edwina nilon - the early bird gets the bed… early discharges ......the early bird gets the...
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The early bird gets the bed… Early discharges to
create early capacity
Aim Statement
Within 12 months, there will be two discharges
or transfers to the Discharge Transit Unit (DTU)
by 9am each weekday from each of the five
Emergency Department (ED) accessible wards.
Background
There is minimal bed capacity within the five ED
accessible wards before 11am each day and
many of the discharges occur between late
morning and late afternoon. Demand for beds
increases from 9am daily with increased ED
presentations and booked surgical cases.
Team MembersSponsor
Ian Hatton – General Manager, Lismore Base Hospital
Project Team Edwina Nilon – Nurse Manager Access and Demand
Shirley Walker – Whole of Health Program Manager
Judi Kolesnyk – Nurse Manager Transfer of Care
Anthony Zuill – Occupational Therapy Acting Manager
Emma Webster – Physiotherapist
Cheryl Hambly – NUM 23 hour unit / Discharge Transit Unit
Dean Byrnes – Pharmacist
Kym Hickey – NUM Surgical Ward
Remy Simpson-Hay – NUM Cardiology/Vascular/Renal Ward
Anthony Mowbray – NUM Medical Ward
Sandra Vidler – NUM Short Stay Medical/Surgical Ward
Mel Ingram - Quality and Safety Manager
Author: Edwina Nilon Position: Nurse Manager Patient Access and Demand Email: [email protected] Phone: 0429 091 661
ECLP Cohort 23
Plans to sustain change• Embedding processes into the structured morning and afternoon
patient flow meetings
• Multidisciplinary use of the electronic patient journey boards
• Consistent morning MDT Board Rounds
• Monitoring of EDD compliance and accuracy with weekly reports
Plans to spread change• Submission of the project to the ACI Innovation Exchange
• Networking with peer sites to improve the potentially expand the
process based on their experiences
Results
Outcome measuresThere are daily transfers to DTU by 9am but not in the desired
numbers yet. The 23 hour ward has increased these numbers
significantly.
Process measures There are transfers out of ED by 9am but not in the numbers
needed to create ED capacity on any given day.
Link to National Standards
• Standard 1: Clinical Governance
• Standard 2: Partnering with Consumers
• Standard 5: Comprehensive Care
• Standard 6: Communicating for Safety
Literature review• A multidisciplinary care pathway significantly increases the number of
early morning discharges in a large academic medical centre (QMHC
Journal)
• Identifying hospitalised paediatric patients for early discharge planning:
A feasibility study (Journal of Paediatric Nursing)
• Understanding and overcoming barriers to timely discharge from the
paediatric units (BMJ)
Process measures continued
Balancing measures
Failed discharges from DTU requiring
re-admission = nil patients
Discussion
Discharge planning is a complex and multifaceted process.
The first phase of the project related to nursing and allied
health interventions however the remainder of the project
will require medical engagement also. Daily discussions
around patients transferred or discharged by 9am occur
and are embedded into the morning patient flow meeting.
Day prior planning and identification of patients for
discharge first thing the following day will be the crucial next
step towards achieving the goal.
Overall Outcome of ProjectWhilst the goal of ten vacant beds by 9am hasn’t been
reached yet, the project is continuing with further
PDSA cycles planned.
There is an increase in the utilisation of the Discharge
Transit Unit overall compared with previous years.
Compliance with Estimated Date of Discharges
(EDD’s) and use of Good to Go’s (G2G’s) has become
business as usual in each ward. In addition to this,
improved MDT Board Rounds and day prior patient
identification and discharge planning from all
disciplines will be key in being able to increase the
numbers of patients being discharged early. Key
successes with multiple transfers by 9am from the 23
hour ward is promising and these processes will be
reviewed and replicated into other ward discharge
processes to try and achieve similar results.
0
1
2
3
4
Number of patients discharged / transferred to DTU by 9am daily (ED accessible wards)
Measure: Transfers by 9am
Median
COVID impact: decreased
hospital occupancy
No. DTU transfers /
discharges by 9am
each day
Transfers by 9am discussed
at AM bed meeting
Increased focus on EDD's and G2G's
Opening of 23 hour
ward
Commenced AM bed
meeting enhancementDesired
direction of
chart is UP