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Paediatric Bed Days Saved

The Children's Hospital at Westmead
Project Added:
13 July 2015
Last updated:
27 July 2015

Paediatric Bed Days Saved

Summary

This project developed a new model of care to allow children with standard or medium risk acute lymphoblastic leukemia, who have received high dose methotrexate, to be discharged within two days instead of five.

Aim

To safely reduce the number of standard or medium-risk acute lymphoblastic leukemia patients with a length of stay (LoS) greater than four days, by 75%.

Benefits

  • Improves outcomes and quality of care for patients and their families.
  • Reduces LoS in hospital and exposure to hospital infections.
  • Increases capacity of the hospital to treat more urgent patients by reducing bed days.

Project status

Project dates: April 2014 - February 2015.

Project status: Sustained - the project has been implemented, is sustained in standard business.

Implementation site: The Children’s Hospital Westmead (CHW).

Background

The project follows the direction set out in the NSW State Health Plan, which focuses on improving clinical practice, reducing the risk of hospital-acquired infections and maintaining the capacity of the health system to treat more urgent patients by reducing bed days occupied by patients suffering preventable complications of care.

At the Children’s Hospital Westmead, there is increasing pressure on bed days across the hospital. To address this issue, staff within the oncology department selected a patient cohort with a five-day inpatient stay and reviewed protocols to reduce the LoS to two days.

Implementation 

  • Barriers to discharge were identified within the existing model of care.
  • Closer collaboration between medical, multidisciplinary and nursing teams was encouraged, through regular communication and team meetings.
  • Updated protocols were developed for paediatric patients with low to medium risk, including children who receive high dose methotrexate for non-Hodgkin lymphoma.
  • Parent and carer information sheets were developed to advise parents and carers of the new protocols and treatments required at home.
  • Education regarding the new protocols was provided to staff. This was achieved through an education program delivered to ward nurses by nurse educators and clinical nurse coordinators. Education was also provided to fellows and allied health staff, including ward pharmacists.
  • The oncology resource manual guidelines were used in the training of new medical staff.
  • Support for children and their families was improved, so they received the appropriate care and information in a timely fashion. This was achieved by using the parent and carer information sheets and discussions with patients and families regarding the change in care.
  • Patient plans that addressed the main points discussed in meetings with patients and their families was documented.
  • No concerns regarding medico-legal compliance of documentation was identified during the project. This model of care was identified to reduce the LoS for a cohort of patients who, through the course of their cancer treatment, already spend lengthy periods of time in hospital.
  • Moving forward, education for nursing and medical staff will continue and the model of care will be adapted in response to ongoing review, feedback and identified needs.

Results

As of February 2015, six patients had been admitted under the new model of care. All were discharged earlier than the previous average of five days, with the new LoS average approximately 48 to 72 hours. There were no incidents or readmissions reported for these patients.

There has been positive verbal feedback from patients and families to staff on their experience. Due to the low numbers of participants to date, an oncology survey will be considered at a later date once the patient cohort is larger.

There is potential to incorporate this project into a new model of care for all paediatric patients with low to medium risk, including children who receive high dose methotrexate for non-Hodgkin lymphoma, oestrogenic sarcoma and brain tumours.

Reference

NSW Health. 2014. NSW State Health Plan: Towards 2021.

Contact

Deborah O’Neill
Clinical Program Director
Sydney Children's Hospitals Network
Phone: 02 9845 2740
Deborah.oneill@health.nsw.gov.au

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