great geriatric care
TRANSCRIPT
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Discovering great geriatric care
Version 3 13 August 2014
Tom DownesConsultant GeriatricianClinical Lead for Quality Improvement, Sheffield Teaching HospitalsThe Health Foundation / IHI Quality Improvement Fellow28th September 2016
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GREAT CARE IS DISCOVERED, NOT DECIDED
Steve Spear, MIT
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Sheffield:• Population of 580k and
growing• Europe’s greenest city• 43% of households
vulnerable to significant financial stress
• Single vertically integrated adult provider
• Single Social Care provider• Single Care Commissioning
Group
Sheffield Teaching Hospitals:• One of largest FTs in
England - £1bn turnover and 16k staff
• Large tertiary provider – around one-third of activity
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Funding constraints:
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George
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A complex system problem
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2003 Toyota Corolla
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The Big Room (Oobeya)
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The Big Room in Action
Physiotherapist gives an account of the test of change to get a patient home on the day theywere discharged by the GSM consultant
Senior registrar
General ManagerFor Medicine
GSMMatron
ServiceImprovement
Social ServicesManager
CommunityServicesmanagerPhysiotherapist
Secretary
DischargeLiaison
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Let me introduce ‘George’
•82 years old•Lives independently and wants to continue doing so•Widowed 5 years ago•Has mild dementia•Daughter lives locally•Losing weight + poor mobility
PDSA tests of moving from ‘post take’ to ‘on take’
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Frailty Unit
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Outcome measure: 34% increase in discharge within 1 day
Frailty Unit
opens
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Length of stay for frailty unit patients reduced by more than 4
days
Frailty Unit
opens
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In-hospital mortality dropped by over 13%
Frailty Unit
opens
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Discharge to Assess (D2A)
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D2A starts
Reduction of 6 days waiting on
implementing D2A
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D2A starts
Sustained 30% reduction of LoS
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D2A starts
30% reduction of inpatient falls on pilot
ward
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In last one year >10,000 patients discharged to
home support in 1.2 days compared with 5.5 days
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Whole system reduction in LoS of patients aged >65y
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“It’s changed the way we think.”
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Future
• Frailty Unit is continuing to discover improved process and hitting highest ever discharge rate
• Purpose designed Frailty Unit opens 2017 to enhance efficiency and care experience
• Big Room is currently testing D2A for more complex patients
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How do we get better at making patients better?
Discovery.