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Co-ordinate discharge to be more effective and efficent for staff and patients alike

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zoe corrigan

on 18 May 2011

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Transcript of Co-ordinate discharge to be more effective and efficent for staff and patients alike

Why is change needed? 'patients being sent home in the middle of the night' 'they sent him home without anyone being there' 'lack / poor communication' How the group worked? Evaluating discharge co-ordinator '5,500 patients ages 75 and over were ready to be discharged but remained in acute hospital beds' DOH 2004 Create an effective and efficent discharge 'By 2004 we will end wide spread bed blocking' NHS Plan 2000 references 'Leaders of leaders' Bennis (1999) Bennis, w (1999) old dogs, new tricks.london:hogan page Goffee and Jones (2000)
significance
community
engagement democratic leadership style Patient Views Professional's Views Government
Policies sometimes up to half of my patients are ‘medically fit for discharge’ but remain in hospital for weeks as we try to find suitable places for them to go once they leave hospital. Policies Ensure individuals and their carers are actively engaged in the planning and delivery of their care (DOH, 2003) Health professionals particularly nurses spend a disportionate amount of time managing the mismatch when a bed is needed and when a bed is available (DOH 2004) At ward level, identify and train individuals who can take on the role of care coordinator in support of the MDT and individual patients and their carers (DOH 2003) Causes of delayed discharge:
Internal hospital factors
Coordination issues
Patient/ carer involvement/ choice
(DOH 2003) Benefits of effective discharge
For patients, their needs are met
do not experience unnecessary gaps or delays in the process
Staff feel their expertises are recoganised
key and timely discharge is achieved
For the organisations, it's resources are used to the best effect
Fewer complients
(DOH 2003) More clarity of what effective discharge entails
Patient and carers involvement
Specific and local evaluations Full time D/C planner worked with 3 GP practices
NI evaluated the scheme, found that GP's and community-based staff more ivolved
Patients and carers enjoyed having D/C planner- provided continuity of care!
To improve: Focus on complex cases Care co-ordinator appointed in Barts and London Turst to ensure no delay in D/C
Average LOS reduced from 8.5 days to 5.9 days over 2 years 3 London medical wards- 626 patients
2 questionnaires; in hospital and 10 days post D/C
Improved D/C planning process and post D/C problems
3 x more likely to discuss anxieties with MDT and improve D/C notes
Reduce need for other medical services post D/C
However, no impact on community services or bed efficiency *"LEADERSHIP"
*"DRIVE"
*"INIATIVE"
*"MANAGEMENT" Enriched role description and change of focus
- Roles defined by Day, McCarthy and Coffey (2009) Challenging assumptions? Medics Physiotherapists Occupational therapists Adult Nurses Child Nurse Social Worker Midwife Tailcoat Patient Discharge And we all agree TTO's Equipment being delivered Packages of care Stressed Staff Beds Blocked AND... Unhappy Patients Communication Discharge Co-ordinator Communicate between staff Communicate to patient All in all to ... Happy Patients Video Economic Andrew Lansley (Health secretary)
162 m pounds between May 26 2009 and April 2010
2575 beds unavailable due to delayed discharge In 2011/2012 expected drawdown of surplus will be up to 150 million pounds come from the PCT sector surplus. Under legislation implemented in 2004, local authorities are liable to pay the NHS a daily fine if a patient remains in hospital because their social services cannot provide adequate housing.
seven other hospitals kept patients in hospital for more than 500 days after they should have been discharged. Coventry link undertook 6 months of community outreach between february and july 2009 to gather feedback looked at discharge policy and process of university hospital Coventry and Warwickshire. Paul Lewis
The Guardian, 2 May 2009 HEALTHY patients have spent more than 228 YEARS waiting to be discharged from our hospitals since 2006
Delayed discharges cost the NHS in Coventry and Warwickshire at least £11 million pounds during that time, our exclusive figures show.
Delayed discharges have cost, Rugby St Cross and Nuneaton’s George Eliot more than £11 million since 2006. Communicate this document to staff, patients, public.
Should include:
Executive summary
History of service
Relevant policies, national , professional and local.
Vision of service, aims philisophy of care, clinicxal perspectives etc.
Objectives against which service can be measures. Process mapping ‘A map of a patient journey is a visual representation - a picture or model - of the relevant procedures and administrative processes.’ Depending upon which approach you use, you will be able to:
•Identify bottlenecks and constraints
•Identify and understand variations in clinical practice
•Develop a shared understanding of the problem
•Build teams
•Identify issues to do with quality of care
•Gain an in-depth understanding of a patient's perspective
•Identify steps that don't directly contribute to patient care (those that contribute are sometimes called value added steps)
•Carry out capacity and demand analysis from core information All approaches will reveal:
•Unnecessary delays
•Unnecessary steps / unnecessary handovers
•Duplication of effort / waste
•Things that don't make sense / not logical
•Likely hotspots, bottlenecks or constraints Discharge co-coordinator
Type of leader
Assigned leadership
Approach
Supporting approach
•High support/ low directive style
•Does not focus exclusively on goals, encourages workers skills around task to be completed
•Includes listening, praising, asking for input and giving feedback
•Gives subordinates control of day to day decisions
•facilitates problem solving
•Gives recognition and social support to subordinates (Northhouse, 2010) delayed discharge effects all age groups, cultures and health conditions

ageing population - account for most patients in hospital

improve image of professions, hospitals, NHS to wider population

improve relations between members of MDT use of email,
telephone calls,
intranet to
communicate with MDT

use of telephone calls
to patients relatives

but also wider community
such as social workers,
equipment stores, transport,
care agencies
community services such as
nurses,physios and OTs transactional and transformational leadership Negative Points of a
Discharge Co-ordinator diverse population
underdevelopment in services
dual role responsibilites
communication difficulties
knowledge of services whilst on the job
disempowerment Inter-professionalism May et al (2009) For staff to make a commitment to work with each other across boundaries for the benefit of the patient... Survival of a System Change Need to challenge the ways things are done, what is done about it and who does it Clinical Governance a useful boundary...a framework to encourage the improvement of standards Who's the best candidate for D.C? SMARTER tool applied to all professionals... NURSE why? 1.Need a broad range of knowledge (qualified 4years)
2.Minimum of a band 6 grade
3.Good working relationships with staff and patients (the RCN supports this!) Hopefully empowering staff to complete tasks they have trained to do... Tools to help the D.C The NHS Knowledge and Skills Framework (KSF) Quality, Innovation, Productivity and Prevention (QUIPP) The NHS Plan Darzi Report Francis Report because we want our service improvement to survive... Audit service against existing services
Clinical standards set by national organisations and professional bodies Gaining feedback from clients
Questionnaires or interview process Feedback from colleagues Review existing strategies- aims, guiding philisophies and objectives Learning Outcomes Introduction Combes et al (2002) Bridges et al (1999) Houghton et al (1996) Job description; Leadership? Salary: Band 7 30,000- 40,000 Theory And... What we want by the end of this session The reasons for why a discharge coordinator is needed How we worked as a team Whether discharge coordinators work What the discharge coordinator will do Political, economical, social and technological impacts waiting for blood results Referals discharge letters transport Conclusion Thanks for listening
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