Transcript 01 BaSIS PosterToufeeq, Bailey, Wijesuriya and Rahman FINAL

Improving the patient journey: identifying and
implementing interventions to increase patient satisfaction
6. Analysis
Shafak Toufeeq, Charlotte Bailey, Rajiv Wijesuriya, Shah M. Rahman [Foundation Year 1 Doctors]
4. Investigation: The model for improvement
1. Introduction
Using anecdotal evidence from junior doctors and our
own experiences of interactions with patients, relatives
and staff, it is possible to highlight a number of areas for
quality and safety improvement.
How will we know that
What are we trying to
accomplish?
How
will we know
a change
is an that a change
is improvement?
an improvement?
What change can we make that will
result in improvement?
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•
•
• More discharge decisions and associated actions
on weekends
• More doctors/nurses with AHP support to
identify discharge-ready patients out of hours
• Increase Pharmacy cover out of hours for
complex medication checking and dispensing
Out of hours (OOH) discharges:
• Increase weekend discharges for medically
fit patients
• Reduce inappropriate bed occupancy in
overflow areas
• Improve bed flow and free up
ED/Admission Unit bed space
How can we prioritise and focus our efforts within a
short space of time to deliver a small improvement in
the patient journey? Patient satisfaction has long been
acknowledged to be an indicator of quality of care1. Our
inpatient satisfaction survey highlighted areas for
development, many of which we were already aware of.
More patient discharges on weekends
Reduced use of overflow areas
Reduced cancellation of elective lists
Identification of different grades of doctors:
• Easier recognition of doctors and their
seniority at a glance or in an emergency
• Better understanding of the experience
and roles of different doctors by patients,
relatives and nurses/HCAs/AHPs
We used the results to identify three issues to tackle...
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•
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Anecdotal evidence from stakeholders
Reports and responses from doctors
Pre- and post-intervention questionnaires
Increased uptake of lanyard users
• Introduction of colour-coded ID & lanyards
• Patient, relative and AHP education though ward
based discussions, cascade at nurse handovers,
flyers in ED /admission areas, posters, hospital
screensavers
Improving information given to patients on discharge:
2. Initial consult
Over one month, a series of questions were proposed and
stratified in importance by junior doctors, before a final
iteration of the questionnaire was released.
• Patients have a better understanding of
their diagnosis
• Patients are clear about follow-up and
post-discharge instructions
• Comparing patient experiences before and
after the intervention
• Reports and responses from patients
• Pre- and post-intervention questionnaires
• A simple handwritten summary for patients on
discharge, to include post-discharge plan,
contact references, symptoms to look out for
• Easier to understand summary of care on
discharge
Weekend
Discharge Team
Colour-coded Doctor
ID / Lanyard Poster
Consultant:
Identifies suitable patients and
makes discharge decision
3. Differential diagnosis:
Identifying patient needs
n = 75
Question Format: Likert
scale (5=highly satisfied,
1= highly unsatisfied)
Time course: 3 months
Respondents: Medical,
surgical and specialty
patients at discharge
Throughout your admission
how well was information
explained to you (by the
below) without using medical
jargon?
Did you feel staff kept you
informed and up to date
about your progress?
5.00
5.00
4.90
4.90
4.90
4.80
4.80
4.80
4.70
4.70
4.70
4.60
4.60
4.60
4.50
4.50
4.50
4.40
4.40
4.40
4.30
4.30
4.30
4.20
4.20
4.20
4.10
4.10
4.10
4.00
4.00
Consultant Junior doctor
Junior doctor
Nurses
Nurse:
FY1 Doctor:
Facilitates transport,
notifies relatives, acts as
liaison
Completes EDN, TTAs
and finalises outpatient
plan
5.00
Ward Clerk:
Completes paperwork,
quality assurance, booking
of outpatient tests/filing
4.00
Consultant
Consultant Junior doctor
“The new posters help
me to differentiate
grades of doctors"
Pharmacy:
Checks To Take Away (TTA)
medication, reconcile
previous prescription and
dispenses new medications
Nurses
Responses were generally positive (scores of 4-5) throughout all
domains, however free text comments highlighted a number of issues,
especially where scores were low (1-2).
Recurring complaints were:
• Slow or impossible out of hours discharges
• Difficulty in identifying doctors, particularly with regards to their role
• Difficulty interpreting discharge letters
Agree
Unsure
11%
64%
Disagree
Strongly disagree
Discharge
Summary
(handwritten)
Consultant
Diagnosis
Plan of
action
7. Conclusions
The weekend discharge team has provided 8-15 extra
discharges a day when operating with just one FY1 doctor
per day. Cost:benefit analysis is still underway, but the trust
has financed four more FY1s for a 1:5 Saturday daytime
cover.
Colour-coded ID and lanyards were well received and
following the introduction of posters, questionnaires have
shown improvement in recognition and understanding of
doctor roles, particularly by patients and relatives, and to a
lesser degree, by nurses and AHPs.
Handwritten discharge summaries were well received by
patients, indicating current EDN printouts can be improved
in terms of both patient safety and understanding.
Symptoms
to watch
8. Summary
Contact
details
Focusing on and distilling an issue is key to making the best
use of time and resources to make an intervention and
measure its effect.
Our projects have lead to an improvement in bed flow and a
reduction in inappropriate bed occupancy, qualitatively
improved the ease of identification of seniority of doctors
and clarified information given to patients on discharge.
Further PDSA cycles and assessment is key to refining our
interventions and encouraging further targeted rollout.
New Weekend Discharge
References: 1. Patient satisfaction as an indicator of quality of care. Cleary PD, McNeil BJ. Inquiry. 1988 Spring;25(1):25-36
Acronyms: AHP: Allied Health Professional, ED: Emergency Department, EDN: Electronic Discharge Notification, HCAs: Health Care Assistant, OOH: Out of Hours i.e. beyond 091700 Mon-Fri (General Medicine) and 08-1600 Mon-Fri (General Surgery), TTA: To Take Away Medications
With thanks to the Northampton General Hospital Junior Doctor Safety Board
18%
7%
5. Treatment: Changes trialled and introduced
A likert and free text based questionnaire was carried out by
FY1 Doctors on patients over three months. Its aims were to
assess satisfaction with focus on communication between
the patient and hospital staff. This included ease of
identification of staff and their approachability. The 75
responses were combined and results analysed.
Did you feel it was difficult
getting the opportunity to
talk to a doctor when you
wanted to?
Out of hours discharges
A single Consultant/F1 based team, trialled on Saturdays only,
increased discharges by 8-15 patients, based on the complexity of
patients and availability of ward medication packs. Previous numbers
of discharges ranged from 20-50 on weekdays and 5-20 on weekends,
just on General Medicine wards, showing that introduction of an outof-hours discharge team can nearly double bed clearances.
Discharge Summaries
100% of patients surveyed found handwritten summaries useful or
very useful. Plan of action was regarded as the most useful feature.
Coloured ID / Lanyard Poster
Following the introduction of colour-coded ID and lanyards, 64% of
patients were completely unaware and only 23% of health care staff
knew more than ‘a little’ about their relevance. Furthermore only 23%
of patients felt informed about the role of different grades of doctor.
Despite this, 82% of those asked thought colour-coded lanyards and
ID badges were a good idea.
Strongly agree