DISCHARGE PLANNING
RAPID IMPROVEMENT EVENT
involving partner organisations
1
57
70
Patients registered
with a GP Practice
670
505
231
30
524
127
22
2235
373
3
310
3018
Skerryvore 7132
Heilendi
407
1337
3372
Priorities leading to involvement with LA
• Many issues surrounding discharge process
• A complex process involving many staff from a range of
organisations
• A number of incidents and complaints relating to this area
• Issues relating to unsatisfactory discharge thought by staff to
impact on quality of care
• No current joint discharge policy
• Orkney Health and Care – substantive from April 2010
• Core Team – multidisciplinary team representing all aspects of
the service from Voluntary sector, Health and Social care
• Opportunistic
3
Goals of the RIE
• Implementation of agreed patient focused
pathway from admission to discharge ‘home’
• All planned discharges will be safe and
appropriate
• Timely access to health and care services
• To have an agreed, relevant, up to date, joint
discharge policy, owned by all
• Effective communication with all agencies at
all relevant stages to support patient pathway
• Initiate a process to achieve a shared and
unified IT system across Orkney Health & Care.
4
Achievements during the week
• Agreed to initiate Multi-disciplinary team
meetings on a daily basis (MDTs) at 11am each
day in the Acute area to plan discharge for each
patient in the Acute area in a proactive manner
• Agreed to develop Standard Operating
Procedures for pre-admission and admission
• Agreed to develop Standard Operating
Procedures for the MDTs with immediate effect
• Agreed to undertake reflective practice
5
Longer term actions
• An action plan was agreed at the end of the RIE
with 48 actions all of which were owned and had
a timescale associated with them
• Some of the major ones included:
– Improving communication between acute care,
primary care and social care
– Improved admin support
– Transport review
– Development of Admit to discharge documentation
6
Outstanding Actions
•
•
•
•
•
•
Improved patient information
A new joint discharge policy
Widespread use of PARIS across health & care
IT system for Minor Injuries
Improved (web-based) discharge system
Pharmacy improvements including self
medication assessments where appropriate
• Linked governance systems for joint working
• Education and training to staff to underpin
principles of discharge planning
7
Measurable Benefits
• Reduction in number of emergency readmissions to
hospital following discharge
• Reduction in length of stay for above
• Reduction in number of incidents reported and
complaints regarding discharges
• Red Cross - improved flow due to improved patient
transport and hostel service (reducing inpatient
length of stay) and communication
• Questionnaire responses from staff and patients
8
Learning and Challenges
•
Opportunity to foster good partnership working and improved integration
•
Opportunity to understand each others challenges and perspectives (intra
and inter-agency)
•
Opportunity to develop joint aims and visions and joint training
•
Cultural differences (e.g. incident reporting)
•
Work towards development of joint policies and protocols
•
Joint governance – person centred approach/involvement
•
Joint discharge arrangements
•
A seamless service
•
Ensure all voluntary sector partners with an interest are involved where
possible
Where Next?
• Ensure actions continue to be followed up
• Overcoming barriers that were identified e.g.
cultural differences – shadowing and joint
training
• Ongoing challenge to access separate IT
systems
• Continue to improve communication
• Roll out to other hospital areas