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The Home for Lunch Project

Project Added:
7 January 2016
Last updated:
21 January 2016

The Home for Lunch Project

Summary

The Home for Lunch Project addressed barriers to safe, timely and efficient discharge of children, using a whole of health approach.

View a poster from the Centre for Healthcare Redesign Graduation, December 2015

Home for Lunch poster

Aim 

To reduce length of stay (LoS) for inpatients occupying emergency department (ED) accessible beds by 10%, improve patient and carer satisfaction regarding the discharge process by 10% and improve admitted emergency treatment performance (ETP) by 10%, by June 2016.

Benefits

  • Reduces LoS and improves ETP performance, resulting in a decrease of bed days and associated costs.
  • Reduces elective surgery cancellations.
  • Improves admitted emergency treatment performance.
  • Improves patient experience and satisfaction.
  • Decreases ED and inpatient discharge waiting times.
  • Supports carer planning.
  • Improved interdisciplinary communication, staff satisfaction and morale.
  • Improves efficiency for medical, nursing and allied health teams.

Background 

A diagnostic study on the patient’s journey was completed in early 2014. It identified a number of issues relating to moving patients through The Children’s Hospital at Westmead and Sydney Children’s Hospital Randwick. These included access to services, availability of inpatients beds and timely discharge once care was completed.

Discharge is a key component of the patient journey and can impact on patient satisfaction and hospital bed capacity. This affects the flow of patients from the ED to their disposition ward.

In 2014, average ETP performance for NSW was 81%, while performance for SCHN admitted patients was 40.9% (38.7% for Sydney Children’s Hospital Randwick and 43.1% for The Children’s Hospital at Westmead). Further diagnostics studies found that patients were often waiting for paperwork or the final clinical review, after they had met the criteria to go home.

Barriers to timely discharge include:

  • patients waiting unnecessarily to be discharged
  • elective surgery cancellation due to lack of beds
  • elective oncology admissions that spend the day in the clinic and are admitted to a ward late in the day when a bed becomes available, due to the lack of coordinated discharge
  • intensive care unit exit block
  • patients held up in recovery waiting for a bed to become available, which results in not receiving care from the most suited clinical team at that stage in their journey.

As a result, the following objectives were identified:

  • to reduce LoS of inpatients occupying ED-accessible beds by 10% by June 2016
  • to improve patient satisfaction with the discharge process, with a percentage to be determined once a baseline survey has been conducted
  • to improve admitted National Emergency Access Target performance by 10% by June 2016, for wards participating in the project (Hunter Baillie and C3 West).

Implementation

An interdisciplinary electronic patient journey board meeting was implemented on Hunter Baillie and C3 West.

Hunter Baillie

  • Held daily, Monday to Friday, between 8.30am and 8.50am.
  • Attendees include general medicine and respiratory medical staff, nursing, allied health, pharmacy and ward clerk teams.

C3 West

  • Held daily, Monday to Friday, between 9.00am and 9.10am.
  • Attendees include general medicine medical staff, nursing and ward clerk (allied health and pharmacy involvement due in 2016).

Patient updates

All patients on the wards are addressed with following updates:

  • patient’s current clinical status
  • referrals or consults required
  • discharge medication or transport requirements
  • estimated date of discharge.

Feedback 

Feedback from staff on the implementation of the inter-disciplinary team patient journey board meetings has significantly improved communication between the care team members and placed the focus on the patient. Staff are better placed to prioritise their workload for the day as a result of having open conversations at these meetings.

Key dates

  • Project start:  February 2015.
  • Project finish: June 2016.

Project status

  • Sustained - the initiative has been implemented and is sustained in standard business.

Implementation sites

  • C3 West Ward (Medical), Sydney Children’s Hospital Randwick
  • Hunter Baillie Ward (Medical and Respiratory), The Children’s Hospital Westmead 

Partnerships

  • Manly Hospital
  • Shellharbour Hospital 

Evaluation 

  • A formal review in December 2015 looked at the following measures for the implementation of the inter-disciplinary team electronic patient journey board meeting:
    • a reduction in ward LoS
    • increased use of criteria-led discharge
    • a reduction in referral times
    • time from referral need identified and entered in PowerChart
    • time from referral to patient consultation entered in PowerChart
    • increased staff satisfaction
    • increased interdisciplinary communication.
  • Final outcomes of the project will be determined in a review to be completed by June 2016.
  • Identified future initiatives include:
    • an enhanced structure for interdisciplinary bedside rounds
    • an agreed framework of defined roles and responsibilities for key stakeholders during handover meetings and daily ward rounds, to minimise duplication of effort and improve patient outcomes.

Lessons learnt

  • Strong sponsorship and governance structure is critical - without it the project will not evolve.
  • The clinical redesign methodology is key to successful implementation.
  • Continue to challenge yourself and the assumptions made by others, to ensure the best outcome for patients and their families.
  • There is potential to apply this project to other areas such as domestic services, allied health referral requests, pharmacy and medication.
  • There is an opportunity to roll out the concept to other wards.

Related resources 

Contact

Sharon Roumanos
Whole of Hospital Program Officer
Sydney Children’s Hospitals Network
Phone: 02 9845 0548
sharon.roumanos@health.nsw.gov.au

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