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

2. Meet the Team

5. Drivers
People
Data
Strategy

6. Discharge

7. 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

8. 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.

9. The Concept
Action the plan
Create the plan

10. 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

11. 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

12. 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

13. Measurements to date

14. Number of Discharges

15. Number of Discharges

16. Number of Discharges – Winter Comparison

17. Number of Discharges – Winter Comparison

18. Length of Stay

19. Length of Stay

20. Time of Discharge

21. 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

22. 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

23. Pharmacy

24. 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

25. Pharmacy

26. Pharmacy

27. 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.

28. 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.’

29. 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

30. 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

31. Q&A