Exemplar Ward programme - Stoke

It will soon be a year since we started our Exemplar Ward programme at University Hospitals North Midlands NHS Trust in Stoke. At the outset we knew that we needed to reinforce the behaviours detailed in our previous patient flow bundle (and again in the SAFER bundle http://fabnhsstuff.net/2015/08/26/the-safer-patient-flow-bundle/ ) but we wanted to take this further with a multi-disciplinary effort to identify and eliminate delays in patient flow.

Phase 1 of our programme was very much about learning; we created a team from across social care, the acute and community Trusts to support 2 pilot wards to maintain patient flow and challenge every delay.We didn't know what we didn't know, but we soon identified some systematic causes of delay and some quick wins that we could put right straight away, a lot of these centred around day to day communication and navigating a complex system.

Phase 2 extended the pilot to 4 more wards, followed by

Phase 3 roll-out to all adult inpatient wards at both our acute sites. At the heart of our exemplar programme is the SAFER patient flow bundle and locally all providers are expected to deliver this, so much so that we're adopting a local CQUIN to maintain this commitment. We know we have some way to go but we've seen the number of 'stranded patients' in our hospitals reduce by 25% year on year - our stranded patient definition is patients aged >70yrs with LOS>=10 days.

Phase 4 is where we are now; consolidating exemplar practice across our community and acute bed base, tackling some of the trickier systematic causes of delay and reinforcing our escalation processes.

Watch this space!