Transcript Discharge - BHPC TAG September 2014

Portsmouth Hospitals NHS Trust
QAH Hospital
Board of Governors
Discharge from Hospital
Sarah Eggleton, General Manager
Medicine for Older Persons, Rehabilitation and
Stroke (MOPRS)
12 September 2014
Portsmouth Hospitals NHS Trust
QAH Hospital
4/11/2017
Page 2
The Discharge Process
 Board Round on the ward: each patient has identified Planned
Discharge Date
 Multidisciplinary decision and actions
 Discharge SAFER bundle
 Discharge Planning Team involved with complex discharged
(onwards health and social care needs)
 In Reach Team for onwards bedded care
 Integrated Discharge Bureau: a Trust wide multiagency service
 Discharge Lounge: 7 day opening
 Transport
Portsmouth Hospitals NHS Trust
QAH Hospital
4/11/2017
Average Length of Stay Data
Non Elective LOS by CSC 2014/15
CANCER
EMERGENCY MEDICINE
HEAD & NECK
MEDICINE
MEDICINE FOR OLDER PEOPLE
MUSCULO-SKELETAL
RENAL & TRANSPLANTATION
SURGERY
WOMEN & CHILDREN
TOTAL TRUST
APR
7.9
0.7
2.3
7.9
17.4
9.3
8.7
4.1
1.3
4.5
MAY JUN
7.7
7.8
0.6
0.7
2.4
2.5
8.3
8.1
15.9 18.1
9.0
9.1
8.7 10.3
4.2
4.3
1.5
1.4
4.5
4.5
JUL
8.1
0.6
8.1
7.9
17.8
9.2
8.4
4.0
1.5
4.7
AUG
8.3
0.9
2.9
7.6
16.8
7.7
9.8
4.1
1.6
4.5
Page 3
Portsmouth Hospitals NHS Trust
QAH Hospital
4/11/2017
Page 4
Discharges: reporting
 Daily target for discharges for each CSC
 Daily PDDs reported to Operations Centre
 Enables estimates on overall bed position
 Actual discharges at midnight reported next day
 Number of discharges through the Discharge Lounge
reported
Portsmouth Hospitals NHS Trust
QAH Hospital
4/11/2017
Page 5
Discharge SAFER Bundle
Why a bundle for the Frail Elderly Patient?
 These patients have complex holistic needs and require a MDT
approach to ensure a concerted focus on discharge planning
throughout the hospital stay, and the ability to discharge 7 days
a week.
 An explicit tool with a small set of interventions and clear
parameters that, when delivered together, as part of a
multidisciplinary approach, help to deliver the best possible
care.
 A criteria-led discharge bundle will also support weekend
discharges.
Portsmouth Hospitals NHS Trust
QAH Hospital
4/11/2017
Page 6
The Frail Elderly Patient Flow Bundle
Content
Drivers
Interventions
Expected Date of Discharge
(EDD)
All patients receive an EDD within
24/48hrs of admission and discharge
is planned around this date
Enables patients to
receive optimum
care for their specific
needs and discharge
is planned
accordingly
Patient receives the
right care, in the
right environment,
by the right people,
at the right time.
Ward Rounds
Daily morning senior ward
reviews,, using a standardised
approach, will facilitate the
development of clear patient
management plans and 7 days
a week discharges
MDT Meetings
Patients are
discharged in a
timely manner at the
date and time set,
with 50% of patients
home before 1pm
Held once a week with MDT
members to ensure managements
plans stay on track and early
escalation of delays
Clinical Management Plan
A patient’s management plan
should consider a facilitated
discharge based on defined
criteria and holistic care needs
Portsmouth Hospitals NHS Trust
QAH Hospital
4/11/2017
Page 7
Discharges by Clinical Service Centre
Discharges for Non-Elective Patients 2014/15
All Discharges by CSC
Disch Spec CSC Name
WOMEN & CHILDREN
EMERGENCY MEDICINE
MEDICINE
SURGERY
MEDICINE FOR OLDER PEOPLE
MUSCULO-SKELETAL
HEAD & NECK
RENAL & TRANSPLANTATION
CANCER
CLINICAL SUPPORT SERVICES
THEATRES
Grand Total
APR
MAY
JUN
JUL
2061
1018
880
649
464
253
152
127
89
3
2174
1111
860
731
470
269
141
136
110
2
2013
1085
784
646
434
242
151
110
102
2119
1106
868
767
505
218
129
134
140
5696
6004
5567
1
5987
Discharges from C Level Discharge Lounge by CSC
Disch Spec CSC Name
APR
MAY
WOMEN & CHILDREN
1
EMERGENCY MEDICINE
99
MEDICINE
141
SURGERY
34
MEDICINE FOR OLDER PEOPLE
92
MUSCULO-SKELETAL
26
HEAD & NECK
11
RENAL & TRANSPLANTATION
3
CANCER
2
CLINICAL SUPPORT SERVICES
1
Grand Total
410
JUN
JUL
122
168
41
122
29
10
6
4
3
126
167
34
156
44
14
7
13
158
215
54
163
27
16
6
6
502
564
645
AUG
Grand Total
1957
10324
1090
5410
807
4199
722
3515
449
2322
231
1213
122
695
115
622
119
560
3
8
1
5615
28869
AUG
Grand Total
1
5
141
646
183
874
50
213
152
685
33
159
14
65
2
24
4
29
1
580
2701
Portsmouth Hospitals NHS Trust
QAH Hospital
4/11/2017
Page 8
Discharges by Clinical Service Centre
Percentage of CDL Discharges compared to All
APR
MAY
JUN
JUL
AUG
Grand Total
WOMEN & CHILDREN
0.0%
0.0%
0.1%
0.0%
0.1%
0.0%
EMERGENCY MEDICINE
9.7%
11.0%
11.6%
14.3%
12.9%
11.9%
MEDICINE
16.0%
19.5%
21.3%
24.8%
22.7%
20.8%
SURGERY
5.2%
5.6%
5.3%
7.0%
6.9%
6.1%
MEDICINE FOR OLDER PEOPLE
19.8%
26.0%
35.9%
32.3%
33.9%
29.5%
MUSCULO-SKELETAL
10.3%
10.8%
18.2%
12.4%
14.3%
13.1%
HEAD & NECK
7.2%
7.1%
9.3%
12.4%
11.5%
9.4%
RENAL & TRANSPLANTATION
2.4%
4.4%
6.4%
4.5%
1.7%
3.9%
CANCER
2.2%
3.6%
12.7%
4.3%
3.4%
5.2%
CLINICAL SUPPORT SERVICES
33.3%
0.0%
0.0%
12.5%
THEATRES
Grand Total
7.2%
8.4%
10.1%
10.8%
10.3%
9.4%
Excluding W&C
5.1%
6.1%
7.0%
7.4%
7.5%
6.6%
Portsmouth Hospitals NHS Trust
QAH Hospital
Daily IDB Themes List Showing Breakdown by Grouping
Against Total list
Portsmouth
Hampshire
Portsmouth Hospitals NHS Trust
QAH Hospital
4/11/2017
Page 10
Attendances By Ward
Arrivals Before 11am
Discharge Lounge
Medicine
MSK
Surgery
Women's &
Children
Medicine for
Older People,
Rehab and
Stroke
Oncology
Head & Neck
Unit
Renal &
Transplantation
Emergency
Medicine
Clinical Support
Totals
13
14
4
1
7
0
0
0
7
1
47
C5
3
1
C6
2
0
E4
3
0
C7/CDU
0
0
E6
0
0
E7
2
1
E8
3
0
D2
2
0
D3
4
0
D4
1
0
D5
D6
5
1
2
1
E1/SAU
1
0
E2
2
2
E3
DAY
SURGERY
0
0
0
0
D7
1
1
D8
1
0
D1
0
0
F1
1
0
F2
0
0
F3
1
0
F4
0
0
G2
0
0
G1
3
1
G3
2
0
F5
0
0
F6
0
0
F7
0
0
G4/HNU
0
0
G6
0
0
G7
0
0
G8
0
0
G9
0
0
MAU
3
1
ED
OPD
CLINICS
4
0
1
0
2
2
3
0
1
0
0
0
1
0
9
Portsmouth Hospitals NHS Trust
QAH Hospital
4/11/2017
Page 11
Patient Experiences
 G3 “Thank you all for the care you have given to me. Seven weeks stay was
helped by your happy smiles. Keep it up.”
 F3 “Thank you for your care and treatment of my mother during her stay here. I
would especially like to thank your OT team who visited my mother’s property on
15.07.14. My mother has now been given the skills back by your staff to hopefully
gain her independence in the home she loves. I cannot thank you enough.”
 F4 “Thank you for all the care and support you gave to SA during her recent time
with you. You treated her with dignity and respect which we really appreciated.”
 For the palliative care team who cared for JH and myself including my family. I
would like to send a heartfelt thanks of appreciation during our hours of need.
Complaints
MOPRS Complaints
MAY
3.0
JUN
3.0
JUL
4.0
AUG
2.0
Portsmouth Hospitals NHS Trust
QAH Hospital
Friends and Family Test
4/11/2017
Page 12
MOPRS Compliance
MAY
41.8%
JUN
54.3%
JUL
47.4%
Portsmouth Hospitals NHS Trust
QAH Hospital
Friends and Family Test
4/11/2017
Page 13
Portsmouth Hospitals NHS Trust
QAH Hospital
4/11/2017
Electronic Discharge Summary
Summary Includes:
 Patient Details
 GP Actions
 Admission & Discharge Details
 Clinical Details
 Medications
 Future Plans
Future Actions:
 Copy to GP and onward providers
 Further rollout needed
Page 14
Portsmouth Hospitals NHS Trust
QAH Hospital
4/11/2017
Page 15
Summary
 Huge progress in integrated systems and delivery
 Further work to be done with Patient Experience Surveys and
Primary Care on EDS
Portsmouth Hospitals NHS Trust
QAH Hospital
4/11/2017
Page 16
LETS MAKE EVERYDAY A ‘D’ DAY (Discharge day)
THE DISCHARGE LOUNGE TEAM: HERE TO HELP YOU
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We will come to your ward & help prepare your patient for discharge.
Arrange transfer of your patient to the discharge lounge.
Assist with any necessary phone calls etc.
Liaise with pharmacy & track TTO’s once they have been screened.
Explain TTO’s to patients/families.
Explain discharge summary & follow up arrangements.
Liaise with ‘warfarin nurse’, once the ward have made the initial
referral.
Assist with referrals to SPA etc.
Organise/Liaise with transport services.
Provide ongoing continuity of care up until the point of discharge.
Provision of snack packs on discharge.
Provision of tracksuits.
Discharge your patient on PAS system.
And anything else you feel we could help with.
CRITERIA
We have a very open criteria in the discharge lounge, so that we can assist
with ‘patient flow’ throughout the Trust.
Individual risk assessment maybe necessary for patients who require closer
supervision due to; falls risk/wandering/psychological care needs. –please
discuss with the nurse in charge, we will always do our best to accommodate
your patients’ needs in a safe environment.
The discharge lounge team enjoying D-Day celebrations
06/06/2014
We are unable to administer IV therapies to patients.
MON-FRI 08:00hrs -1930hrs
W/ENDS & BH 09:00hrs – 17:00hrs