Area | Original work stream | No | What did you plan as your last step and what did you expect? | What happened? | What did you learn? |
Ward Y | Baseline data collection | 1a | Date: 3 April Capture ward data regarding planned discharges versus actual discharges with reasons if a difference exists. Capture issues and problem on a daily basis. To be collected at the board round each day at 09:00 as part of MDT in paper format Prediction: Data will be captured during RIE due to focus but may be more difficult when returning to normal working due to lack of focus. | Information was captured for the week of the RIE and the following week, but documentation was thrown away by mistake before analysis, so 3 weeks’ worth of data was lost. Staff generally found this an easy measure to collect and ensured that ward staff were focussing on the discharge of patients for the following day. | It was a useful way to get staff thinking about discharges, but there is a need to ensure all staff know about data collection and why this is required. To develop more formal ways to capture data which cannot be discarded |
Ward Y | Baseline data collection | 1b | Date: 6 May Data to be captured daily at board round with MDT related to those who were planning to go home the following day and those who were discharged on the previous day versus those who were planned. Reasons for delay to be captured on a daily basis This will be captured electronically during board round. Prediction: Data will not be discarded this time and through collecting data we will see an increase in those discharged from the ward. | Data collected through Excel format. Due to absence of baseline data, it was difficult to see improvement, but for the 3 weeks captured, it was possible to see a general increase in the numbers discharged and matching of predicted to actual discharges. On average, two patients were predicted for discharge, but three patients were actually discharged. | This tool was an effective mechanism not only for data collection but also as a mechanism for developing a plan and shared model around discharge of patients. Adopt this approach and embed. |
Ward Y | Earlier referrals to community hospitals | 2a | Date: 1 July Referral to community hospitals at 4 days postsurgery as opposed to 10 days as part of ortho transfer checklist | Checklist agreed with surgeons and community hospitals, and now patients are being discharged where appropriate. However patients and carers are unsure of the process patients will take especially in relation to transfer to care home. | Process is working well and has not had any issues so far. To develop a patient leaflet to identify the process that will be followed for surgical patients |
Ward Y | Earlier referrals to community hospitals | 2b | Date: 30 July ‘Yellow brick road’ patient journey leaflet to be shared with patient to share the road journey for patients and family and transition between acute care hospital to community hospital. This will be explained to patients before and after surgery as well. | This has been completed for the majority of patients and has provided a better experience so that patients and family know about next steps patients will be taking into recovery. | Useful tool which has kept patients/families apprised of road maps Adopt process. |
Ward Y | Communication with patients and relatives | 3a | Date: 20 July ‘Ward communication board’ to be redesigned to improve communications with the patient and staff. This will be developed with staff, and then education will be completed on new standards and set handover time. Prediction: As a result of the new design and staff understanding, there will be an improved communication with patients and carers, including ensuring that staff are aware of progress towards discharge. | Clear actions visible to all MDTs, including red delays highlighted and now fit for purpose, following design by team. SOP/guide being discussed with MDT and implemented once board was delivered and developed. | Overall good MDT working once boards had been implemented and now clear understanding related to patients’ progress with care Adopt process. |
Ward X | Baseline data collection | 1a | Date: 3 April Capture ward data regarding planned discharges versus actual discharges with reasons if a difference exists Capture issues and problem on a daily basis. To be collected at board round each day at 09:00 as part of MDT in paper format Prediction: Data will be captured during RIE due to focus but may be more difficult when returning to normal working due to lack of focus. | Data were not captured after the RIE as staff felt that this was not helpful and did not help discharging patients earlier. Therefore, no further data were captured. | This ward did not see the value of this data collection and therefore PDSA was abandoned. |
Ward X | Ward communication | 2a | Date: 20 April Previously, there was no formal ward MDT ward meeting (apart from board round), and therefore ward teams were not all aware of issues relating to ward workings. The plan was to implement a weekly MDT meeting which was 30 min/week on a Wednesday at the same time and place to discuss patients as well as improvements to the ward. Prediction: It may be difficult to get all the right staff together to begin with, but once they are aware, the consistency will support better attendance. | After 4 weeks of testing, the team felt well informed about patient issues and appeared to work well. Suitable time and place had been difficult due to restricted area on ward away from patients, but MDT team found really useful and keen to keep implementing. | Need a place to display information related to actions and next steps, but otherwise has worked well and should be adopted |
Ward X | Discharge documentation | 3a | Date: 10 May Estimated date of discharge Monday–Friday to be collected for each patient and captured on ward communication board and on hospital information technology system to support an agreed plan for when a patient will be discharged Following ward rounds, medical staff to provide any update/changes to discharge facilitator Prediction: This may be difficult to pin down medical staff for a date in the first instance, but if completed frequently, it will be a useful planning tool. | This information is now being collected at daily board round. This has worked so far and produced good discussion between staff on when patients may go home. Follow-up to discharge facilitator has been a useful way to capture any anomalies. Sometimes, there is a discrepancy about when the patient is actually supposed to go home between medical and nursing staff. This is a similar intervention to 1a, but ward staff feel more ownership over this, so it is more likely to be adopted. | Useful tool to use to capture when a patient may go home To prevent confusion when patient is ready to go home, staff will capture in notes when patient is medically stable for discharge. |
Ward X | Discharge documentation | 3b | Date: 3 June Doctors to provide an update in medical documentation of ‘medically stable for discharge or transfer’ on electronic patient notes This will ensure that there is no missed communication between medical and nursing staff. Prediction: Consultants have led this change, so more likely to embed; this needs to be raised with registrars and junior doctors to ensure they follow practice. | This has now been completed regularly by medical staff, and nursing staff feel happier about clarity of communication. Discussion occurred with junior doctors to make sure they were following the process, but this has worked well. | Process to be adopted with no further changes |
Ward X | Super stranded patient | 4a | Date: 20 June A patient was on ward X for 114 days—a root cause analysis will be completed to identify why this patient was in the hospital for so long. Consultants, nursing staff and management to complete a process mapping exercise using Red2Green principles to identify how much value was added with this patient receiving acute care hospital | Of the 114 days in the hospital, 102 days were red days where no ‘value’ was added by them being in hospital where care could have been provided elsewhere. This included 95 days awaiting funding for a community bed and totalled £28 500 in bed day costs. | Hospital was not the safest place for this patient. This showed how the patient fell through the gaps because there was an issue between hospital and community processes. To implement a week-long length of stay review on this ward, which will bring together system MDT to look at how patients can be discharged earlier |
MDT, multidisciplinary team; PDSA, plan–do–study–act; QIP, quality improvement project; RIE, Rapid Improvement Event; SOP, Standard Operating Procedure.