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.