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Someone’s Sleeping in My Bed

Project Added:
19 August 2014
Last updated:
10 October 2014

Someone’s Sleeping in My Bed

Discharge Planning at the Prince of Wales Hospital

By Prince of Wales Hospital, South Eastern Sydney Local Health District

Summary

To review and streamline the discharge process on an acute medical and surgical ward in order to reduce waiting times for patients at all stages of their hospital journey.

Download a presentation on this project from the Centre for Healthcare Redesign graduation, August 2014.

Aim

To improve patient access to care by focusing on safe and timely discharge planning from acute inpatient wards.

Benefits

  • Improved access to patient care at the beginning of the hospital journey Patients are better informed and prepared for discharge.
  • Enhanced coordination processes to assist ward staff manage discharges more effectively.
  • Streamlined discharge processes will assist in meeting the National Emergency Access Target (NEAT) and Transfer of Care (ToC) trajectories.

Background

Whole of facility changes were required to meet new national benchmarks, such as NEAT and ToC. Discharge from hospital was revealed to be a vital component in creating access for patients in the Emergency Department. In the diagnostics phase significant delays occurred in the discharge process. To create a better experience for our patients and reduce length of stay, discharge delays and barriers to associated planning were explored with key stakeholders.

Solutions implemented

Process mapping and root cause analysis identified two key issues common to both wards. Patients were not always aware of their estimated date of discharge, leaving them unprepared and the multidisciplinary teams were not always aware of the patients plan, leaving allied health referrals to the day of discharge. Initiatives to improve team communication around discharge plans, and communications with patients and carers included the roll out of a patient bedside journey board and redesign of the ward boards to capture allied health referrals and plan of care.

Results

Monitoring of the project objectives has assisted in improvements of NEAT by specialty, increased use of the Patient Discharge Lounge, improved utlisation of estimated dates of discharge and an increase in the number of patients discharged by 10am. Patient and staff surveys in relation to the bedside journey boards showed they are a useful tool for keeping the patient and multidisciplinary team informed.

Lessons learnt

We recognised the value of sponsorship to help guide the project and facilitate change. We learned skills in how to engage medical staff which would have been more powerful if used earlier during the diagnostics and solution design phases.

References

Stokes, B (2011) “Four hour rule program progress and issue” Department of Health, Western Australia.

Geelhoed, G & de Klerk, N (2012) “Emergency department overcrowding, mortality and the 4- hour rule in Western Australia” MJA, 196 (2), 122-126.

Acknowledgments

Acknowledgments to the Clinical Excellence Commission “In safe hands” project, NSW Ministry of Health Whole of Hospital Program and Agency for Clinical Innovation, for sharing information on patient bedside and ward journey boards.

Contacts


Nursing Unit Manager, Outpatients and Ambulatory Care Services
Prince of Wales Hospital, South Eastern Sydney Local Health District
Phone: 02 9382 0364


Project Lead Whole of Hospital Program
Prince of Wales Hospital, South Eastern Sydney Local Health District
Phone: 02 9382 2941

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