1. Further Opportunities Possible actions for achievement
Title of
Urgent & Emergency Care (UEC)
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Healthy London Partnership: UEC Improvement Team
QEH: Implementing a ward-to board process to reduce the number of long length of stay patients (>21 days) on wards
Queen Elizabeth Hospital (QEH) has been a consistently high bed occupancy rate, with high occupancy from long length of stay (LLoS) patients. LLoS reviews were implemented to reduce the unnecessary stay of patients in a hospital bed and improve flow from ED.
The improvement support offer between QEH and Healthy London Partnership (HLP) included:
Review of current status of current operating model on LLoS patients
Lead on training sessions with ECIST on benefits of LLoS reviews and use of ECIST tool
Engage with Exec Team and system partners to increase awareness and collaboration to enable development of LLoS reviews and unblock issues
Use a QI approach to ensure a site-based co-designed model for embedding ward-based LLoS reviews agreed
Identify system-wide opportunities to improve discharge processes, including aligning programmes of work, governance structures and reviewing impact of current processes.
What we did
Scope of impact
Barnet
Enfield
Haringey
Camden
Islington
City
Barking and Dagenham
Hackney
Havering
Newham
Redbridge
Tower Hamlets
Waltham Forest
Croydon
Richmond
Wandsworth
Kingston
Merton
Sutton
Brent
Ealing
H&F
Harrow
Hounslow
K&C
Westminster
Hillingdon
Lambeth
Bromley
Bexley
Greenwich
Lewisham
Southwark
Approach
Delivery
HLP/ECIST led training sessions on value of LLoS reviews and harm caused by long stays
System-wide engagement to share rationale and benefits of reviews
Planned small scale pilot roll-out of reviews on four wards wards
Ward level coaching to promote discharge remit
Co-design, implement and support delivery of LLoS Reviews – initially office-based, then on wards
Link site with UEC ‘Once For London‘ improvement work: Enhancing Health in Care Homes, CarePulse, NHS 111 Star lines
Facilitated meetings to introduce LLoS reviews, with key stakeholders at QEH and Bexley/Greenwich system partners
Introduced and delivered training on the ECIST LLoS toolkit
Used QI methodology to implement and continuously improve the conduct of reviews
Connected the ToCC team with several pan-London community-based UEC programmes
Established a weekly cycle for LLoS reviews, including membership, capturing data, escalating actions
Highlighted further opportunities for improvement, including clarifying discharge team responsibilities, ward-based discharge training, developing robust system-wide escalation processes
TIPS REGARDING FORMATTING
Use graphic elements, like boxes, to highlight each section of your poster.
Use space to create emphasis.
Use no more than 2-3 colours, and dark type on a light background.
Conclusions first, keep them short and to the point in the upper left-hand corner.
Simple graphs are effective graphs.
Make the text big enough to read.
Use Arial or Lato font.
ALWAYS left align the text.
Keep your headings the same size and style throughout.
Avoid chaos, keep the layout easy for the eye to follow.
Images and graphs say more than words, so keep your poster visual.
If you are using a photo, avoid web images – use at least 150 dpi, but no more than 300 dpi.
Don’t forget any other logos where necessary.
Greenwich
HLP has supported LLOS (Long Length of Stay) Reviews
HLP has supported MADEs (Multi Agency Discharge Events)
HLP has supported both LLOS Reviews and MADEs
Progress Update
Further Opportunities
Organisational and stakeholder engagement
Good trust executive team support; ward and the discharge staff committed to improving the management of long stay patients
Moving LLoS reviews from office based to wards
Opportunity to avoid duplication of discussions at ToCC meetings and output from LLoS reviews
Workforce
Clinical Lead and admin support identified to co-ordinate LLoS review activities
Support established from the medical director to clinically review unfit patients
Lead Occupational Therapist embedded in LLoS review team, providing effective challenges
Opportunity to improve on data collection and IT analytical support of data and performance
Governance
In the process of establishing formal governance structure for escalations from ToCC team
Development and embedding of LLoS reviews now part of the QEH Emergency Care Improvement Programme of work, encompassing all improvement activities
System-wide partnership opportunities to improve upon collaborative working, promote Enhanced Healthcare in Homes and Alternative Care Provision
Weekly patient reviews
Opportunity to reduce knowledge variability at ward level
Coding consensus on why patient waiting, leading to accurate reporting for escalation
Ward-based reviews ensure full capture of clinical and patient picture
Further discipline and challenge required around the community offer and support
Metrics required to understand impact and outcomes of discharge process
Recommendations
Possible actions for achievement
Confirm the approach for reviewing both medically fit and unfit patients across the hospital
Pilot clinically-led “complex cases” meeting
Review clinical pathways for discharging, to include board round discussions; early discharge planning
Review interface with system partners and D2A model – promote and maximise on community offer
Obtain baseline data of current discharging profile
Stakeholder engagement; gap analysis of what is happening v. what should happen; clarification/re-education of D2A model
Embed DPTL Toolkit and improve the overall programme leadership for LLoS reviews and align to the wider governance arrangements at QEH
Identify a Clinical Lead for the LLoS programme of work
Agree a governance process to clarify patient flow escalations through site processes
Align implementation of LLoS review improvement work with wider improvement programmes
To find out more, please contact:
Eileen Sutton
Sudipinder Sian
@healthyLDN