Post on 27-Mar-2015
Seaton Hospital Pursuing Perfection Discharge Project
Pursuing Perfection means raising standards to ensure patients have the right care at the
right time in the right place.
Discharge pathway
Discharge planning and the results
How we reduced the length of stay. How this increased the number of admissions. How this created capacity. How this impacted on other hospitals. The advantages and disadvantages. The future.
Whole systems
Community
Community Hospital
Acute Hospital
Community Hospitals
N&E Devon has 18 community hospitals, of which : Exeter has 2 community hospitals North Devon has 5 community hospitals Mid-Devon has 4 community hospitals East Devon has 7 community hospitals (Seaton is one of these 7 community hospitals
serving a local population of just over 13,300). Seaton Hospital has 28 beds
Discharge planning process
Goal setting by discharge team – ie, what we plan to achieve and by when.
(Team; physiotherapist/
social worker/OT/Ward staff)
- Take account of admission form
- Knowledge of home circumstances
Planning the pathway
The plan is based on : How long it will take for certain goals to be
achieved. Who will do what tasks.
We then set an estimated discharge date and discuss with the patient.
Review of the pathway
The discharge process is reviewed daily by the team.
Reviewing means we are constantly taking into account of the clinical planning process.
Involving the GP.
Doing well with predicting discharge (42 patients)
less time thanpredicted(17patients)on time (15patients)
within three days(4 patients)
over three days(7 patients)
Reducing length of stay at Seaton Hospital (Excludes transfers to RD&E and deaths)
0
10
20
30
40
50
60
70
80
90
100
02
.06
.03
3.0
6.0
3
8.0
6.0
3
10
.06
.03
12
.06
.03
16
.06
.03
21
.06
.03
2.0
7.0
3
8.0
7.0
3
12
.09
.03
23
.09
.03
26
.09
.03
29
.09
.03
1.1
0.0
3
3.1
0.0
3
9.1
0.0
3
10
.10
.03
14
.10
.03
17
.10
.03
21
.10
.03
25
.10
.03
29
.10
.03
2.1
1.0
3
3.1
1.0
3
6.1
1.0
3
8.1
1.0
3
11
.11
.03
15
.11
.03
17
.11
.03
21
.11
.03
25
.11
.03
28
.11
.03
4.1
2.0
3
9.1
2.0
3
11
.12
.03
15
.12
.03
16
.12
.03
22
.12
.03
24
.12
.03
25
.12
.03
Date
LO
S in
Da
ys
LOS
Mean
UCL
LCL
Improving the flow of patients through Seaton Community Hospital
05
101520253035404550
2002 2003
Sept (37 patientsin 2002 / 50patients in 2003)Oct ( 33 patientsin 2002 / 50patients in 2003)
Admissions to Seaton Hospital since the start of the project
0
10
20
30
40
50
60
70
Sep-03 Oct-03 Nov-03 Dec-03
Number of admissions
Improving the flow of patients (admissions to Seaton Hospital)
0
5
10
15
20
25
RD&E Home OtherHospitals
Res. Care
Sept 02 ( no ofpatients)Sept 03 ( no ofpatients)
RD&E Waiting list for transfer from RDE to Seaton Hospital reduced follow ing improvements to the discharge process at Seaton Hospital
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
05/0
8/200
3
08/0
8/200
3
13/0
8/200
3
18/0
8/200
3
21/0
8/200
3
28/0
8/200
3
02/0
9/200
3
05/0
9/200
3
10/0
9/200
3
15/0
9/200
3
18/0
9/200
3
23/0
9/200
3
26/0
9/200
3
01/1
0/200
3
Date
Nu
mb
er o
f p
ts w
aiti
ng
Seaton
Discharges from Seaton Hospital
0
5
10
15
20
25
30
35
Home RDE Otherhosp
Rescare
Rehab Died
Sep-03Oct-03Nov-03
A faster pace of turnover…...problems
Outliers (increased no. of outliers) Staff (more work) Patient expectations (wanting to stay longer) GP expectations (re; who decides to
discharge ) Culture change (re; shared care)
Advantages for the Patient
Bed available locally Shorter stay Psychological benefit Motivating environment for the staff Patient involvement in their care
Goals for the future
Sustainability Roll out to other hospitals Identifying gaps in the community Checks on why discharge was delayed
Pursuing Perfection means
raising standards to ensure patients have the
right care at the right time in the right place.