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Discharge on Time ... Every Time

Nepean Blue Mountains Local Health District
Project Added:
25 July 2013
Last updated:
30 September 2014

Discharge on Time ... Every Time

Zena Wilson and Kathy Gradidge, Nepean Blue Mountains Local Health District

Abstract

The 'Discharge on time...every time' project at Nepean Hospital aims to improve the flow of patients throughout the hospital, thus improving the overall patient journey by:

  • increasing the number of discharges by 10am to 30% hospital wide within a 12 month period
  • realigning the mismatch between discharge and admission times within 12 months
  • increasing the confidence and satisfaction of patients, carers and staff regarding the discharge date and time within a 12 month period.

The key issues identified are:

  • the inability to correctly identify the expected date of discharge
  • the lack of planning for discharge
  • medical availability to perform the tasks necessary to complete the process
  • the ability to provide reliable transport in a timely manner.

A whole of hospital approach is being used to achieve the cultural change required.

Listen to Zena Wilson talking about the project ( mp3 - 7MB)

Planning and Diagnosis

The project was initially called '10am Checkout'. Following much deliberation and research this was subtly changed project from '10am Checkout' to 'Discharge on time ... every time'. This was a significant step for the project, because it was impossible to discharge all patients by 10am and unnecessary.

The most important objective for Nepean was to realign the mismatch between admissions and discharges, achieve 30% discharges by 10am and improve patient and staff satisfaction in relation to the discharge process.

Consultation

90 patients and 244 staff members were consulted and have provided valuable comments to help shape this project.

Graph of stakeholders. 90 patients, 224 nurses, 135 medical and 18 allied health

  • The patient survey revealed frustrations with not knowing the expected date of discharge.
  • 89% of patients had no idea when they were going home
  • 27% of staff knew the correct Expected Date of Discharge

Sponsorship and engagement

50-60 people across five groups; medicine, surgery, cancer, aged, and maternity, each with medical, nursing, allied health and the executive staff, attended a diagnostic workshop to review the consultation findings and understand the current discharge process.

Flyers and communiqué for all staff and patients were developed and circulated in an attempt to raise awareness, get people involved and eventually to maintain momentum.

Nepean has an established Patient Flow Executive Team (PFET). This project became part of the standing agenda and still is. This is vital to obtain the cultural change. The PFET enabled the project to reach more key stakeholders, especially in relation to the medical clinicians.

The General Manager and the Executive Medical Director are the project sponsors. They are very influential and have strong leadership qualities throughout the organisation. Their support and leadership is critical to the success of this project.

Discharge on time...every time is discussed and deemed to be important by the most important people in the hospital. This sends very powerful messages.

Developing and Implementing Solutions

The implementation plan extends over the next twelve months and ends in October 2013. The solutions are divided into three phases and are the project is currently working to implement phase two.

 MedicalPlanningTransport
Phase 1
  • Education/fact sheet for interns re completion of discharge summary
    • Improving communication with multidisciplinary teams will ensure treatment and processes are on track, reduce waiting times and increase efficiencies
    • Develop Business Rules to be used as a guide for the meetings.
    • Develop a criteria and evaluate at 3 months
  • Increase day to day utilisation of patient flow portal
    • Increasing the day to day utilisation of the patient flow portal will improve predictability of patient flow portal, ensure patient flow plans more accurate and enable earlier escalation to avoid blockage.
  • Raise profile of Stranded Sam
  • Home oxygen available 24/7
  • Raise profile of discharges at ward rounds
  • Highlighting out of area patient to treating teams
  • Earlier referrals to Allied Health
  • Discharge checklist Envelope –carbon copie
  • Fast track discharge process for simple cases
  • Improve communication between multidisciplinary team
  • Contract with hire car company to provide door to door service
  • Exact time of discharge provided to patient by teams
  • Designated pick up points & limited free parking
  • Hope Cottage / Motels for patients waiting overnight for transport
Phase 2
  • Activated voice discharge summaries
  • Defined escalation process for consultant reviews
    • Escalation process when patients exceed agreed Doctor/Patient ratio Escalation process when patients exceeds agreed Doctor/Patient ratios will result in heads of departments taking responsibility for the number of admissions for their speciality at any one time.
  • Commencement of discharge plan by medical staff on admission
  • Completion of prescriptions during ward rounds
  • Transition Lounge
    • Home base Admission/Discharge Lounge or transition lounge will accommodate patients waiting for admission and those waiting discharge. It is planned to utilise this area for simple treatments for those patients that will be discharged following their last dose of antibiotic or dressing or waiting result of tests.
  • Criteria led discharges processes
  • Better utilisation of Aged Care NP
  • Revolving door pathways
  • Hospital ambulance 18/7
Phase 3
  • Electronic medication scripts
  • Drop in clinics
    • Increases confidence in consultant knowing they can review patient on ward the next day
    • Provides an area for follow up of patients for several appointments post discharge preventing readmission
  • Floating Medical Officer to do paperwork
  • Early morning rounding
  • Allied Health available at weekends
  • More ComPacks/TACP and other services
  • Helpline – Aged care nurse
 

Results

  • Clinician defined Estimated Date of Dishcarge increased from <10% to 75% February 2013
  • Discharge by 10am results in line with projection of 30% within 12 months
  • Identifiable shift in discharges between 8am and 10am
  • There has been a significant reduction in patient complaints relating to waiting times in the emergency department

Contact


Operations Nurse Manager, Nepean Hospital
Nepean Blue Mountains Local Health District
PO Box 63, Penrith NSW 2751
Phone: 02 4734 1599

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