We identified that admitted patients were often waiting longer than neccessary to recieve the interventions they needed to progress their recovery and ensure safe discharge planning. We reviewed patient pathways and identified key areas where we could change processes to improve patient care. We devleoped standards of care linked to our electronic whiteboard processes which gives us realtime information on what patients are waiting for.
We used this information to identify key themes for change and then developed strategies for change. We monitored progress weekly to identify if we were improving and where we needed to focus on getting better. This has led to reduced lengths of stay and the organisation having a realtime overview of the reason for patients waiting
The Trust experienced the following issues;
1. A&E Department which was full of patients waiting for patient beds
2. There was a gap between the A&E Demand and Release of Cpacity
3. Patients expereinced delays in accessing diagnostic interventions
4 Patients experienced delays in accessing Specialist and Community reviews
5. There were delays in decision making for patients waiting to be seen by Consultants
1. We collated evidence of delays to share with Staff
2. We trained staff in identifying Red & Green days
3. We used electronic whiteboards to support realtime monitoring
4. We monitored outcomes
5 We gave feedback of change to staff
1. We have reduced out length of stay across the Trust equivilant to a reduction in 26 beds
2. We have managed our bed base more effectively
3. We have identified key barriers to accessing interventions on a daily basis and can focus time and effort into reducing waits in areas which matter
4. We have a comprehensive process for managing day to day capacity and demand
5. We have reduced the wait time for the most vulnerable patients entering the Trust through reduction in handovers from ambulance staff to A&E
1. Bed days have reduced by 26
2. We reduced the time to intervention for Echocardiography which led to a 1.2 million CQUIN Funding
3. We developed realtime identification of patient waits on our whiteboard system which is monitored three times per day
4. We reduced the number of patients on the Long length of stay programme through developing daily meetings with social care and commissioners
5. We enabled information regarding the patient discharge to be uploaded to the whiteboard system
At the beginning of the financial year, the Trust embarked on a review of the processes for monitoring patient flow through the acute pathway and identified the need to improve patient experience by reducing the time they waited for their care to be progressed. This review was completed against a background of increased demand to emergency services and the acknowledgement that there was a mismatch between the demand of acutely ill patients needing a bed and delays in progressing safe patient discharge through ensuring a planned process to support staff and patients to access support systems in a timely fashion.
The Trusts aim was to develop new processes to support the daily decision making of clinical staff and give operational managers and the executive team the assurance that patients were being monitored and their care delivered to support a safe discharge. ambition, outcome, spread, value.
Our ambition was to improve patient care in our Emergency Department by freeing up capacity at ward level to support the demand of emergency patients and to enable the carrying out of safety programmes by releasing 20 beds to be closed to enable works to develop an increase of Intensive Care capacity. Involvement The programme was developed using quality improvement leadership and involved the development of new ways of working which was disseminated through a roll out programme across all acute wards.
The team implementing the programme adapted the electronic systems available to support SMART ways of working and reduce the need for duplication. The programme involved senior clinicians , senior nursing staff and operational managers to set up monitoring systems to identify unnecessary waits for patients using a Red and Green approach with Red identified as time wasted and the reasons identified and themed Once implemented the team monitored themes and gave feedback to the operational teams. This enabled changes to be made in real-time as actions were identified and completed on the same day. Spread Once the proof of change was identified the team worked with IT colleagues to enable information to be shared electronically at a local , divisional and Trust level.
Support was then given to staff to enter data within real-time and standards were set for completion of key performance indicators. This included Standards for setting Expected Date of Discharge Identifying 10 discharges before 10 Identifying and theming waits through implementation of Red & Green days electronically Identifying patients who are delayed due to social or other issues
The Trust set monitoring measures to review length of stay and has identified a reduction in Los from 22.99 days to 13.87 days for those wards taking part in the programme and an overall saving of 26 bed days We set standards for echocardiography to be completed within 24 hours for 90% of patients and this trajectory has been met We have monitored time from admission to consultant review and have been identified in the National Audit for 7 days as one of the top 2 Trusts in the country meeting the target for patients to be seen.
We have improved our handover times for emergency patients from being the worst in the country to being in the top ten
The implementation of the programme has led to the reduction in length of stay leading to 26 saved bed days. This has led to the closure of beds to reconfigure services and support the Critical Care pathway The Trust has received £1.2million in funding for the reduction in echocardiograph waits and this has also supported the best practice tariff for Heart Failure and Acute Coronary Syndrome enabling the Trust to receive £300 per patient equivalent to £500k per annum.