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Gunyah Oncology Weekend Discharge Project

Sutherland Hospital and Community Health Service
Project Added:
28 October 2016
Last updated:
11 November 2016

Gunyah Oncology weekend discharge project

Summary

This project added potential discharges to the agenda of a weekly meeting and developed a discharge process where oncologists worked in teams of two during ward rounds.

Aim

To increase weekend discharges for eligible oncology patients at Sutherland Hospital by 50% within six months.

Benefits

  • Reduces length of stay for oncology patients.
  • Reduces bed block in hospital wards.
  • Enhances collaboration among oncologists.
  • Increases the number of overall separations (when an episode of care for an admitted patient ceases).

Background

The Gunyah Ward at Sutherland Hospital cares for adult oncology and neurology patients. It is a small ward, with many treating clinicians not located onsite full time. An audit found that prior to the project, the Gunyah Ward had low rates of discharges on weekends, compared to other wards at the hospital.

Low discharge rates on weekends can create bed pressure if new patients arrive over the weekend or on Monday. It can also keep patients in hospital longer than necessary. It was determined that increasing weekend discharges would reduce bed pressure and improve patients’ experience and health outcomes.

Implementation

Solutions implemented

  • Consultation was undertaken with hospital executives, bed managers, patient flow coordinators and other stakeholders, to review the discharge process and identify potential reasons for low weekend discharge rates. It was determined that low levels of ward rounds, a lack of decision-making capabilities in registrars, a lack of discussion in weekly meetings and the removal of a discharge coordinator nurse were contributing factors to the low weekend discharge rates
  • An audit was undertaken in June 2015 to compare the rates of discharge over the weekend with other wards at Sutherland Hospital. The length of stay compared to peer group hospitals was also measured
  • Potential discharges were added to the agenda at the weekly oncology case conference. The weekly conference occurs on a Wednesday and discusses patients who can be discharged over the next two days, prior to the weekend
  • To increase efficiency during weekly ward rounds, oncologists were paired up and worked in partnership to manage discharges.

Project status

Implementation - the initiative is ready for implementation or is currently being implemented, piloted or tested.

Implementation sites

Gunyah Ward, Sutherland Hospital, SESLHD

Partnerships

Clinical Leadership Program

Evaluation

Discharges on Fridays, Saturdays and Sundays increased from 11 in 2015 to 20 in 2016. Average length of stay was measured, with results as follows:

  • January 2015: 4.5
  • January 2016: 5.1
  • February 2015: 10.5
  • February 2016: 6.6
  • March 2015: 7.7
  • March 2016: 7.5
  • April 2015: 7.0
  • April 2016: 5.8

The number of overall separations was measured, with results as follows:

  • January 2015: 37
  • January 2016: 47
  • February 2015: 33
  • February 2016: 60
  • March 2015: 30
  • March 2016: 61
  • April 2015: 24
  • April 2016: 56

Lessons learnt

  • Group size and make up plays an important role in the success of the project. It’s important to clarify expectations for each team member in terms of their role, responsibilities and communication requirements.
  • There was difficulty gaining buy in from staff on the ward, as no members of the project team worked on the Gunyah Ward.
  • The sample size was low, which made evaluation difficult.
  • The amount of work required outside of project meetings was underestimated and should be considered in the planning stages of a project.

Contact

Vincent Salomon
Nurse Unit Manager, Anaesthetics
Sutherland Hospital
South Eastern Sydney Local Health District
Phone: 02 9540 7600
vincent.salomon@health.nsw.gov.au

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