Emerging leaders.
Mainstreaming:
Communication, collaboration, continous improvement process utilising audit to monitor compliance.
PAS being replaced by IPMS which will include bed mangement module to support IDP.
Working group remains active.
The Kirkpatrick Model4 was used in the evaluation stage. Evaluation tools utilised were a questionnaire for the education sessions and an audit of 70 medical records pre and post implementation of the project.
Figure 2: Compliance with hospital policy 2
Figure 1: Home by 11 poster
Aims & Objectives
The overall aim of the project is to improve patient flow through the implementation of the hospital’s Admission and Discharge policy2 and the HSE Integrated Care Guidance1. This requires that patients have a predicted date of discharge set within 24 hours of admission and that the initiative of Home by 11 on day of discharge is implemented.
The objectives are to achieve 85% compliance with:
the hospital’s admission and discharge policy.
completion of the IDP form, discharge checklist and discharge summary.
And to:
Develop a patient information leaflet for IDP.
Increase the number of clinicians participating in IDP MDT meetings.
Organisational Impact
IDP is now a high priority at the hospital.
Increased participation by clinicians in IDP focused MDT meetings from 43% to 71.5%.
High visibility of IDP priniciples in the hospital through the use of posters, white boards, patient information leaflets and supporting documentation.
Conclusion
Improvements in compliance to IDP policy by the MDT.
Recommendations:
Discharge Co-ordinator Role
Nurse/Midwife Facilitated Discharge
Regular Audit
References
1.HSE (2014a) Integrated Care Guidance: A practical guide to discharge and transfer from hospital. Dublin:HSE.; 2.HSE(2013a) Admission and Discharge Policy for the Midland Regional Hospital Mullingar, HMM004. Mullingar:HSE.; 3.HSE(2008b) Improving our services. A Users Guide to Managing Change in the Health Service Executive. Dublin:HSE.; 4.Kirkpatrick, D. (1996) Great ideas revisited. Techniques for evaluating training programs, Revisiting Kirkpatrick’s four – level model. Training and Development, 50,