MADE in Wirral

When Wirral University Teaching Hospitals director of operations (@ChrisOliverNHS) asked his SAFER team how they could support patient flow over the summer bank holiday. They dug deep into the ECIP (Emergency Care Improvement Programme) tool kit identifying a MADE (Multi Agency Discharge Event) as a possible solution. They never imagined that it would support the organisation in achieving their most successful week to date, when compared to their ECIP cluster group!

Multidisciplinary Accelerated Discharge Events (MADE) are designed to support patient discharge and are normally conducted over several days. The hospital team adapted the model to help support the summer bank holiday period and provide capacity for the anticipated influx of patients.

A MADE team consists of senior managers and clinicians that review every ward patient to identify reasons for delays that can be resolved ‘on the spot’ and any barriers to patients achieving their future target date for discharge. Information gathered on all patients is used over the subsequent days by the site management team to deliver discharges.

Wirral’s ‘One-Day’ MADE - Prior to the event:

• Enlisted support from the Head of Emergency Preparedness to plan event.
• Invite senior staff from the following areas - Nursing,  Therapies,  Integrated Discharge Team,  Intermediate Care,  Social Services,  Diagnostics,  Pharmacy,  Senior Medical Consultants and dministration Support
• Circulate the programme for the day
• Provide clear instructions to ward teams, who should be able to answer questions about every patient on their ward and identify any barriers to their discharge.
• Ask the MADE team to come armed with knowledge of their service capacity/demand and the ability to act as ‘friendly’ challenger during patient reviews.

On the day…

Briefing meeting, chaired by the Director of Operations

Review every patient to identify:

• Are they medically fit for discharge?
• Have they got a targeted date for discharge?
• Can the MADE Team expedite a discharge today
• Can the MADE Team remove any barriers allowing safe earlier future discharges
• Note outstanding patient actions and handover to the Site Management Team to support discharge planning over the subsequent days
• Developed a checklist for future events in a ‘off the shelf’ style
• Follow the event with a ‘Survey-Monkey’ on-line questionnaire to the MADE team (for PDSA)
• Identify common themes from across the wards that result in delayed discharges and ensure these are communicated to senior managers to try to remove these barriers.

Quote from Dr Deborah Lowe -Consultant Stroke Physician & Geriatrician “This is about a change in culture. I act as a critical friend and I ask the question for every patient….do they need to be in hospital, if not how can we support their rapid discharge?

“ The key to our MADEs success was effective forward planning and communicating of clear expectations to all team members prior to the event plus the introduction of consistent clinical challenge. We are considering regular MADE events over the winter months to ensure momentum is maintained and hopefully a culture change is embedded".