Discharge Planning Ward 7C News Briefing
Issued 31st October 2013
Discharge Planning Ward 7C
Report Back from Kaizen Event
“Best ward round ever”
Charge Nurse Sandra Campbell
The Kaizen event held on Ward 7C (Renal and GI) last week took an in-depth look at ways
of improving discharge planning. And on Friday 25th October it was fed-back to a wide
range of colleagues, including Deborah Jones (Chief Operating Officer) and Garry Coutts
(Chair) that “considerable progress” had been made.
On the run up to the event ways of working were closely observed and a number of Plan Do
Study Act (PDSA) small cycles of change were carried out. Esther Dickinson, Quality Lead for
the work said: “it allowed the team to hit the ground running.”
The review of current ways of working revealed that staff were often “in chaos” with little or
no standard ways of working and a general lack of planning. This often resulted in patients
experiencing delays to get admitted into a bed and waits to get discharged from hospital.
Stewart Lambie, Renal Physician said: “Ward rounds were chaotic”, and he highlighted that
there was no “no set start time, no structure or safety checks.” And because of no set start
times it meant nurses were not available to support the ward round further impacting on
poor communications. The work carried out during the week saw a number of improvements
introduced, including:
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Structured Ward Rounds
Structured Daily Board Round
Structured MDT Meetings
Agreed structure for completing Immediate Discharge Letter (IDL)
Introduction of a Visual Discharge Planning Board
By introducing structured ways of working and Estimated Dates of Discharge patients are
now being discharged earlier in the day. Stuart Caldwell (Service Manager) said that changes
introduced and adding structure to the ward “all felt good.” Board Rounds, Ward Rounds
and Multi-Disciplinary Meetings, all started on time and were completed following the
agreed standard structure.
During the course of the week improvement work supported 75% of patients being
discharged by 12 (at the start of the week only 25% achieved this).
For further information contact Sandra Campbell (Ward Manager and Process Owner)
Sandra.campbell@nhs.net Tel: 01463 704479
Discharge Planning Ward 7C News Briefing
Issued 31st October 2013
SYNOPSIS OF THREE DAY KAIZEN
Scope
All elements to support improved discharge planning in Ward 7C
Situation
A lack of understanding of roles and no standard processes relating to key components
relating to discharge planning
Aim
To test new ways of working to contribute to safe and efficient discharge for patients. This is
to contribute to making sure they are able to leave hospital in the morning and with their
medications and discharge letters completed.
Some Targets to Measure Improvement
 To reduce length of stay to 5 days from 6 days (median) by 90 days
 To increase percentage of patients discharged by mid-day to 75% from 30% by 90 days
Some of the Issues with the Current State
 No beds available to admit patients when they need to be admitted
 No standardisation of Board Rounds, Ward Rounds or Multi-Disciplinary Meetings
 No clear process or training for doctors in the completion of IDLs
 Poor communications and no visual systems to highlight when key tasks not completed.
Update on Action
Ward Rounds
 Daily Board Round
 Immediate Discharge
Letter (IDL)
 Estimated Date of
Discharge and IDL status
 MDT Meetings
 Visual Discharge Planning
Board
 5S Doctors Room
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 Now structured with checklist prepared. Agreed start times
in place and consultant of the fortnight introduced
 Now structured and multi-disciplinary approach
 Standard Operating Procedure in place for completing IDL
 Dates consistently set and colour coded to show status of
IDL
 Now structured with EDD and IDL discussed and
documented. Actions formally recorded
 Normal state defined allowing any deviations to be
recognised and rectified quickly
 Room tidied up and organised to provide better working
environment
For further information contact Sandra Campbell (Ward Manager and Process Owner)
Sandra.campbell@nhs.net Tel: 01463 704479
Discharge Planning Ward 7C News Briefing
Issued 31st October 2013
“We have moved from what was a fuzzy process to
one that is more polished in structure and function.”
Dr Ken MacDonald, Renal Physician
And the impact of the changes resulted to what Sandra Campbell (Charge Nurse) described
as the “best ward round ever.” Key ingredients to improve the ward round included:
 Reducing the hierarchy gradient with better team working
 Appropriate ceiling of therapy including DNACPR discussed status discussed reliably on
an individual patient basis
 Adults with Incapacity discussed
 Diabetes chart reviewed
 Estimated Date of Discharge discussed
Key challenges
 Sustaining the improvements
especially with medical staff on
rotation
 Developing a system for escalating
delays out with ward control
 IDL printed and structure tested
 Addressing cover for annual leave
Key Lessons learned
 We need determination and commitment
 Introducing new ways of working is like
changing an engine while the plane is in
flight
 PDSA cycles pre-Kaizen helped us move
quickly in the actual Kaizen
 The staff have all the ideas and this
process has simply supported with
implementation
Summing Up
Dr Stewart Lambie said that feed-back during the week had been “really positive” with ways
of working “more efficient, more controlled and with a big huge reduction in chaotic ways of
working”.
Adding “It’s been a hugely positive week and I am grateful to staff who have all embraced
news ways of working.”
Impact
Over time the work should also support reducing overall length of stay. Importantly, for all
concerned, but particularly from a patient and family perspective, there should be no
surprises and sudden decisions around discharge.
The 30 Day Report Out will take place on 6th Dec 2013
Venue to be confirmed
For further information contact Sandra Campbell (Ward Manager and Process Owner)
Sandra.campbell@nhs.net Tel: 01463 704479