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Ready, Set, Go! Effective Discharge Planning at St Vincent’s Hospital

St Vincent's Hospital
Project Added:
20 April 2015
Last updated:
22 April 2015

Ready, Set, Go! Effective Discharge Planning at St Vincent’s Hospital

Summary

This project implemented a range of tools to reduce discharge delays at every stage of the patient journey, reducing length of stay (LoS) and improving patient satisfaction and access to inpatient beds.

Poster from the Centre for Healthcare Redesign graduation, April 2015  Poster from the Centre for Healthcare Redesign graduation, April 2015

Aim

To reduce discharge delays by providing an effective, coordinated and timely approach to discharge planning, thereby reducing LoS, improving access to inpatient beds and improving patient satisfaction throughout St Vincent’s Hospital (SVH).

Benefits

For patients

  • Allows patients to stay in hospital for the optimum amount of time for recovery, reducing the risk of an adverse event from an extended stay.
  • Helps patients plan their return home and organises the right services and support for their needs.
  • Provides access to a bed on a ward within a short time of being admitted through the Emergency Department, so patients receive the right care in the right place at the right time.
  • Improves patients’ experiences and allows them to be included in decisions about their care.

For staff and the organisation

  • Improves job satisfaction and morale of staff, making their working life easier and clearer.
  • Improves the quality of services provided to patients, with less time-wasting and duplication of work.
  • Increases bed availability, resulting in the effective and efficient use of resources.

Project Status

Project status: Implementation - the initiative is currently being implemented.

Project started: 2 April 2014

Background 

In October 2013, a three-day study was conducted at SVH to identify latent capacity within inpatient beds and quantify the impact on delays to patient care. This study found that 32% of beds were occupied due to a delay in discharge.

An Acute Flow Rapid Improvement event in December 2013 identified an ineffective, uncoordinated approach to discharge planning. Health Roundtable data showed that the SVH Acute Relative Stay Index was at 102%, compared to a rate of 91% by its peers. In addition, the National Emergency Access Target (NEAT) was 64% in March 2014, where the expected target is 81%.

A review of discharge planning processes was undertaken at SVH, which identified that communication on discharge planning required improvement. The Ready, Set, Go! project updated existing tools and implemented new ones, to facilitate improved communication within the team and to patients regarding discharge planning. 

Staff will use these tools to begin planning for a patient’s discharge from the time of admission or pre-admission, with the most complex of cases managed by a care coordinator. This will ensure patients receive the right care, in the right place, at the right time.

Implementation 

  • The Discharge Planning Traffic Light System has been implemented on all inpatient wards, which visibly displays a patient’s discharge status via a traffic light colour scheme.  Staff are able to prioritise patients highlighted for discharge today or within 24 hours.
  • Rapid discharge planning rounds attended by all staff involved in the patient’s care occurs in conjunction with the traffic light discharge status. This assists with communication sharing.
  • Transition of Care Coordinators from specialty based to inpatient wards to coordinate patients with complex care needs and prevent delays.
  • The Transfer of Care Risk Assessment tool is currently being developed as an electronic tool, to identify any issues that may cause a delay in discharge earlier in the patient’s stay.
  • The Discharge Planning Checklist tool is currently being reviewed by a working party, to transition from a paper-based to an electronic format. This will help identify and complete discharge planning tasks in a timely manner.

Implementation site

St Vincent’s Hospital, Sydney.

Results

  • Average LoS for patients in eight inpatient wards has remained below 6.6 since October 2014, when implementation began.
  • Beds occupied due to a delay in discharge has decreased from 32% in October 2013, to 18% in March 2015.
  • NEAT performance for admitted patients has increased from 36% in March 2014, to 43% in January 2015.
  • According to Press Ganey Surveys held between October and December 2014, patient satisfaction with the discharge process improved from 78% to 80.2%.

Lessons Learnt

  • The value of strong leadership and teamwork, consultation with staff and patients.
  • The importance of regular communication to stakeholder groups.

Contact 

Susan O’Shea
Nurse Manager
St Vincent’s Hospital, Sydney
Phone: 02 8382 1111
Email: Susan.OShea@svha.org.au 

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