Issue 1 enews October 2017 Welcome to our first CUH Project Flow enewsletter Ever wanted to know the answers to the following questions: - Where did the interest in Project Flow arise from? - What does good flow look like in a hospital? - What happens when patient flow is not so good? - What will success in the Project look like? - Is it all about targets? Is flow more important than patient safety? - How do we know that it is more than an aspiration? - What are the top three items for implementing change? Listen to Dr Mike O Connor, Clinical Director for Medicine discuss the importance of Project Flow by clicking BACK TO COVER Share your ideas with us today by emailing: CUH.ProjectFlow@hse.ie BACK FORWARD 1
Staff Feedback to Project Flow Thank you for all the feedback to CUH.ProjectFlow@hse.ie and to the suggestion box that was in the canteen for August/September. Main themes: 1. Admission and discharge processes 2. Access to wheelchairs 3. Signage/directions in the hospital 4. Email access for staff 5. Processes/systems/services supplied on wards 6. Cardiac tests 7. Awaiting other consults 8. Outliers 9. Confidentiality on whiteboards 10. Radiology All of the feedback is being considered and we really value your input into ways to impact on patient flow in the hospital. Thank you. BACK TO COVER BACK FORWARD 2
Over the past few months we have put a number of different methods of communication in place to provide information and to encourage all staff to respond with their ideas on how to enhance Patient Flow. These methods include: A poster campaign to highlight staff involvement in flow Dedicated email address for staff to share their ideas CUH.ProjectFlow@hse.ie More regular communication status emails re flow in the hospital from Damian McGovern (Unscheduled Care Lead) Auditorium sessions for a week in August PF17 display in canteen, plus new noticeboard in Emergency Department New website: cuh.hse.ie/about-us/project-flow/pf17-project-flow-2017/ YouTube video: www.youtube.com/watch?v=rkre8zhkpas&feature=youtu.be Twitter account #pf17cuh, plus Ward/team education sessions re: whiteboards Ward-to-ward information regarding discharges and PDD s. If you have other ideas you think would be good to communicate what is happening in the hospital, please let us know by emailing CUH.ProjectFlow@hse.ie BACK TO COVER BACK FORWARD 3
Mission of Cork University Hospital The staff in Cork University Hospital aim to provide quality acute healthcare services and to positively impact on the lives of those we encounter. What is Project Flow 2017 (PF17)? In order to achieve our mission we need to ensure we efficiently and effectively care for members of the public - starting from the Emergency Department, right through to care received on the wards, until eventual discharge from the hospital. Project Flow 2017 (PF17) aims to clearly identify the processes and systems that are required for safe, timely and effective delivery of care to the people that enter the hospital site. It includes looking more in depth at: each patient s required length of stay planning for each patient s individual discharge looking at weekday and weekend demand linking with integrated care programmes in primary and community care services a visual display of data in the hospital. No idea is too obvious, small or simple Tony McNamara, Chief Executive Officer BACK TO COVER continued on the next page BACK FORWARD 4
Why is Project Flow important? It is important because it aims to enhance the experience for the patient that comes through the doors and also aims to ensure a smoother delivery of service. In addition it aims to receive feedback from our loyal staff about their experiences and their thoughts on the delivery of care in Cork University Hospital. Who is involved in it? All members of staff in the hospital. There is a working group responsible for ensuring Project Flow 2017 meets its aims and ultimately enhances the delivery of effective care in the hospital. What do I need to do? We welcome the opinions of all staff on how they think flow can be enhanced through the hospital system. Please send any suggestions for improving patient flow to: CUH.PatientFlow@hse.ie BACK TO COVER BACK FORWARD 5
Phase 1 By 10th July 2017 Achieve 30% reduction average ED Trolley number at 8am 85% of patients discharged directly from ED <6 hours No patient >75yrs wait >9 hours for a bed No patient >24 hour Patient Experience Time Phase 2 By 31st December 2017 Achieve 50% reduction average ED Trolley number at 8am 95% of patients discharged directly from ED <6 hours No patient >75yrs wait >9 hours for a bed No patient >24 hour PET BACK TO COVER BACK FORWARD 6
The graph below shows the number of patients waiting on trolleys in ED for admission to the wards. Each day it is updated to reflect the average of the last 30 days. The blue line indicates 2017. The yellow line indicates 2016. The green line is the threshold set nationally at 12 (i.e. 12 people waiting in ED for admission to the wards). BACK TO COVER BACK FORWARD 7
The SAFER patient flow bundle S Senior Review. All patients will have a senior review before midday by a clinician able to make management and discharge decisions. A All patients will have an Predicted Discharge Date (PDD) and Clinical Criteria for Discharge (CCD), set by assuming ideal recovery and assuming no unnecessary waiting. F Flow of patients to commence at the earliest opportunity from assessment units to inpatient wards. Wards routinely receiving patients from assessment units will ensure the first patient arrives on the ward by 10am. E Early discharge. 33% of patients will be discharged from base inpatient wards before midday. R Review. A systematic multi-disciplinary team (MDT) review of patients with extended lengths of stay (>7 days also known as stranded patients ) with a clear home first mind set. The SAFER bundle is a tried and trusted method to improve patient flow processes. https://improvement.nhs.uk/uploads/documents/the-safer-patient-flow-bundle.pdf BACK TO COVER BACK FORWARD 8
Predicted Discharge Date One way to aid flow is for all patients to have a discharge plan discussed among the multidisciplinary team. We carried out an audit in July and October of notes in the hospital. There is variation in the notes with regard to documented PDDs for patients. Some wards have 6% of notes with PDDs, other wards have >40% of notes with a documented PDD. The hospital aim is for 100% of notes to have a documented PDD and for this to be changed daily on the ward whiteboards. This will give greater visibility for patient flow in CUH. BACK TO COVER BACK FORWARD 9
Key initiatives of PF17 The graph below illustrates the key initiatives established for PF17. These initiatives will be discussed in future editions of our newsletter. Ambulance turnaround times Focus on patients with length of stay over 14 days Ward whiteboards and documenting PDDs Acute surgical pathway PF17 KEY INITIATIVES Cardiothoracic pathway Optimal discharge planning People who come to the ED, and do not require admission, will be in and out in <6 hours BACK TO COVER BACK FORWARD 10
CUH Project Flow Focus on staff initiative to improve flow P P P??? H CU is WHAT ARE THE BENEFITS FOR THE PATIENT? #e nd sup PJ po pa rts ra ly si s UP UP DRESSED DRESSED MOVING MOVING #e nd sup PJ po pa r ts ra ly s CU H #e nd sup PJ po pa r ts ra ly si CU H s This month the focus is on: #endpjparalysis UP Quicker recovery Able to maintain normal routine Return home WHAT ARE THEsooner BENEFITS FOR THE PATIENT? P P P Quicker recovery Able to maintain normal routine Return home sooner DRESSED MOVING BACK TO COVER WHAT ARE THE BENEFITS FOR THE PATIENT? P Quicker recovery P Able to maintain normal routine P Return home sooner???? BACK FORWARD 11
Mismatch of people admitted versus people discharged Admissions Discharges Ideally we need approximately 80 discharges per day from the hospital to ensure the most effective patient flow. There is a daily mismatch of patients admitted to CUH versus patients discharged from CUH. Hence ideally we would ask each team/specialty to see can they work towards discharging one extra patient approx every two days. 80 DISCHARGES PER DAY REQUIRED The mismatch between admissions and discharges is more visible at weekends, where traditionally patient discharges are very low but people are still arriving in ED and need to be admitted to an in-patient bed. Using ward whiteboards and having PDDs for all patients would help to improve patient flow. BACK TO COVER BACK FORWARD 12
FLOW IS A TEAM SPORT Thank you for your continuing support of Project Flow. If you would like to showcase what you are doing to improve patient flow, we would love to hear from you and we will publish your progress in the next newsletter. Please email CUH.ProjectFlow@hse.ie Or contact Olivia Wall on 087-1954839 BACK TO COVER BACK FORWARD 13