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ReADI: Redesigning Access and Discharge Through Innovation

Top End Health Service, Northern Territory
Project Added:
26 April 2016
Last updated:
28 April 2016

ReADI: Redesigning Access and Discharge Through Innovation

Summary

Royal Darwin Hospital redesigned its patient flow systems, with an estimated date of discharge (EDD) tool and electronic patient journey board.

View a poster from the Centre for Healthcare Redesign graduation, April 2016.

ReADI poster

Aim

To improve National Emergency Access Target (NEAT) performance through the safe and timely discharge of patients at Royal Darwin Hospital.

Benefits

  • Improves the patient experience and care planning.
  • Improves community and staff confidence and satisfaction with clinical management.
  • Streamlines patient discharges and reduces delays.
  • Enhances coordination processes for ward staff.

Background


Since the NEAT was introduced in 2011, Royal Darwin Hospital has consistently not met its performance benchmarks. Prior to the project, the benchmark for patients seen within four hours was 85%, with performance at 68%.

This led to a range of issues which impacted the patient journey, including placing two patients per bed bay in the emergency department (ED) and caring for patients in ward corridors. The lack of discharge policy also led to inconsistent practices, including a disparity between the time of discharge at 4pm and peak admission times to the ED at 11am.

A whole of hospital change was required to meet NEAT benchmarks. Discharge from hospital was identified as the key action required to improve the flow of patients from the ED and increase access to beds for those who need care.

Implementation

  • Patient and staff satisfaction surveys were undertaken to identify the extent of the problem, in addition to staff workshops and data analysis.
  • Process mapping and root cause analysis identified two issues common to the Division of Medicine and Division of Surgery at Royal Darwin Hospital. These were:
    • patients were not aware of their EDD, which left them unprepared to leave hospital
    • multidisciplinary teams were often not aware of the patient’s EDD, causing delays to the discharge process.
  • Two key solutions were designed to improve, streamline and coordinate the discharge process. These were:
    • implementing an electronic patient journey board, which allows referrals and discharge information to be viewed by all staff on iPads, so better decisions can be made by multidisciplinary teams
    • development of an EDD tool so that multidisciplinary teams, patients and carers can prepare for discharge from the hospital.

Project status

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

Key dates

  • Start date: March 2015
  • Integrated with the ‘Improving Patient Flow’ project in November 2015
  • Finish date: March 2016

Implementation sites

  • Division of Medicine and Division of Surgery, Royal Darwin Hospital, Northern Territory

Partnerships

Results

  • The number of patients discharged by midday increased from 23% to 27% between January and December 2015.
  • The EDD tool has been expanded for use across Royal Darwin Hospital.
  • Staff surveys showed the electronic patient journey board was a useful tool for understanding the EDD and improving the discharge process.
  • The number of patients moved to a ward within four hours increased from less than 20% to 41% between January and December 2015.
  • The ReADI project has now been incorporated into a number of active work projects at Royal Darwin Hospital, including the ‘Improving Patient Flow’ and ‘Access to Elective Surgery’ projects.

Percentage of acute care episodes discharged between 12am and 12pm

NEAT trend Jan 2014 - Dec 2015

Lessons learnt

  • The regular rotation and turnover of medical and nursing staff can make engagement difficult, which impacts the sustainability of the project.
  • Communication is critical and it’s important to reflect on all feedback.
  • During the project, there were a number of changes in the project team, including the project sponsor. Despite this, the project has been completed which is a credit to the staff and the framework under which it was designed.
  • The project has positively impacted other areas in the hospital, such as the Division of Maternal, Child and Youth, and has been anecdotally credited with fostering a culture of change and ideas in the hospital.

Further reading

  • Johnson M, Capasso V. Improving patient flow through a better discharge process. Journal of Healthcare Management 2012; 57(2): 89-93.
  • Lees L. Exploring the principles of best practice discharge to ensure patient involvement. Nursing Times 2009; 106(25): 10-14.
  • Lees L, Holmes C. Estimating date of discharge at ward level: a pilot study. Nursing Standard 2005; 19(17): 40-3.
  • Marchette L, Holloman F. Length of stay: significant variables. Journal of Nursing Administration 1986; 16(3): 12-20.
  • Ou L, Chen J, Young L et al. Effective discharge planning: timely assignment of an estimated date of discharge. Australian Health Review 2011; 35(3): 357-63.
  • Wilson MJ, Nguyen K. Bursting at the seams: improving patient flow to help America's emergency departments. Washington DC: Urgent Matters, The George Washington University Medical Center, School of Public Health and Health Services, Department of Health Policy; 2004.

Contact

Roma Smyth
Clinical Redesign Manager
Royal Darwin Hospital
Top End Health Service, Northern Territory
Phone: 08 8922 8888
roma.smyth@nt.gov.au

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