Long stays in hospital lead to patient deconditioning, harm to patients and unnecessary additional demands on health and care services. We were aware that by tackling long stays in hospital it would reduce harm, disability and cost.
The Long Stay Wednesday Team was established with the support of the Executive team consisting of: the Deputy Chief Operating Officer, Deputy Director of Nursing, Head of Discharge, Head of Therapies, Project Manager and Administrator. The Long Stay Wednesday Team took the weekly long stay patient meeting to the wards and engaged with the ward MDT and provided support on the spot.
Each ward was advised what time the team would be approximately coming over to the ward. This was communicated by email, screen savers and verbally. Super Stranded data was pulled for each ward giving the team a focused list of patients to discuss.
Each patient was discussed with the ward team including the nurse in charge, a therapist and occasionally a consultant or registrar. All information from the review meetings including actions to progress the patient’s journey, are recorded electronically and emailed to the ward staff before leaving the ward. The team focused on asking the questions below to ensure each patient had a clear, agreed, plan in the notes that included expected date of discharge and clinical and functional criteria for discharge.
- Does this person need to be in an acute hospital bed?
- What is this person waiting for/ what specific action needs to happen next?
- Which code should we enter for this person?
- Why not home? Why not today?
There was a significant reduction of super stranded patients at KGH from July 2018 – December 2018. The number of super stranded patients was reduced by approximately 80 patients and this has been maintained over Christmas, New Year and the Winter Months. There has been significantly improved flow across the Trust with an average of 12 escalation beds being open in February 2019, in comparison to 41 escalation beds on average open in February 2018.
The staff on our wards are engaged and utilise the Long stay team to escalate delays, ask for support and share good news stories.
GHFT - The implementation of adapted SAFER ward rounds within paediatrics to reduce waiting times for discharge