6 Essential Actions to Improving Unscheduled Care

Monthly Case Study Template - to be submitted first Monday of each month

Date submitted 28/7/17Board/Site NHS Lanarkshire Wishaw General HospitalName of author Murdoch WilsonTitle of author Service Improvement ManagerTitle of Case Study

Improving the Flow of patients to CoE Wards

Please reflect on your project in around 250 words, what was it you set out to do?Project start and end date/s 1/5/17 and now ongoingAimThe aim was to improve the flow of Care of the Elderly patients from the Emergency Medical receiving Unit (ECU) to the Care of the Elderly wards

Anticipated Benefit (what did you expect to deliver?)

We expected to deliver a simpler one step patient pathway which would ensure patients are transferred from the Emergency Medical receiving Unit earlier in the evening avoiding transfers after 22.00

Outcome (what did you actually deliver?)

We delivered a simpler one step patient pathway for Care of the Elderly patients resulting in them being transferred earlier in the evening avoiding late transfers after 22.00

The original process rule was that patients could not be transferred from the emergency care unit directly to the ward with the stroke unit as the medical staff in the ward were not on the acute receiving rota and the cover was also slightly less in this ward. Therefore to utilise empty beds in this ward patients had to be transferred to the ward with the stroke unit from another CoE ward and then patients transferred from ECU to the CoE ward that then had the freed up empty beds. This two step process could clash with visiting, treatment or mealtimes and therefore it could take into the very late evening early night before the beds were available for patients to be transferred out of ECU which created late night transfers.Supporting Data (what did you measure, what did the data tell you? Please attach any data you think is useful)Since the new process has been implemented there has been no late night transfers of CoE patients. There may also be a less obvious reduction in waiting times in patients in the emergency department waiting to get into a bed in ECU. This is hard to isolate and quantify at there are multiple factors affecting waiting times.

Key Lessons Learned (what would you like anyone else undertaking this to know, be aware of?)Process mapping of patient flows is a highly effective way to demonstrate anomalies in the pathway to the multidisciplinary team.The mapping should be carried out with attendance from the full multidisciplinary team.

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